Insulin resistance

The Insulin Resistance Time Bomb

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I seldom watch television but for some reason nearly every time I do, the same commercial pops up. It goes something like this: a couple of women are sitting on a bench, chatting, when a guy walks up to them and asks if they have T2D (the answer is “yes”) and then he asks if they know that T2D can cause heart disease. The women act very surprised since they didn’t know. Why did they not know? And how come the pharmaceutical companies know that people don’t know? This commercial always makes me pause because it is so clear that we do not know what is happening to us.

We all know the scary statistics: the CDC admits that 9.3% of US adults are diagnosed with type 2 diabetes (T2D) as of 2010. The key word here is diagnosed. That is because more people are not diagnosed but have T2D than those who are diagnosed. It is estimated that over 30% of the population has T2D only they don’t know they have it. So one must ask a few questions:

  1. Why do so many Americans have T2D?
  2. Why don’t so many Americans know that they have T2D?
  3. What causes T2D?
  4. How does T2D start, why, and when?
  5. Can T2D be prevented?
  6. Can T2D be reversed or at least put to remission?

So let me be the one who tries to explain. The topic is not easy to explain so I am breaking it up into several parts, each at a different level of depth. In part 1 of this series, I will begin by discussing what nutrients are and how they connect to T2D. This will help explain why so many Americans do not know they have T2D and why they remain undiagnosed.

What Are You Eating?

If you look at what is sold in grocery stores today, you will find that over 80% of the stores are filled with commercially prepared foods: cereals, breads, canned foods, frozen pre-cooked foods, juices, soft drinks, candy, dried fruits, health bars, potato or veggie chips, crackers, popcorn, cooking oils, sugar, flour, prepared lunch meals, etc. Fresh dairy, meat, seafood, poultry, and fresh produce represent 10%, and toiletries, kitchen supplies, healthcare products, supplements, and sometimes cosmetics and greeting cards are the remaining 10%. The prices seem to be inversely related to the percentage these occupy in the store. Food-like products that are commercially processed are the cheapest, while fresh produce, dairy, and fresh meat are often prohibitively expensive. Thus, as budget allows, we end up buying a bunch of prepared foods; not only are they cheaper, they are also more convenient. In today’s busy world, who doesn’t want precooked foods that only require re-heating? What a time saver! Indeed, not a health-saver though. The money we save on food will end up in the pockets of medical institutions and pharmaceuticals for healthcare later, because most commercially prepared foods will make us sick.

Unfortunately, the cheapest and most readily available foods contribute most to type 2 diabetes. This takes a little explanation, so I am breaking foods down into the basic nutrient groups; macronutrients. There are three macronutrients: carbohydrates, protein, and fats. Because so many people don’t know what food falls into what macronutrient category, let me help you; some of the foods really aren’t obvious where they belong.

Protein

In our minds, protein refers to meat or fish though a small amount of protein is found in most every food item; even lettuce, only too small to matter. More protein is found in whole foods like unprocessed meats and fish than in processed foods like sausages or hot dogs. Protein is essential, meaning we must eat protein to survive. Proteins are made up of amino acids that form some of the most important macronutrient elements in our body. Protein is not just important for body building but it is essential for our brain and body to function and to survive.

There are a number of amino acids that are nonessential—meaning the body can create them–and others are essential–meaning we must eat them because our body cannot create them. All nonessential amino acids convert only to glucose, some essential amino acids convert to ketones only and some essential amino acids convert to either glucose or ketones based on dietary need. Over 50% of the amino acids convert to glucose. Glucose is in the family of carbohydrates, another macronutrient.

Carbohydrates

The largest nutrient group in most Americans’ life is carbohydrates. Carbohydrates are nonessential nutrients, meaning we can live perfectly healthy lives without a bite of carbohydrates. There is nothing in carbohydrates our body cannot make or we cannot eat in protein. Carbohydrates include the following foods (short list here): candy, sugar of all types (including honey), fruits, vegetables, legumes, nuts, seeds, grains, all foods sweetened with sugar like cookies, pastries, juices, and all natural vegetables, fruits, nuts, legumes, seeds, and alcohol. Carbohydrates are made from starches, glucose, fructose, lactose, and galactose. For example, most fruits contain glucose and fructose, most vegetables have glucose or some have starches (potatoes and carrots contains a lot of starch), milk has lactose, nuts are mostly glucose, and grains are glucose and starches. Although fiber is categorized as a carbohydrate, fiber is not used by the human body; it simply gets eliminated, so I exclude it from this category.

