The current global health challenge has shone a light on the poor state of metabolic health in developed countries such as the UK and US. The Covid-19 virus has exposed an underlying pandemic that is insidiously destroying our health and making people far more susceptible to the devastating potential of opportunistic viral infections.
The metabolic condition known as Insulin Resistance is attributed to the development of a number of serious health conditions such as obesity, hypertension, hyperlipidemia, heart disease and type 2 diabetes. It may also be the primary driver behind various Cancers and Alzheimers disease, which is often referred to as ‘diabetes of the brain’
Insulin resistance in the brain is strongly linked to the progression of Alzheimers disease.
Historically, people living with metabolic conditions have suffered worse outcomes when afflicted with viruses such as the flu. In relation to Covid-19, type 2 diabetes and two of its complications- hypertension and heart disease, are the most common comorbidities in people experiencing the worst outcomes.
People with poor metabolic health are in a state of metabolic inflammation, which compromises the immune system and predisposes them to an exaggerated inflammatory response (cytokine storm). In severe cases of Covid-19 this can lead to multi-organ failure and death.
Good metabolic health has been defined as having ideal levels of blood sugar, fat (triglycerides), cholesterol (HDL), blood pressure, and waist circumference, without the need for medications.
Unfortunately, a survey of over 8000 American Adults between 2009-2016, concluded that less than one third of American adults were metabolically healthy. In the UK, metabolic syndrome is on the rise due to increasing levels of obesity, and the NHS estimates that it already affects 1 in 3 adults over the age of 50.
Metabolic syndrome is the name used to define a group of 5 risk factors that increase the risk for developing diabetes, heart disease or a stroke. Having 3 or more of the risk factors below is classified as metabolic syndrome.
- Having abdominal obesity or a large waistline. Having excess fat in the stomach area is a greater risk for heart disease than excess fat in other areas such as the hips. (94 cm in men/80cm in women)
- High levels of fat (triglycerides) in the blood.
- A low level of HDL cholesterol in the blood (this type of cholesterol is regarded as ‘good’ because it helps remove cholesterol from the arteries.)
- High Blood Pressure consistently above 140/90
- High fasting blood sugar levels.
The prevalence of impaired metabolic health is increasing dramatically around the world, and at every stage of human development. In his book- Metabolical, Dr Robert Lustig states that the cases of Diabetes worldwide have grown more than triple the predicted rate, from 151 million in the year 2000, to 463 million in 2019.
Insulin Resistance- The Spark that Lights the Fire
Insulin resistance is when the cells in our muscles, liver and body fat become more resistant to the actions of the hormone insulin. When we eat, Insulin is released from the pancreas to take sugar (glucose) out of the blood stream and store it in our liver, muscles and fat cells. As it becomes more difficult to move glucose into the cells (due to an excess of glucose), the pancreas releases more insulin to help the cause, which leads to elevated levels of insulin (hyperinsulinemia) and eventually high levels of blood glucose (hyperglycemia). This situation sets up a host of other complications that include obesity, type 2 diabetes, hypertension, heart disease and an impaired immune system.
One of the greatest challenges in addressing insulin resistance is that it can go unnoticed for a long time and may take years for the body to express any significant symptoms. Unfortunately, our standard conventional medical tests detect problems that may have been building up for years beforehand. Fasting blood sugar (glucose) tests are an example of a test that detects a problem which may have been building up for a long time before the high levels of blood sugar are detected. The most common tests used for metabolic health detect levels of blood sugar, either at one point in time or as an average over a period of time.
Research performed on overweight nondiabetic children with normal blood glucose levels found that insulin levels (evidence of insulin resistance) were associated with higher levels of a number of risk factors for heart disease. The study concluded that detecting insulin resistance may be the earliest way of detecting risk for heart disease.
Insulin resistance is the insidious condition that precedes high blood sugar, and is a solid early indicator of metabolic dysfunction. Therefore, if we test ourselves for high levels of insulin (hyperinsulinemia), which is a sign of insulin resistance, we can catch conditions such as metabolic syndrome and type 2 diabetes a lot further upstream.
If you lead a sedentary and generally unhealthy lifestyle, or have a family history of type 2 diabetes, insulin resistance may be worth investigating. If you’re experiencing any of the following symptoms, my advice would be to adopt the mindset that you have a degree of insulin resistance, and begin proactively remedying it with a few lifestyle changes.
