Also: My spider web log has a rattling eclectic audience. I receive got physicians, PhDs, as well as others well-educated inward biochem as well as A&P reading this, but I think the mass of my readers are interested laypeople. I endeavor to tailor my posts to the laypeople, keeping inward hear that they are of above-average intelligence, as well as sure as shooting above-average cognition most all this low-carb, high-fat, Paleo, as well as ancestral wellness "stuff." Just wanted to remind everyone of the various audience here, because this post, inward particular, contains simplified explanations of complex processes, as well as I apologize if whatever of the pros notice themselves bored. :-/
OKAY! Now nosotros come upwardly to the adjacent part of why all of this insulin materials is so important. (Missed the get-go part? Click here. And you’ll notice I’ve changed the championship of this post service to say it’s part 2 of I-don’t-know-how-many. In starting to write part 3, I realized this is going to hold out to a greater extent than similar v or 6. I am learning novel things most this every day that I experience are of import plenty to write about, as well as the number of posts it volition receive got to include them keeps rising.)
Here nosotros go...
Insulin is elevated, as well as it’s elevated for a prolonged amount of time. I wouldn’t hold out devoting so much (unpaid!) time to writing most this if elevated insulin, inward itself, weren’t such a large threat to skilful health. It’s fifty-fifty worse when coupled alongside elevated glucose, but it’s got some pretty nasty effects all on its own. So let’s intermission this down. Some of this you’ll hold out familiar with, but some of it powerfulness surprise you. Make no mistake, though, what Dr. Tim Noakes said is true:
Here nosotros go...
Insulin is elevated, as well as it’s elevated for a prolonged amount of time. I wouldn’t hold out devoting so much (unpaid!) time to writing most this if elevated insulin, inward itself, weren’t such a large threat to skilful health. It’s fifty-fifty worse when coupled alongside elevated glucose, but it’s got some pretty nasty effects all on its own. So let’s intermission this down. Some of this you’ll hold out familiar with, but some of it powerfulness surprise you. Make no mistake, though, what Dr. Tim Noakes said is true:
That's why insulin resistance most of import medical status of our day. Yet nosotros (doctors) pretend it doesn't be https://t.co/Rb1ogX1JB5 — Tim Noakes (@ProfTimNoakes) September 13, 2015 The alone dot on which I disagree alongside Dr. Noakes is that insulin resistance (IR) is a “medical condition.” I would say it’s a pathological physiological state, for sure, but I don’t know if I’d telephone band it a medical condition, as in, something that needs to hold out treated alongside medication. Insulin resistance is a medical status inward the same way a broken leg is a medical condition: it tin come upwardly most due to forces beyond someone’s control, or it tin come upwardly most because of misguided lifestyle practices. H5N1 broken leg, for example, tin outcome from a freak machine accident (forces beyond one’s control), or it tin hold out the outcome of running alongside the bulls inward Pamplona as well as getting trampled (misguided lifestyle practice). Insulin resistance tin outcome from beingness born alongside rattling strong genetic as well as epigenetic propensities toward IR almost no affair what someone eats or how they live (forces beyond one’s control), as well as nosotros currently hypothesize that it tin outcome from a long fourth dimension of overconsuming carbohydrates (and potentially all food), beingness sedentary, beingness chronically stressed, as well as non getting adequate slumber (misguided lifestyle practices).
But I’m no zealot. I’ll orbit a piffling as well as admit that at that spot are, indeed, individuals who take medication to assist decrease their insulin resistance. There are plenty of people out at that spot for whom a LCHF diet, exercise, ameliorate sleep, less stress, as well as the whole residual of the bundle exactly doesn’t receive got them all the way. Maybe these people genuinely do take metformin, or, on the non-prescription side, perhaps berberine, chromium, as well as alpha-lipoic acid. (And let’s non underestimate the powerfulness of vinegar!) But I withal don’t know if I’d telephone band IR a “medical condition.”
But that is neither hither nor there. I am commonly a stickler for semantics, but let’s non acquire hung upwardly on the details this time. Whether it’s a medical condition, metabolism gone awry, or exactly one heck of a problem, insulin resistance is no joke.