The key factor to know is that all carbohydrates convert to glucose (or to fructose and that partly converts to glucose). The speed with which they convert to glucose makes some difference but ultimately they all become glucose. Starches convert to glucose in our mouths before we swallow them even if they are not sweet (this includes whole wheat bread as well). Since protein is essential and over 50% of protein converts to glucose, carbohydrates become nonessential since we can make glucose without them. Carbohydrates play the biggest role in T2D because they provide excess glucose we don’t need. Although there is genetic predisposition to T2D as well, even those who are genetically so predisposed can prevent T2D by avoiding carbohydrates.

Fats

The third macronutrient group is fats. Fats represent the only nutrient that do not, under normal circumstances, convert to glucose. Fat remains fat. Fat is an essential nutrient in our body made of fatty acids, all of which are essential: omega 3 and omega 6.

From the three macronutrients, carbohydrates is the only one that poses a problem for insulin management and lack of proper insulin management leads to T2D.

How Do We Get T2D?

While most people think that T2D is the start of the problem, in reality it is the outcome, and thus, the end of the problem. There are many ways one can look at the progression to T2D. Most medical professionals (and the general population at large) think that people with T2D are obese. This is far from the truth and this causes the biggest problem in diagnosis. I think the confusion comes from the lack of understanding the progression toward T2D.

T2D starts when a person is thin and knows/cares very little about what she eats. The cause for T2D is too much insulin in response to excess glucose, that cannot be delivered to the liver. Though this sounds simple, it is complex enough to get many confused even in the field of medicine. We must ask a few questions:

  • Where does excess glucose come from?
  • Where does excess insulin come from?
  • Why is insulin not able to pick glucose up from the blood and deliver it to the liver?

Understanding the Liver and Insulin

  1. Insulin is a signaling hormone for many functions, including packaging glucose into the liver for storage.  Thus insulin is a storage hormone.  Without insulin, people cannot gain weight—a typical problem for type 1 diabetics (T1D) who lack insulin production. T1Ds need to use insulin injections in order to survive, and gain and maintain healthy weight.
  2. Since insulin is a storage hormone, it automatically implies that it stores whatever food we were not able to immediately burn. This is healthy. Think of hibernating bears; they fatten up all summer and then in the winter hibernation they live off of the accumulated energy stored as fat. The key to their health is that they don’t eat during hibernation–meaning all year long. In contrast, humans continue to eat and store excess energy all year long.
  3. Once the storage cabinet of our body has reached its comfortable limit (the liver is our storage cabinet), insulin cannot pack more glucose into it. The liver refuses insulin’s attempts. This is called insulin resistance.
  4. Prediabetes and insulin resistance are the same phenomenon at different stages. Prediabetes usually occurs in people who already have insulin resistance.
  5. During insulin resistance, the excess glucose and the excess insulin circulate in the blood causing damage. They damage arteries by causing inflammation1 increasing blood pressure as a result, and can cause nerve damage (in the brain as well as in the body). Diabetic neuropathy starts at the stage of insulin resistance for many people and not at a later stage when T2D developed, which is how it is always portrayed.
  6. Insulin resistance is compartmentalized—meaning one may have insulin resistance in one organ (such as the liver) but not in another. This makes insulin resistance very hard to diagnose with conventional tests. The most typical test is the hemoglobin A1c (HbA1c), which measures the average amount of glucose the person had in his blood for a period of two to three months.
  7. Alzheimer’s disease is the insulin resistance (or type 3 diabetes) of the brain but not the body. Hence, the first sign of Alzheimer’s disease is the disease itself and not insulin resistance. This further shows the difficulty of diagnosing insulin resistance.
  8. During the start of insulin resistance, as more and more insulin is released to carry the glucose into the liver that cannot handle any more, the liver becomes ill with non-alcoholic fatty live disease. It makes the liver bigger, inflamed, and less able to do its job, which is the detoxification of the blood.