- Fat developing around the belly
- Feeling unusually tired
- Feeling persistently hungrier than normal
- Difficulty concentrating
- Elevated blood pressure
Testing for Insulin Resistance
The gold standard test for assessing insulin action is the hyperinsulinemic-euglycemic clamp, however this is regarded as a difficult and costly test, so may not be the easiest to obtain from your doctor. A 2 hour insulin glucose challenge test may be more obtainable, and will help identify high levels of insulin. Failing that, it may be easier to pay for your own Insulin Resistance blood test, which will measure both blood glucose and insulin levels.
How to Reverse Insulin Resistance.
In a nutshell, we need to reduce the amount of glucose in the body and make our cells more responsive to insulin. Excessive body fat, in-particular abdominal fat, is associated with greater insulin resistance, and improvements in insulin sensitivity are largely driven by weight loss. This is best achieved through a combination of dietary restriction and exercise.
The Insulin Resistance Diet
A low carbohydrate, high fat diet interspersed with periods of intermittent fasting is proving to be one of the most effective approaches for improving insulin resistance.
Unfortunately, it seems as though public health guidelines around diabetes have not fully embraced the well-established benefits of a low carbohydrate diet yet, and are still encouraging people with diabetes to base meals around starchy carbs such as potatoes, pasta and bread! They also assert that there is no particular dietary approach for type 2 diabetics and even recommend wholegrain breakfast cereals and pasta salads! Thankfully Diabetes.co.uk have criticized this advice, based on its potential to actually increase insulin resistance and worsen peoples condition.
The bottom line is that carbs, sugar and even excessive dietary protein raises insulin levels, while healthy fats do not. Therefore a low carb, moderate protein and high fat diet is a beneficial diet for insulin resistance, fat loss, metabolic syndrome, type 2 diabetes and numerous other metabolically related conditions.
Both calorie restriction and intermittent fasting are effective ways of improving insulin sensitivity, however for many people, intermittent fasting is easier because you don’t have to worry about monitoring the amount of calories you eat, you can just choose a time period in which not to eat. In addition, intermittent fasting has shown to preserve muscle mass, whereas approximately one third of weight loss through calorie restriction is lean muscle mass. The preservation of ‘metabolically active’ muscle is highly important when combatting IR.
Exercise for Insulin Resistance
In the realm of exercise, a combination of cardio and resistance exercise is superior to either type of training alone for improving insulin sensitivity. Cardiovascular exercise increases insulin sensitivity in muscles and an increase in muscle mass gained through resistance training contributes to greater glucose utilization.
Research into strength training and insulin sensitivity has demonstrated that performing just one set of 9 different exercises (15-20 mins), 3 x per week for 6 weeks, significantly improves insulin sensitivity. Insulin resistance is particularly common in the elderly, as a result of decreased activity, muscle mass and increased abdominal obesity. Prolonged resistance training results in significant increases in strength, decreases in abdominal fat and improved insulin resistance in elderly people suffering from type 2 diabetes.
Exercising in the fasted state is more effective at improving glucose tolerance and insulin sensitivity than training in the fed state.
So in conclusion, eating a low carbohydrate, moderate protein, high fat diet, coupled with regular bouts of intermittent fasting and exercise, is one of, if not the most effective way of achieving greater insulin sensitivity, losing fat, feeling better, protecting your immune system, and the list goes on…..
Many of us are already aware of the benefits of eating well and moving more, but this year has been a stark reminder just how important these simple habits are. Although the narrative coming from our public health experts has not really focused on how we can improve our natural defences against opportunistic disease, I sincerely hope that people with risk factors for metabolic syndrome feel a greater sense of motivation to take positive action.
Improvements in metabolic health are driven by weight loss, which is undoubtedly becoming a greater challenge in a modern-day society that has somewhat normalised being overweight. We are constantly under assault from food industry, unhealthy environments, and unhealthy social norms that make healthy choices difficult. Despite these challenges, it is still relatively simple to get the basics of good health right.
Insulin resistance is increasing among all age groups, and as adults and role models, we should adopt the mindset that we have a degree of it already. Whether this is true or not, embracing an anti-insulin resistance lifestyle is one of the best things we can do for ourselves and our loved ones.
If you want to transform your health, bolster your immune defences, look better, be a strong role model and a metabolic machine, get in touch HERE for all the guidance, motivation and support you will need.
An ounce of prevention is worth a pound of cure!