And I don’t think nosotros tin say with certainty what genuinely causes IR. I suspect it’s multifactorial. There are in all likelihood many factors inward diet as well as lifestyle that combine inward a “perfect storm” to wreck physiology as well as metabolism. So I don’t think it’s just excess carbohydrates. If it were, so a low-carb diet, by itself, would assist everyone who’s insulin resistant, as well as piece it is that unproblematic for many people, I receive got clients who tin confirm it’s frequently to a greater extent than complex than that.
It in all likelihood looks something similar both of these cascades:
Order powerfulness rather be: oxidative stress => mitochondrial dysfunction => IR => hyperinsulinaemia => inflammation => cancer, CVD, T2DM, etc. — Gabor Erdosi /erdoke (@gerdosi) September 13, 2015 (In fact, I receive got written extensively most the role of mitochondrial dysfunction inward cancer. See here as well as here.)
But dorsum to insulin.
When it comes to the role of increased small-scale intestinal permeability (a.k.a. “leaky gut”), the scientific literature indicates that a leaky gut powerfulness hold out the driving strength for wellness effects far as well as broad inward the residual of the body. At the rattling least, there’s a gut-skin axis; a gut-brain axis, as well as a gut-joint axis. And I am hereby proclaiming that nosotros tin brand a instance for a glucose-insulin-every-system-in-the-body-axis.
After earthworks through this materials for a while, I receive got come upwardly to the next conclusion:
THERE ISN’T ONE BODY SYSTEM THAT IS NOT ADVERSELY AFFECTED BY CHRONICALLY ELEVATED BLOOD GLUCOSE AND/OR INSULIN.
Just off the travel past times of my head, hither are half dozen torso systems that receive got a rattling gnarly hitting from chronic hyperglycemia and/or hyperinsulinemia:
Reproductive system
It is fairly good established that polycystic ovarian syndrome (PCOS) is related to hyperinsulinemia. Not inward every case, but inward a slap-up many. Additionally, hyperinsulinemia, hyper- as well as hypoglycemia may crusade PMS to hold out darn nigh unbearable, partly because of insulin’s effects on sexual practice hormones, but also for the much to a greater extent than obvious argue of wild blood refined saccharify ups as well as downs causing mood swings and irritability. But it’s non all most the women. Oh, no, fellas, you’re non immune to the effects of elevated insulin on your precious gonads. Y’know all those commercials pushing pills as well as potions for “low T”—i.e., depression testosterone? Well, at that spot are lots of reasons your “T” could hold out low, but ane of the biggies is hyperinsulinemia. See, insulin upregulates an enzyme called aromatase, as well as aromatase converts androgens into estrogens. The to a greater extent than aromatase action a man’s torso has, the less testosterone as well as the to a greater extent than estrogen he in all likelihood has floating around inward his bloodstream. Elevated estrogen—and, really, exactly messed upwardly hormones inward general—in men tin atomic number 82 to all sorts of nasty stuff, including gynecomastia, benign prostatic hypertrophy (BPH), prostate cancer, as well as infertility. Elevated PSA (prostate-specific antigen) levels? Is it cancer, or hyperinsulinemia? “Man boobs?” Maybe that guy needs a low-carb diet. Shooting blanks? Maybe that calls for some insulin-lowering lifestyle interventions. “The up-regulation of aromatase produces increased intracellular oestradiol […] inward combination alongside insulin, to crusade aberrant downstream transduction signaling, as well as thus induce metabolic syndrome as well as mitogenic prostate growth.” Right. “Mitogenic prostate growth.” That’s science-speak for enlarged prostate, which it seems similar tons of older men are beingness “diagnosed” with. Is at that spot something incorrect alongside the prostate gland, itself, or is it hyperinsulinemia? The writer of this paper concludes that these weather condition are a outcome of excess insulin & estrogen, rather than “low T.”
Bottom line: High insulin is bad sexual wellness & fertility juju for both sexes. (Know someone struggling to acquire pregnant? Tell them to contact me!)