Since we feel none of this as pain or illness, nearly 100% of the people with insulin resistance have no idea that they have insulin resistance! As insulin resistance continues over decades being undetected, the body slowly degrades in its ability to fight back. Finally, when it is time, T2D arrives. By the time T2D is diagnosed, most people (not all) are overweight, because of the preceding years of insulin resistance that went unnoticed.

Manifestations of Insulin Resistance

Insulin resistance is not felt by anyone (the pain in the legs may be diagnosed as something else) and so its diagnosis is usually accidental and often inaccurate2,3. The tools used to check for insulin resistance, in the US and elsewhere, require one to be obese or pregnant with gestational diabetes risk. This presents a major problem since obesity tends to develop only after years of insulin resistance. An individual may have insulin resistance at age 11 and not know about it until at age 35, when she suddenly develops neuropathy with hurting feet, or gets shaky and dizzy if the food is five minutes late on her table. The achy feet are often misdiagnosed as a pinched nerve, Plantar fasciitis, or fibromyalgia. If you are ravenously hungry before breakfast and must eat every 3 hours, chances are pretty high you are have insulin resistance, even if you are paper thin, exercise a lot, even at the level of an athlete, and have no aches and pains.

There are two ways insulin resistance can be manifested and there is a bit of confusion in categorizing them so here I cap them under one roof: insulin resistance. The most common is simply being hungry very often with correspondingly high blood sugar—one can use a blood sugar measuring kit (finger poke) to test. This type of insulin resistance is hyperinsulinemia, which only lets itself be known by frequent hunger when the blood sugar levels are still high. The body’s ideal blood sugar level is <100 mg/gL and a healthy individual will not feel hungry while the blood sugar level is at or above 100 mg/dL. A typical hyperinsulinemic person feels hunger pangs at blood sugar of over 110 mg/dL. Normal blood sugar is defined as 70 – 140 mg/dL.

The hardest to treat insulin resistance is reactive hypoglycemia. Its manifestation is feeling shaky, dizzy, cold sweaty, feeling nauseous, whose blood sugar drops below the pre-meal starting blood sugar very shortly after eating. A typical hypoglycemic may start eating with pre-meal blood sugar of 90 mg/dL, an hour after finishing the meal may end up with 70 mg/dl, and an hour and a half later she may drop to 60 mg/dL. The level of glucose in the blood is closely regulated for its healthy minimum. Below 70 mg/dL, the body is in trouble so consider it a major warning. Below 60 mg/dL call the paramedics immediately. Below 50 mg/dL you may be dead—so don’t wait!

Can Insulin Resistance Be Prevented?

Yes it can. Since insulin resistance is too much insulin in response to high dietary glucose (glucose spikes insulin), if you stop eating those foods that give instant glucose access (see the glycemic index of foods), or more glucose than your body needs in general, you can reverse insulin resistance. Examples of foods to avoid include: all sweets with any shape or color, sugar, raw or otherwise, honey, etc., all foods sweetened with sweeteners of any kind (including sugar substitutes and naturals since they may also cause health problems, including obesity and T2D4), all juices whether they are sweetened or not, all smoothies and shakes whether they are sweetened or not, all tropical fruits and 90% of other fruits, all vegetables grown below the ground (like potatoes and carrots), peanuts, cereals, pseudo cereals (like quinoa), rice, corn, starches used in place of flour, all breads and pastas of all grain types, including whole grain or whole seed, oats, in general all grains, fermented alcohols, and legumes.

For some people dairy is also insulinogenic but not for all so I am not including dairy on the list. Stop eating all of the high glucose spiking foods listed above and increase animal fats, meats, eggs, and dark green leafy veggies in your diet, and you will be able to prevent insulin resistance.

So what can you eat when you cut out all these great tasting “foods” from your diet? Once you understand that these are really not foods but conveniences, you can see the replacements: increase green leafy vegetables in your diet; eat only those fruits we associate with vegetables: zucchini, bell peppers, squashes, tomatoes, cucumbers, and alike or low carbohydrate veggies like broccoli and cauliflower. Consume only raspberries, blackberries, and strawberries as your fruits with an occasional small orange or if must a very small serving of cantaloupe. Avoid all other fruit. Increase healthy dairy with full fat in your diet, use animal fats for cooking since vegetable oils are unhealthy and can be harmful. More details on the types on fats in part 2 of this series. Animal fats are butter, ghee, pork lard (buy pure pork lard and the not hydrogenated types available in grocery stores), beef tallow, bacon drippings (save it in a ceramic container–no refrigeration needed), poultry fat is super too.

