Chapter 8 Insulin “Hero or Villain”

If I were to reduce this whole book into a single concept, I’d say that one of the main “clashes” is the interplay of insulin within our bodies and our new modern environment. I’m not saying that insulin is bad; it’s just that Mother Nature didn’t anticipate our strange new environment.  She established a very stable and healthy process for insulin production for people who ate “normal” whole foods and worked physically hard to survive. Insulin kept our ancestors alive by instructing their bodies how to use and store energy. Now, with so much food available and so little required physical activity, the excess insulin derails the whole system.

 To be as simplistic as possible, when we eat a meal, our blood sugar goes up.  The pancreas becomes aware of the higher levels of sugar in the blood and begins to produce insulin.  The function of insulin is essentially like a key to unlock doors.  In this case, the doors lead to “loading docks” where sugar is unloaded into the cells of our body.  This is the fuel that all body parts need.  Insulin works really hard to make sure that the loading docks of the muscle cells and liver cells are serviced well.  These organs are key to the management of a stable blood sugar. This is where the extra glucose is stored as glycogen, a reserve source of energy.

When the pancreas senses that the blood sugar is dropping, it blocks the production of insulin and starts producing another balancing hormone called glucagon.  Glucagon acts on the liver and muscle storage area to break down glycogen back into sugar for the energy needs of the brain, heart, lungs, digestive system and everything else in between.  So you might say that insulin and glucagon are the “Yin and Yang” of the body.  They are opposite, but they create balance.  This is why we do not need to eat continuously, night and day. 

Now enter our modern environment and “clash” with a wonderful, but ancient biology.  How did it all go wrong?  The answer is twofold.  One is environment related and the other is a dysfunctional biology.  The environment problem will be described in the “Environment Section” of this book.  You will learn how the industrialization of food production created highly refined carbohydrates, fats, and proteins that would cause insulin to “go crazy.” As we have previously discussed, the biology side, related to this change in available food, caused people with the “heavy-biology” to gain weight.  So the liver and muscles were not able to store any more glycogen and the extra sugar had to be sent to fat storage sites. 

The fat storage sites that you and I can feel and see, between our skin and muscle walls, do not seem to add as much to the mounting obesity disease as does the fat storage inside our bellies.  This intra-abdominal fat is a major contributor to what is called “insulin resistance”.  While it is poorly understood why it happens, we certainly can know and understand the results.  First, the pancreas senses that there is way too much sugar in the blood because the liver and muscles cannot take any more sugar into their systems.  So, that extra sugar has to now be transported by triglycerides into fat stores of the liver, muscles, and the fatty organs inside our abdomen.

I am sure that you may be wondering how this elevated blood sugar happened.  Well, the calculations have been done for us.  Normal blood sugar is about 80.  This equates to about 1 teaspoon of sugar in the bloodstream.  If you have a fasting blood sugar of 126, you are thought to be diabetic, and this is equivalent to 1 & 1/4 teaspoons of sugar.  So how much sugar is in a medium bag of French fries found at a fast food restaurant? This adds 10 more teaspoons of sugar to your bloodstream, and we didn’t even add in the 20 ounces of soda.  Do you understand how it is so easy to overwhelm our well-designed body system?

What other factors can throw us into the dismal “dysmetabolic” or “insulin resistant” syndrome?  Remember that our muscle cells have been sent a lot of sugar.  Muscles that work will burn sugar.  This is what they were supposed to do.  As we review the experience of our “Hunter-gatherer” ancestors, they did not have the manufactured foods that you will learn more about later, but just living required physical work.  So how much would you have to exercise for just the soda alone, which added another 16 teaspoons of sugar?  To burn off that amount of sugar would require you to run for 50 minutes!  Now, our ancestors were probably doing that all the time, but what about you? 

We are now back to our overweight, non-exercising selves.  What has the insulin resistance done to me?  We are just seeing the tip of the iceberg, but it seems that there is a seemingly endless list of bad things that happen to us.

Let’s start with inflammation.  Anyone who has ever lost 30 or 40 pounds will remember that everything that hurt– joints, muscles, and body aches–got better.  This is because excess body fat sparks an inflammatory process.  It may surprise you that over 100 years ago doctors were treating diabetes by giving large doses of aspirin.  This was before insulin was discovered and its relationship to diabetes was understood.  Patients got better because the aspirin treated the inflammation associated with the diabetes that was caused by the obesity.  Amazingly even the amount of sugar that their kidneys were leaking into urine went down!  This was in 1901.  By accident, this finding was “re-discovered” in 1957 when diabetics who had rheumatic fever were given high doses of aspirin to treat this condition, and the amount of insulin that they needed dropped dramatically.  As science goes, even this finding was lost again for several decades, until the understanding of the connection between inflammation and insulin resistance re-emerged. 

You may know that inflammation itself often does good things to help us fight off invading bacteria and even cancer cells that may have formed.  The normal, healthy inflammatory process takes place when the body senses an invader or something abnormal.  This is totally independent of the inflammatory process caused by “insulin resistance”.  When the fat cell gets “hyper-expanded”, the abnormal inflammatory process begins.  A normal sized fat cell does not make inflammatory products.