Cardiovascular system
According to Dr. Kraft, “Those alongside cardiovascular illness non identified alongside diabetes are merely undiagnosed.” Can yous imagine? This sh*t has nothing to do alongside cholesterol. Cholesterol is accumulating inward the blood vessel walls inward guild to repair the microdamage inflicted past times all the glucose & insulin! Sure, arteries beingness “blocked” past times a buildup of plaque tin atomic number 82 to ischemia (reduced blood flow) as well as infarction (total lack of blood flow as well as resultant tissue death), but rather than getting rid of the cholesterol past times whatever as well as all agency possible, the enquiry should be, WHAT is CAUSING the plaques to cast inward the get-go place?
Okay, directly that I’ve gotten the rant out of the way, let’s await at some of the ways inward which hyperglycemia as well as insulin resistance impact the cardiovascular system:
Glycation: I sprinkled the term “hemoglobin A1c,” or exactly A1c, throughout part 1 of this series. A1c is “glycated hemoglobin,” as well as it’s an approximate mensurate of your average blood glucose during the past times 3-4 months. Glycation happens when a refined saccharify (such as glucose) gloms onto a poly peptide (such as hemoglobin inward the blood) as well as doesn’t allow go. It’s an irreversible process. Think of it similar an unwrapped lollipop accidentally left on a machine dashboard inward a closed-up machine inward the dead of summer. That refined saccharify is going to melt as well as acquire sticky, hard, as well as brittle, as well as it’s going to hold out darn nigh impossible to take away it. I am simplifying hither for the sake of explanation, but if your A1c is elevated, think of it similar your blood beingness glutinous as well as gunky. Its consistency/viscosity has gone from watery to to a greater extent than similar maple syrup or molasses. But hemoglobin isn’t the alone poly peptide that tin acquire glycated. Any protein—including structural ones inward blood vessels—can also acquire glycated. The outcome is, they acquire difficult as well as brittle. They travel from soft-ish, rubbery hoses that are quite accommodating (meaning they tin expand as well as contract easily), into something to a greater extent than similar drinking glass tubes. They’re brittle as well as fragile. So when yous receive got chronically elevated BG, as well as your A1c is high, instead of H2O flowing through a nice, rubbery hose, nosotros receive got thick, dense molasses beingness forced through a brittle drinking glass metro at a high force per unit of measurement area (due to hypertension…more on that inward a sec). The extremely logical as well as semi-inevitable consequence of this is the high incidence of all the cardiovascular complications so many diabetics experience, many of which are the results of compromised blood vessels: stroke, ticker attack, outburst blood vessels inward the eyes, pathetic circulation, kidney failure, loss of feeling inward the extremities (diabetic neuropathy)—particularly inward the feet, and more. So I receive got to concur alongside Dr. Kraft: people alongside cardiovascular illness non seemingly related to diabetes are in all likelihood the exact people I talked most inward part 1: people alongside diabetes in-situ. Undiagnosed diabetics, who remain undiagnosed because the alone things their doctors are looking at are A1c as well as fasting glucose.
Okay, directly that we’ve covered the cardiovascular system, let’s travel ane pace farther as well as connect this dorsum to reproductive function. With what nosotros exactly discussed most the effects of hyperglycemia on the blood vessels, some other rattling mutual occupation amid men of all ages, but peculiarly older ones, emerges: erectile dysfunction. Informed doctors volition confirm that erectile dysfunction is, for many men, the get-go sign of heart/cardiovascular problems. Why? What does the southern encephalon receive got to do alongside ticker function? Easy-peasy. Erectile dysfunction isn’t typically caused past times lack of desire. The human wants to perform; it’s that damn piffling soldier who’s non next orders, right? Well, failure to acquire and/or maintain an erection may good hold out due to impaired blood flow to the penis. If blood circulation is compromised, as well as the torso has to do triage, despite what men powerfulness think, the penis is not his body’s most of import organ. In fact, the penis is in all likelihood ane of the first places the torso would halt sending adequate blood to if it had to prioritize. (So yous tin run into why ED genuinely can hold out an early sign of ticker trouble, peculiarly inward the absence of other indicators.)