Can Insulin Resistance be Reversed?

One of my migraine group members in the keto mild for migraine group had reactive hypoglycemia–that is the insulin resistance that is harder to treat. I asked her to switch to the zero carbs diet for a short time, after which she wrote the following:

So looking back Aug 31st was my last low blood sugar [reactive hypoglycemia] day, yay! I followed Angela Stanton’s advice and did the zero carbs program for 6 days; I have reintroduced carbs back now, up to almost my norm for the ketogenic diet and still no low blood sugar!! I’m ecstatic! I have the bruised fingertips as proof of all the poking (I was actually eye spying my toes as an alternative ☺️) for me the increase in protein was the key. I realized I was not eating enough before. So for those of you struggling with reactive hypoglycemia this is the answer.” –LM 9/6/2017

As you can see, she reversed her reactive hypoglycemia by cutting all carbohydrates out of her diet for 6 days, and ate only protein and fat. Why does the zero carbs diet work? This and the rest of the information about nutrition and T2D are going to be discussed in the second part of the series on diabetes. So stay tuned and look for part 2!

Sources:

  1. Dandona P, Chaudhuri A, Ghanim H, Mohanty P. Proinflammatory Effects of Glucose and Anti-Inflammatory Effect of Insulin: Relevance to Cardiovascular Disease. American Journal of Cardiology.99(4):15-26.
  2. Kraft J, R;. Diabetes Epidemic &You. revision 1 ed. North America & International: Trafford; 2011.
  3. Crofts C, Schofield G, Zinn C, Wheldon M, Kraft J. Identifying hyperinsulinaemia in the absence of impaired glucose tolerance: An examination of the Kraft database. Diabetes Research and Clinical Practice.118:50-57.
  4. Shearer J, Swithers SE. Artificial sweeteners and metabolic dysregulation: Lessons learned from agriculture and the laboratory. Reviews in Endocrine and Metabolic Disorders 2016; 17(2): 179-86.

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Angela A Stanton, PhD

Angela A Stanton, PhD, is a Neuroeconomist who evaluates changes in behavior, chronic pain, decision-making, as a result of hormonal variations in the brain. She lives in Southern California. Her current research is focused on migraine cause, prevention and treatment without the use of medicines.

As a migraineur, her discovery was helped by experimenting on herself.

She found the cause of migraine to be at the ionic level, associated with disruption of the electrolyte homeostasis, resulting from genetic mutations of insulin and glucose transporters, and voltage gated sodium and calcium channel mutations. Such mutations cause major shifts in a migraine brain, unlike that of a non-migraine brain. A non-migraineur can handle electrolyte changes on autopilot. A migraineur must always be on manual guard for such changes to maintain electrolyte homeostasis.

The book Fighting The Migraine Epidemic: How To Treat and Prevent Migraines Without Medicines - An Insider's View explains why we have migraines, how to prevent them and how to stay migraine (and medicine) free for life.

Because of the success of the first edition and new research and findings, she is now finishing the 2nd edition. The 2nd edition is the “holy grail” of migraines, incorporating all there is to know at the moment and also some hypotheses. It includes an academic research section with suggestions for further research. The book is full of citations to authenticate the statements she makes to be followed up by those interested and to spark further research interest.

While working on the 2nd edition of the book she also published academic articles:

"Migraine Cause and Treatment" Mental Health in family Medicine, November 23, 2015, open access
"Functional Prodrome in Migraines" Journal of Neurological Disorders, January 22, 2016, open access
"Are Statistics Misleading Sodium Reduction Benefits?", Journal of Medical Diagnostic Method, February 3, 2016, open access
“A Comment on Severe Headache or Migraine History Is Inversely Correlated With Dietary Sodium Intake: NHANES 1999-2004” Angela A Stanton PhD, 19 July 2016 DOI: 10.1111/head.12861 not open access, membership required to read it.

