Understanding Insulin Resistance
As I traveled on my own journey to lose weight and follow a low carb diet I discovered a paradox related to weight control: the role of insulin resistance in contributing* to weight gain. As I unraveled this paradox and discovered how insulin resistance affects us, I also discovered that it was a Perfect Storm of trouble for any of us who tend to gain weight.
As a start on this issue, you might want to watch the following video on insulin resistance.
We are always being warned to avoid becoming insulin resistant as it may contribute* to weight gain, possibly leading to more insulin resistance and the possibility of even more weight. Since we are also being told that elevated insulin levels cause us to gain weight, why wouldn’t becoming insulin resistant (in other words, becoming relatively more immune to the effects of insulin) just solve our problems for us? In other words, if we become resistant to insulin, why wouldn’t our bodies stop reacting to insulin and start to lose weight rather than gain it?
The video exposes the dual role of insulin, which is why it appears to be a paradox. At normal and low insulin levels, insulin ENABLES GLUCOSE METABOLISM by body tissues. In other words, when the insulin levels are normal and low (aren’t dangerously high), glucose from the blood is absorbed by body tissues and converted into energy – a good thing. At high insulin levels, however, insulin plays the opposite role as a defensive mechanism against the dangers of high glucose levels and ENABLES GLUCOSE CONVERSION TO FAT. This removes the glucose from the blood stream so it can’t cause harm. So the INSULIN IS ACTING IN DUAL ROLES, converting glucose to energy under normal conditions, but quickly getting glucose out of the bloodstream (by converting it to fat) when glucose levels are high enough to cause bodily harm. The pancreas secretes more or less insulin into the bloodstream as the blood glucose levels go up or down, respectively.
It turns out that when a health professional uses the term Insulin Resistance, he/she is really addressing just one of the roles of insulin (glucose metabolism). In other words, Insulin Resistance is the sluggish reaction of body tissues to insulin at normal insulin levels, when insulin is supposed to be enabling glucose metabolism. A good example of this is one of the symptoms mentioned in the video. People who are insulin resistant sometimes have the symptom of not being hungry in the morning. A person who is not insulin resistant will have normal levels of insulin during the night and, because of its presence, will absorb glucose overnight, resulting in a low glucose level in the morning – and resultant hunger. An insulin resistant person, whoever, will not respond as well to the normal insulin levels during the night, will not remove much glucose during the night, and will therefore tend to not be as hungry in the morning.
So, now that we know what insulin resistance really is, how does it contribute*, in some people, to increased weight gain? The answer lies in the timing of insulin releases into the blood stream. This timing actually produces a one-two punch – a perfect storm of trouble for a patient who is insulin resistant. The brain and the pancreas check the glucose levels every now and then and inject more insulin into the bloodstream if the glucose level is too high. After someone with insulin resistance eats something laden with sugar or refined carbs, they will often experience a sugar high, but the insulin still doesn’t do very well to reduce the glucose levels by converting the glucose to energy, which is the “first punch”. The pancreas, therefore, delivers the “second punch” by continuing to inject insulin, and overdoing it, in the end removing too much glucose (by converting it to fat), producing a sugar low (the patient is famished, weak, and desperate for something to eat). So therefore the “second punch” is a sugar low caused by storing glucose away as fat instead of using it for energy – with the patient ending up both a little fatter and very hungry. So, the patient finds something else to eat (usually high in sugar) and sets off another one-two punch cycle. This cycle often repeats throughout the day. One of the most common examples of this is the standard breakfast for many Americans: cereal, milk and sugar for breakfast. This is actually a very high sugar meal, which will cause a sugar low for many of us at mid-morning, which often results in a high carb snack – and the cycle may then repeat all day. Unfortunately, it is this cycling up and down through this one-two punch that intensifies insulin resistance, leading most to a slippery slope of ever increasing levels of insulin resistance.
So what causes insulin resistance in the first place? In other words, if a person is not insulin resistant, what can cause insulin resistance to begin building up? The answer is in sugar and sweets. The intensity of the sugar and carb levels in some of our foods are so high, that even in a perfectly normal person with no insulin resistance, that person will experience some form of sugar highs and lows, with resultant ups and downs of insulin levels. Years of insulin ups and downs can lead to the beginning stages of insulin resistance.
My parting recommendation is to review the symptoms noted in the film and if you are concerned about Insulin Resistance for yourself, look into low carb diet plan or Paleo dieting.
*Please see Jeff Reagan’s helpful comment below on some of the complexity of the interrelationship between insulin resistance, metabolic syndrome, and obesity. These factors are all related in several ways but it is difficult to prove causation (in other words, this condition always leads to that condition). The clarify this issue, medical professionals have developed the concept of the Metabolic Syndrome to define a set of 5 conditions, which, if they exist for a patient, indicate an increased risk for Heart Disease, Stroke, or Diabetes. Insulin Resistance isn’t one of the 5 conditions but it is a “player” in several of them. It is therefore, a condition we should all pay attention to. The 5 conditions, which if all true, indicate the Metabolic Syndrome are:
- Elevated blood pressure
- Elevated fasting glucose
- Elevated waist circumference:
- Elevated triglycerides
- Reduced HDL (“good”) cholesterol
This post is featured on the Modern Paleo Blog.
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It is incorrect to say that insulin resistance will lead to obesity. The work of Gerald Reaven at Stanford has clearly shown that there are people who are lean and insulin resistant as well as people who are obese but insulin sensitive. This is the main reason that Reaven never included obesity in his definition of Syndrome X. Later, the medical community coined the term “metabolic syndrome” to include obesity as a risk factor for cardiovascular disease. However, obesity in and of itself does not necessarily mean unhealthy. It is the underlying condition of insulin resistance that is unhealthy independent of adiposity. Reaven’s 1988 Banting lecture is a must read for anyone interested in insulin resistance as there is a lot of misunderstanding about the science of this fairly common condition. Here is the reference for the orignal Banting lecture and a more recent review.
Reaven (1988). “Role of Insulin Resistance in Human Disease.” Diabetes 37: 1595-1607.
Reaven, G. M. (2010). “The metabolic syndrome: time to get off the merry-go-round?” Journal of Internal Medicine 269(2): 127-136.
Jeff,
Thank you very much for this information. I’m afraid I can’t get to this today, but will in the next few days review the materials you suggest and modify this article accordingly. I was aware that metabolic syndrome isn’t particularly a causation for obesity but rather a set of symptoms associated with it. This adds a wrinkle to this I am very interested in understanding. Are you related to Gerald Reaven?
…Joe…
Jeff,
Thanks again for your inputs. I have modified the post per your suggestions to make sure the readers don’t think that Insulin Resistance always causes obesity, as well to expand the discussion to include Metabolic Syndrome. The causation question on this topic is complicated so if you have any other suggestions for making this a more accurate article I would appreciate it. I wrote it mostly to clarify for our readers what Insulin Resistance is and to acquaint them with its symptoms and impacts.
…Joe…
The long time use of insulin will cause resistance by blocking or shutting down the receptors of insulin in the body tissues..
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That makes perfect sense. No wonder I have a hard time losing weight.
Yep it does. Too bad many, many people haven’t heard the message yet…
…Joe…