Insulin resistance and its negative impact on health.

I love learning about and talking about metabolic health. It’s easily my favorite “problem” to tackle because helping my patients find metabolic health now means helping them have the best chance at minimizing future chronic illnesses. 

Here’s a little info about insulin resistance (IR): One of insulin’s jobs is to help glucose enter the muscle, fat, and liver cells. IR can become a problem when cells stop “listening” (or become resistant) to the signal from insulin to allow glucose to enter. As a result, glucose stays in the bloodstream and wreaks havoc all over the body. It causes inflammation, damage to blood vessels, and puts us at increased risk for developing conditions like type 2 diabetes, heart disease, and other metabolic issues. I’ll talk more about these later.

When assessing metabolic health, many only check fasting blood glucose and hemoglobin A1C. The problem with that is, insulin can be elevated long before fasting blood sugars and hemoglobin A1C are elevated. The pancreas works hard to keep blood sugars in a healthy range. We know the body loves homeostasis! We can catch IR early by checking fasting insulin! It’s an opportunity we shouldn’t miss because catching and treating IR early can help drastically reduce the likelihood of developing future health complications. 

Some of the health complications IR can cause include: 

Type 2 diabetes mellitus (T2DM): IR is a primary factor in the development of T2DM, where the pancreas cannot produce enough insulin to overcome the resistance, leading to hyperglycemia.

Cardiovascular diseases: IR is associated with an increased risk of atherosclerosis, coronary artery disease, and hypertension. These conditions are part of metabolic syndrome - which is closely linked to IR.

Nonalcoholic fatty liver disease (NAFLD): IR contributes to the accumulation of fat in the liver, leading to NAFLD, which can progress to nonalcoholic steatohepatitis (NASH) and cirrhosis.

Dyslipidemia: IR often results in an abnormal lipid profile, characterized by elevated triglycerides and low HDL cholesterol, contributing to cardiovascular risk.

Polycystic ovary syndrome (PCOS): IR is a common feature in women with PCOS, contributing to hyperandrogenism, menstrual irregularities, and infertility.

Hypertension: The compensatory hyperinsulinemia associated with IR can lead to increased sodium retention and sympathetic nervous system activity, contributing to elevated blood pressure.

Cancer: IR and the associated hyperinsulinemia can promote cellular proliferation and growth, increasing the risk of certain cancers, such as colorectal, breast, and endometrial cancers.

Dementia: IR is increasingly recognized as a significant risk factor for dementia, particularly Alzheimer's disease, potentially due to shared metabolic and inflammatory pathways. 

We want our cells to be as insulin sensitive as possible. Meaning, they see insulin and they respond by allowing glucose to enter. One of the best ways to prevent/improve insulin resistance is with resistance training!! Too much fat in the cells makes it difficult for glucose to enter and having muscle to help “soak up” the extra glucose floating around is huge! The more muscle we have, the more insulin sensitive we become!! And keep in mind, if your testosterone is low, it’s going to be difficult to put on muscle. Make your hard work in the gym count!!

Muscle is like a sponge for glucose! I love learning from Dr. Benjamin Bikman who teaches cell biology and has a lab that, “Aims to identify the molecular mechanisms that explain the increased risk of disease that accompanies weight gain, with particular emphasis on the etiology of insulin resistance and disrupted mitochondrial function." They also work to “reveal novel cellular processes that are responsible for fat development.” He explains that with the help of insulin, 80% of the glucose from a meal is taken up by the muscle!! If we don’t have muscle to take up the glucose, we can get into trouble!

When we exercise, muscle can take up glucose without the help of insulin! As Dr. Bikman says, the muscle demands the glucose floating around in the bloodstream because the energy demands are high during exercise! When the muscle helps us keep glucose out of the blood stream, insulin can also come down!! This helps tremendously with insulin sensitivity!

Prioritizing protein is another great way to improve insulin sensitivity. I encourage my patients to eat at least 30 g of high quality protein at each meal. It takes 30 g of protein to stimulate muscle protein synthesis, so 30 g is the minimum we should be getting with each meal. If we’re working hard to build muscle, we want protein working for us! With snacks, by the end of the day, everyone should have eaten at least 100 g of protein. For men and some ladies, this number goes way up!! I personally try to eat at least 150 g of protein every day. When we prioritize protein, it helps minimize carbohydrate intake, which also goes a long way toward improving insulin sensitivity. 

Tomorrow I’ll be posting the list of labs I like to check to get a good grasp on metabolic health. In the meantime, if you have questions, feel free to email me at kami-@seaside-med.com!