Dr. Stanton received her BSc at UCLA in Mathematics, MBA at UCR, MS in Management Science and Engineering at Stanford University, PhD in NeuroEconomics at Claremont Graduate University, and fMRI certification at Harvard University Medical School at the Martinos Center for Neuroimaging for experimenting with neurotransmitters on human volunteers.

For relaxation Dr. Stanton paints and photographs. Follow her on Twitter at: @MigraineBook

6 Comments

  1. Eliminating carbohydrates from your diet is a recipe for disaster for many people. Read Chris Masterjohns article in Weston Price Entitled: Why We Need Carbohydrates. Insulin resistance is way more complex an issue then is implied in this article. With the overuse of antibiotics there are all sorts of people walking around with biotin, vitamin k , and selenium deficiencies that will suffer serious consequences if they go low carb. People interested in alternative health need to be careful that in seeking to create their “protocols” they don’t cause the same level of harm as mainstream medicine. We need humility for the level of biochemical diversity that exists among humans. We need to stop declaring whole categories of food bad. It’s way more “grey” then that. Most of all please be careful and do your research before putting a child on a low or no carb diet.

    • Dear Melanie,

      Carbohydrates are not essential nutrients. There is not a single essential element in carbohydrates that the human body cannot create or do without. There are millions of people on the zero carbohydrate diets—eating only meat and fat—having completely eliminated all their illnesses and health condition. There are even more millions of people on the ketogenic diet with very limited carbohydrates and they all have eliminated all their illnesses, reversed diabetes, insulin resistance, cancer too, and a host of other health conditions. You are referring to antibiotics: do you realize that pathogens live on carbohydrates and glucose? Those on the ketogenic diet don’t get bacterial infections—they just simply don’t.

      So when you are talking about some of these nutrients, like vitamin K and selenium, consider beef: “One cup of beef liver contains approximately 5 mcg of vitamin K” and as for selenium, Yellowfin tuna. 3 oz: 92 mcg (over 100% DV) as is rich in most other fish and organ meats of beef and others, Halibut, cooked. 3 oz: 47mcg (67% DV), Sardines, canned. 3 oz: 45mcg (64% DV), Grass-fed beef. 3 oz: 33 mcg (47% DV), Turkey, boneless. 3 oz: 31 mcg (44% DV) etc…

      So do we need carbs? Nah… we don’t. Not a bite!

      Best wishes,
      Angela

      • I followed the High Fat Low Carb protocol for over 8 years. I had been diabetic for 12 years at that point, controlled by insulin for 6 years. Whilst it seemed to help initially, not only did I actually GAIN even more weight, but over time I developed Gastroparesis, had more & more trouble digesting animal protein & eventually my body became so fat-saturated my insulin resistance went into orbit & the injected insulin was hardly working. It was a very worrying time, & I knew taking more & more insulin was not the answer.

        In desperation I went plant-based. For the first month I just juiced to give my poor beleaguered gut a break. To my utter amazement, by the end of the month (without any fats or oils) my insulin sensitivity returned, my blood sugar dropped & I had to radically cut my insulin by more than half, from 50+ units I had to take in the end to just 20-25 or even less!

        What this has taught me is not to fear carbohydrate. What I do need to avoid is crap, nutrient-devoid, ‘empty-calorie’ highly-refined, pseudo-food carbohydrate such as refined wheat & sugar & pasteurised (denatured) dairy. All these foods in their natural unprocessed forms are rich in nutrients, including B vitamins, but the refining & pasteurisation processes either strip them out or destroy them.

        To lump all carbohydrates together is like saying glass & diamonds are the same because you can make crystals out of both. Natural, unprocessed carbohydrate-rich vegetables & fruits are worlds apart from junk carbs. They come packaged with their own rich array of nutrients, often including those vital B vitamins (Except B12, of course) & unlike the junk, do not rob the body of nutrition but nurture & sustain it.

        Had I only had experience of a plant-based life I could not have any right to comment, but having experienced both sides of the ‘fence’ – and believe me, not only was I doing Keto before it became ‘fashionable’, but I also tried it every which way but loose, even going Zero Carb at one point in an attempt to get it to work better – I feel quite qualified to comment.