As over expanded fat cells multiply, what are the effects on the body?  Asthma gets worse.  Fibromyagia hurts more.  Arthritic joints ache more. Blood vessels become more prone to “hardening” or the development of atherosclerosis.  Sadly, even the brain gets more inflamed.  Some are even calling Alzheimer’s disease, “diabetes type III”.  As we observe a marked increase in this disabling condition,  this linkage is very sobering.

Next, let’s look at how insulin resistance might cause us to have disordered lipid or cholesterol levels.  Remember that most people with insulin resistance may not be aware that this is happening in their bodies.  Diabetes may not yet have occurred.  The body is fighting, attempting to compensate for all of this extra sugar and refined carbohydrates that we are eating.  The pancreas is patiently producing more and more insulin in an attempt to “do something” with the excess sugar.  The liver can’t take any more.  The muscles are not being used enough to burn sugar, so now we switch to infiltrating the muscles, the liver, the fat between your skin and muscle walls, and the fat inside your abdomen with fat, big hyper-expanded fat cells.  You are not yet diabetic but you are now insulin resistant.

 All of this sugar transportation into fat cells first requires “packaging” as triglycerides. Remember, from the last chapter on fat, these are the little fellows that are made up of three fatty acids connected by the sugar glycerol. These fat/sugar combinations need lipoproteins to get around in your water based blood, which then increases the low density lipoprotein (LDL) levels, commonly known as the “bad cholesterol”.  And sadly, the “good cholesterol”, or high density lipoprotein (HDL) levels go down. 

When you get your cholesterol checked at your doctor’s office and you find the triglycerides greater than 150, your HDL less than 40, and your LDL greater than 100, you are officially “insulin resistant” if you have all these plus one more marker.  Do you want to know what that final marker is?  Well, just look at yourself in the mirror and search for the thinnest place between your chest and hip bones and measure it.  If you are a female and that measurement is greater than 35 inches you are now officially insulin resistant.  For males, if that measurement is greater than 40 inches, watch out, you too are insulin resistant. 

When this happens, you have a much higher risk for developing coronary artery blockage and a heart attack.  It also increases your chance of having a stroke.  We have gotten a little caviler about coronary artery disease.  Most of us know someone who had chest pain, rushed to the Emergency Room, and someone placed a “stent” in a blocked artery before it could cause heart muscle cells to die.  Or a relative that had open heart surgery and had four or five block heart arteries bypassed.  So, we think all this seems fixable.

 What we should fear more is the strokes or brain death caused by blood clots that form in an artery in our neck where we might have atherosclerosis or hardening of the arteries.  These do not get bypassed or stented.  The brain cells that die are dead.  We may be left with permanent paralysis of the muscles that control our speech, our legs, or our arms. 

Or we just have “little strokes” that do not cause paralysis, but we find that our brains just do not work quite as well.  Obviously, a decline in brain function can have many causes, but this is an important one.  All of this happens because of insulin resistance from too much sugar and refined carbohydrates.  It is a sobering thought.  Hopefully sobering enough for you to read this book and make some changes. 

Now we come to the next step in insulin resistance.  Our pancreas has been doing the best it can when our blood is swamped with sugar.  It continues to produce more insulin.  But at some point it can just not keep up and now things really get out of control.  The blood sugar continues to rise.  The kidney does not know what else to do and it starts letting sugar spill into our urine in an attempt to bring things back into balance.  More sugar in the urine makes us start urinating more.  Now, we finally have a symptom that just might get our attention.  Maybe  it’s a urinary tract infection.  People with that condition tend to urinate more.  When it becomes annoying enough, we finally seek some medical help.

We discover that not only do we have too much sugar in our urine, but the fasting blood sugar is 200!  Oh no, I have diabetes!  You have heard the stories.  We all fear diabetes.  Relatives have had diabetes and we remember that they even had to give themselves “shots”.  This is called diabetes type 2 and is the fastest growing form of diabetes, affecting one out of every eight Americans.

When you add insulin resistance to the picture, you have a much bigger problem.  One out of every three has pre-diabetes or insulin resistance.  Now, put diabetes and pre-diabetes together and we now have 50% of all adults in the United States being affected!  This is very recent information, reported in the Journal of the American Medical Association on September 8, 2015. 

The increased consumption of sugar and refined carbohydrates both cause diabetes type 2 as well as obesity. What is interesting is the increase in prevalence of diabetes has accelerated even beyond the rise of obesity in this country.

 Now we have a choice.  Shall we just “wring our hands” and talk about how horrible this is or are we ready to “do something”?  Well, you can do something right now!  Turn to the end of this book and look at the foods that are “high glycemic” and just stop using them!  These foods make the sugar in your blood surge.  As you have learned in this chapter, you know what happens next.  Your pancreas starts producing more insulin and if there is still too much sugar, you start depositing more fat, which leads to a greater distortion of your lipid/cholesterol levels. 

What else can you do?  Start using your muscles.  Burn off that sugar.  I often say to my patients at the end of our visit together, “Have courage!”  This may be the best way to end this vital chapter.