Insulin Resistance – Causes, Effects, Management & Reversal

Insulin is a hormone produced by the pancreas (beta cells) for regulating blood sugar. It helps glucose enter cells in muscles, fat and liver where it is used for energy. Besides blood glucose regulation, insulin also plays an important role in fat regulation. Elevated insulin levels promote fat storage whereas lower levels promote lipolysis.

Post a carb loaded meal, the pancreas release insulin so as to keep blood sugar in normal range because elevated blood sugars can cause a variety of complications.

What Is Insulin Resistance

When the cells in human body start resisting the action of insulin, pancreas release more of it to counter the resistance. This elevation of insulin often goes undetected as no one tests for fasting and postprandial insulin levels.

Elevated insulin levels work fine for some time — few years may be — before partial beta cell burnout happens. This results in blood sugar control becoming erratic, and levels climb up. However, before this stage is reached, the body gives you many warning signs, which are normally ignored.

Even signs of hypertension are just covered with drugs. Hardly any doctor recommends insulin tests. But, before type 2 diabetes is detected these visible signs of manifestation of damage become quite evident, sometimes as long as 20 years before onset of Type 2 diabetes. That’s metabolic syndrome.

What Is Metabolic Syndrome

Metabolic syndrome is not a disease in itself but is a cluster of conditions. Any clustering of three of the following medical conditions is metabolic syndrome called by various acronyms like MetX, SyndromeX etc:

  1. Central obesity
  2. Hypertension
  3. High blood sugar
  4. High Serum Triglycerides
  5. Low serum High Density Lipoproteins (HDL)

Ideally, if insulin tests were a part of standard blood panel, even elevated insulin would have been a condition, taking the total to six conditions. What’s surprising is that despite the epidemic of obesity and diabetes, the mainstream establishment still hasn’t included insulin tests as part of standard. It’s really baffling! The famous insulin essay from Dr Joseph Kraft below is self explanatory:

Kraft Curves Cummins 300x193 - Insulin Resistance - Causes, Effects, Management & Reversal

While managing Type 2 diabetes reversal, we on invariably look for fasting and sometimes postprandial insulin levels. Insulin is a necessary evil, and maintaining higher insulin levels to control blood sugar is counter-productive.

Causes Of Insulin Resistance

If we leave the genetics part out, we find that mainstream experts blame “inactivity” as one of the major cause of insulin resistance. Our take is slightly different. While inactivity maybe a problem, it’s the wrong diet that pulls the trigger.

Eating carbs that one cannot burn results in excessive fat storing, which then acts as the stepping stone for central obesity. That itself ticks off one of the three needed conditions for metabolic syndrome. Invariably associated with central obesity is higher triglyceride. So two conditions are met.

Being active is good for health. But being active just to ensure non insulin mediated glucose uptake and burn off and overload of glucose (read carbs) in diet makes absolutely no sense. Why not simply cut down on carbs? This is precisely the basis of what we call “Indian Low carb High Fat Diet” which focuses on limiting carbs intake in a day to less than the Liver’s glycogen holding capacity — limiting carbs to 100g/day or 20% max of calorie intake.

Medications can be the other cause of insulin resistance. For example:

  1. Steroids. Corticosteroids elevate blood sugars. This leads to pancreas releasing more insulin to get the blood sugar down. Long term use of steroids can cause insulin resistance and finally in many cases diabetes.
  2. Statin drugs. This is said to increase the chances of Type 2 diabetes.

Patients on peritoneal dialysis (PD) are more likely to develop insulin resistance.

Effects Of Insulin Resistance
  1. Link between insulin resistance and hypertension
  2. Insulin resistance and cardiovascular disease.
  3. Insulin resistance with onslaught of high blood sugars damaging the beta cells, leads to Type 2 diabetes.
  4. Insulin resistance in diabetics can cause proliferative retinopathy.
  5. Insulin resistance can cause peripheral neuropathy.
  6. Insulin resistance greatly increases chances of CHD
  7. Elevated blood sugar due to insulin resistance (or deficiency) can cause CKD.
  8. Insulin resistance causes Lipid Disorders.
  9. Insulin resistance can also cause Polycystic Ovary Syndrome (PCOS)
  10. Insulin resistance can also cause Non Alcoholic Fatty Liver Disease (NAFLD).
Managing & Reversing Insulin Resistance

While I do not dispute the advantages of active lifestyle, but one must also note that one cannot outrun a bad diet. For this reason, we advocate the High Carb Low fat diet. We live by following sequential line of action on

  1. Achieve control through diet first. Cut down carbs intake to 20% or 100 g/day max. This is the premise of LCHF that we follow. Ketogenic end of the spectrum is an option but not a compulsion.
  2. Diet change + strength building.
  3. Diet change + strength building + medications.

Medications come in at the last as they should not be the first line of action. Aim for fasting insulin of 3 to 6. Don’t go for what the lab range says. That’s criminally wide range.

I have often come across good carbs vs bad carbs marketing gimmick. Look at carbs from a Type 1s perspective. To process the same amount of digestible carbs in a day one would need same amount of  insulin. I have quoted Type 1 as they have no endogenous source of insulin.

The type of carbs one takes doesn’t matter as the production of insulin is directly proportional to the amount consumed. The talks of Glycemic Index (GI) are irrelevant. As Dr Bernstein mentioned in one of his videos – “There’s lot of nonsense going around in nutrition circles with respect to GI”.

Wrapping Up
  1. Insulin resistance starts creeping in years before one turns diabetic.
  2. Central obesity is one sign of insulin resistance. Others of course include PCOS, Hypertension, Dyslipidemia etc.
  3. Cut down CARBS to fix insulin resistance problem. Aim for fasting insulin of 3 – 6.
  4. Do some strength building exercises for non insulin mediated glucose uptake.
  5. Diet should always be the first line of action. One cannot outrun a bad diet, unless one can jog for an hour after every meal. YES, after every meal and not just one long jog in the morning.
  6. Focus on the “Satiety” aspect of the diet and not CICO (Calorie-in-Calorie-out) model of obesity. High carb diets are the worst when it comes to satiety.
  7. Lower insulin levels promote fat loss.
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