Glucose is our major source of energy. Proteins and fats cannot be used to produce energy until first transformed into glucose by biochemical processes in our bodies. Glucose is taken in to the cells of our body and transformed into smaller molecules that are the final common pathway for energy production.
Our cells require insulin in order to facilitate the uptake of glucose. Insulin is a hormone secreted by our pancreas. It is secreted in response to a rise in glucose in our serum. It activates “insulin receptors” on our cell walls. These receptors signal our genetic material to produce molecules that transport glucose into our cells where it is processed.
When glucose insulin function becomes inefficient there is an increased risk to diabetes and a variety of other chronic health problems such as obesity, hypertension, heart attack, stroke and cancer.
In Type 1 Diabetes the pancreas fails to make an adequate amount of insulin. In Type 2 diabetes the pancreas makes an adequate amount of insulin but the cells of the body lose their sensitivity to the insulin message and blood sugar rises. Ultimately, the pancreas loses its ability to make insulin and the blood sugar stays elevated because of an inadequate amount of insulin. Dysfunction of glucose insulin metabolism is not an on or off phenomena. It is not true that we either have the problem or we don’t. We are talking about a continuum from optimal function to overt illness.
There are a variety of names given to this phenomenon. Dr. Gerald Reaven was one of the first scientists to describe the problem. He referred to the reduced sensitivity of the cells to the insulin message as “insulin resistance”. This meant that while a person makes enough insulin, the insulin receptors on the cell membranes have a reduced sensitivity to the insulin message. As a result the person must make an excessive amount of insulin in order to control blood sugar, (glucose levels in the blood). He named the clinical pattern of individuals with the problem; Syndrome X. This name has evolved to Metabolic Syndrome. Individuals with Metabolic Syndrome have a constellation of findings, which include central obesity, (fat tissue around the waist and within the abdominal cavity), hypertension, high triglycerides, low HDL cholesterol, elevated glucose, (above 100), elevated Hemoglobin A1c, (above 5.8%) and elevated fasting insulin. These individuals are at increased risk of developing diabetes, arteriosclerosis, heart attack, stroke and cancer.
About 20-30% of the population is genetically predisposed to insulin resistance. Some but not all of these people will develop the pattern of abnormal physical findings, laboratory findings and diseases characterized by Metabolic Syndrome. A predisposition means that there is a greater chance that the problem of insulin resistance will develop during an individual’s lifetime. Not everyone with the predisposition will develop the problem.
Factors that can lead to the manifestation of insulin resistance in a predisposed individual include stress, diet, and activity level. This means that susceptible individuals can be identified and can minimize the adverse health consequences of insulin resistance/metabolic syndrome with appropriate life style changes.
Insulin Resistance/Metabolic Syndrome can lead to Type 2 diabetes with the adverse consequences of heart disease, stroke, kidney disease, eye diseases, and peripheral artery insufficiency.
Insulin Resistance is a factor in other health problems that can occur without the development of overt Diabetes. These problems include Obesity, Hypertension, Arteriosclerosis, Heart Attack, Stroke, Cancer, and Accelerated Aging.
Historical Factors that Suggest Insulin Resistance:
Signs and Symptoms of Insulin Resistance:
Insulin Resistance/Metabolic Syndrome is not a disease. It is an abnormality of normal metabolism. As such, it does not have classical disease symptoms. As noted above, it can be a contributing factor to many chronic diseases.
Laboratory Findings in Insulin Resistance/Metabolic Syndrome:
Lipid, (blood fat), abnormalities associated with insulin resistance include:
Coagulation abnormalities associated with insulin resistance include:
Dietary Measures:
Obesity is a contributing factor to the manifestation of Insulin Resistance but it does not cause insulin resistance Weight loss, no matter how modest, will improve glucose insulin metabolism. In individuals who are obese we recommend modest calorie restriction to achieve a gradual and sustained weight loss.
Please see our section on Diet and Nutrition for general recommendations.
The basic principles of a good diet include:
Modest calorie intake
Carbohydrates should contribute 40-50% of total calories. Emphasize foods that are unprocessed and low in refined sugar and refined starches. Minimize calories from candy, soft drinks, pastries and dairy desserts. Do not add sugar to beverages or breakfast cereals. Minimize calories from refined carbohydrate sources such as white flour, white rice and potatoes. Avoid snack foods such as pretzels, corn chips, potato chips, etc.
Fats should provide an important source of calories, (up to 30%). Try and minimize saturated fats found in processed meats, feed lot fed animals, fried foods, baked goods and rich dairy desserts. Fats from vegetable sources such as olive oil, nuts and seeds are considered healthful. Fats from deep-sea fish and sea vegetables are considered healthful.
Protein is essential to good health. The idea that a diet rich in protein will prevent obesity or improve insulin resistance has not been verified by scientific studies. Protein can be obtained from red meat, poultry, seafood, and vegetable sources. A varied diet that emphasizes, foods that are organic and unprocessed is most desirable.
Exercise:
A modest exercise program will improve metabolism and aid in preventing the expression of Insulin Resistance in individuals at risk. Walking for 30 minutes per day is adequate. For those who cannot walk I recommend riding a stationary bicycle for 30 to 45 minutes. The benefit of exercise only exists while you are exercising regularly. Consistency is the key to achieving benefit.
Vitamins:
Fats:
Certain fats can improve cell membrane sensitivity to insulin.
Nutrients:
There are “conditionally essential” nutrients that are helpful in optimizing glucose metabolism.
Stress is a natural part of life. Chronic, persistent stress is an important contributing factor to poor health, chronic illness and accelerated aging. With chronic persistent stress a hormonal pattern evolves that increases insulin sensitivity. The adrenal gland makes cortisol, which is a catabolic hormone. Among other actions, it increases glucose and creates an environment where insulin resistance can manifest. Catabolic hormones increase with chronic stress, chronic illness and the aging process. Anabolic hormones are made by the adrenal gland as well. The dominant anabolic hormone produced by the adrenal gland is DHEA. DHEA is a precursor to the sex hormones such as testosterone and estrogen. Other metabolites of DHEA support optimal thyroid function and immune function. DHEA declines with chronic stress and the aging process. When the DHEA level is low, careful supplementation with physiological doses may improve body composition, general well-being and glucose insulin metabolism.
The recommended dose of DHEA is 10-50 mgs per day.
Insulin /Metabolic Syndrome is present in 20-30% of the population. It is a contributing factor to a variety of chronic health problems and the aging process. Individuals with Insulin Resistance can be identified. The problem can be managed through life style modification and appropriate nutritional supplementation.