        For me, fats are the issue. The more fat I consume, the worse my insulin resistance. I now not only consume far more carbohydrate than I’ve ever done, but I’m also on less insulin now than I was initially put on 17 years ago…..

        • Dear Ali,

          It was interesting to read what you wrote, because clearly, whomever told you to eat low carbs high fat (LCHF) with “high fat” (and we don’t know what “high fat” meant for you as far as the type of fat and quantity consumed) was truly misleading you. I works with hundreds of people with type 2 diabetes (T2D) of whom many start out while taking insulin. I have never ever seen anyone have the experience you had, because the first thing I teach each person is the importance of eating real food: the right fat, the right protein, and the right carbs.

          Carbohydrates are nonessential nutrients, meaning we humans need zero carbohydrates in our diet to live a healthy life. It is not that they are evil but that they contain nothing in them that we need. There is absolutely nothing wrong with eating carbohydrates, except that since they contain no nutrients that are important or necessary for human survival, unless lots of supplements are also consumed, they lead to bone loss, cognitive function loss, and a host of other health conditions. Plants are severely deficient in essential nutrients, which are the right kind of fats and bioavailable protein.

          I totally agree with you that junk food is the evil food, which is the prepackaged ultra-processed food, be it carbohydrates, or fats, or protein. It doesn’t matter which, if it is over-processed, its value is zero and negative, in fact. So when you ate a LCHF diet, if the higher fat you ate were vegetable or seed oils, those increase T2D–I suspect that is what you consumed. Those oils are extremely harmful no matter under what nutritional regime one consumes them. If something is cooked (or contains) vegetable or seed oils, I won’t touch them. I rather don’t eat.

          In terms of protein: processed protein foods are still junk. Living off of hot dogs, salami, burgers prefabricated in or for grocery store sales or are produced by fast food chains, are still junk processed foods. They contain vegetable and seed oils and a ton of preservatives, flavoring, etc.

          I suspect your negative results and bad experience came from insufficient information–or totally wrong information–of what a true LCHF diet is. With this said and done, those with T2D benefit most from eating no carbs at all (carnivore diet) or the ketogenic diet (less than 20 carb grams) and also time restricted eating (TRE) or intermittent fasting (IF). The people I deal with who have T2D are placed on a whole food (meaning they have to cook from scratch), eat higher protein (animal protein) than average, and higher fat (animal fats only) diet with low or no carbohydrates.

          The caveat is in selecting the right fats (only animal fats), the right protein (only animal protein counts), and the right carbs (only non-starchy veggies and very minimal non-starchy fruits). There is also great emphasis placed on eating no sweeteners at all–not even naturals or substitutes–no grains at all, no imitation breads–like no almond flour bread, etc.,–drinking plenty of water and salt to balance the high potassium diet.

          I have yet to meet a single person following this kind of healthy low carbs high fat diet that ended up with the results you have. 100% of those who use insulin initially are completely without insulin or any other T2D medication and their A1c shows that they are officially not diabetic, often as fast as 6 months (some as fast as 6 weeks!) after starting the real program. There are several nutritional and medical professional who follow the plant correctly, but unfortunately there are more who don’t.

          Best wishes,
          Angela

  2. Hello

    I write from Spain
    I am a nutritionist dietitian
    It is true that the problems of people with diabetes start before suffering from the disease.
    For this reason a good prevention, is possibly a great tool

    • Hi Pascual,

      Thanks for your comment–nice to know that we have Spanish readers as well. 🙂 Prevention is the essence of health. Much easier to prevent insulin resistance by eating low carbohydrate foods and high fat, avoiding all refined carbohydrates, that contain, among other things, grains, most fruits, and many vegetables. This is quite against what the American nutritionists/dietitians are told to teach but slowly the wheels are turning. So many millions of people have switched in the US at least, to the low carbs high fat diet, and they all reversed their obesity, their type 2 diabetes, insulin resistance, GERD, arthritis, urinary incontinence–just to name a few. It is now also known that type 1 diabetics do way better on the low carbs high fat diet as well, needing way less insulin by not eating carbs.

      It is a fun time to be part of nutrition science as it is changing right under our noses to be healthy. 🙂

      Best wishes,
      Angela

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