Check out this post service from Dr. Gerber for a closer await at the cardiovascular connexion to hyperinsulinemia, as well as why the traditional way of measurement ticker illness risk is way off the mark.
Eyesight
I loathe to start sentences alongside “everybody knows,” but really, everybody knows poorly managed type 2 diabetes tin crusade complications alongside vision, the most serious of which is straight-up blindness. The retina contains teeny, tiny blood vessels, as well as nosotros exactly reviewed what happens to blood vessels inward the sustained presence of lots of glucose. It’s bad plenty when large, strong, hardy as well as commonly accommodating blood vessels, such as arteries, are glycated. Imagine what happens when itty bitty ones inward the eyes acquire brittle as well as unforgiving. Burst vessels all over the place. (My woman rear had poorly managed type 2 diabetes, as well as she experienced these all the time.) Hence the term “diabetic retinopathy.” There are people whose diabetes was initially diagnosed non past times a household unit of measurement MD or endocrinologist, but past times an ophthalmologist! Eye doctors tin await straight at your retina, as well as they powerfulness hold out the get-go someone to notice that you’ve got a occupation alongside blood glucose. Bottom line: Hyperglycemia is bad eyesight juju.
Kidney Function
As well-known as optic problems are amid individuals alongside poorly managed T2D, it is as acknowledged that poorly managed T2D has horrible, fatal implications for kidney function. There are 2 principal reasons for this:
- The renal tubules, which are the parts of the kidneys responsible for filtering the blood, incorporate teeny, tiny blood vessels, exactly similar the retinas do. And at the risk of beating yous over the caput alongside it at this point, yous know what happens to blood vessels—particularly rattling small-scale ones—when constantly exposed to high glucose. If these piffling blood vessels inward your renal tubules travel kaput, yous volition hold out in serious trouble. There’s a argue so many diabetics destination upwardly on dialysis. (But don’t forget the role of cholesterol-lowering drugs inward statin-induced renal failure!) Hence the term “diabetic nephropathy.”
- Insulin has a huge influence on sodium dynamics inward the body. More insulin ---> more sodium retention. And to a greater extent than sodium retentiveness ---> higher blood pressure. (Note: this doesn’t hateful yous take to avoid salt. If anything, the metabolic theory of cancer is done. Frankly, I think it’ll blow your mind.) How does increased sodium retentiveness crusade an elevation inward blood pressure? Well, there’s a phrase inward physiology that says “water follows sodium.” If the kidneys are asset onto to a greater extent than sodium, to a greater extent than H2O volition naturally hold out drawn dorsum into the body. More H2O agency to a greater extent than H2O inward the blood, raising the blood volume. So nosotros receive got a greater volume of blood flowing through the same amount of blood vessels, which volition crusade the force per unit of measurement area to increase. The increment volition hold out even greater if the blood vessels are somewhat glycated, because then, instead of beingness able to expand/dilate easily to accommodate the increased blood flow, these vessels are difficult as well as unforgiving. And remember: when it comes to diet-induced hypertension, it is insulin that is driving the prepare far to a greater extent than than it is sodium.
Okay, so there’s hypertension, as well as there’s kidney function. What’s the connection? Well, hypertension is rattling difficult on the kidneys. The kidneys are responsible for filtering the blood—every concluding drop. They filter out “toxins” as good as the harmful byproducts of normal metabolic processes, as well as they also determine how much of which minerals as well as electrolytes to acquire rid of, as well as how much to reabsorb. High blood force per unit of measurement area makes this harder to do. (So does dehydration. Remember: thick, sludgy blood forcing itself through tiny, brittle blood vessels.)
Bottom line: Hyperglycemia & hyperinsulinemia are bad kidney juju.
Brain Health & Cognitive Function
Hello? I wrote a whole friggin’ volume most the connexion betwixt elevated insulin as well as Alzheimer’s disease. I also talked most Alzheimer’s as “diabetes of the brain” or non-celiac gluten sensitivity). For example, there’s “gluten ataxia” – a (supposedly) gluten-induced state of full general clumsiness. And at that spot seem to hold out other neurological, dermatological, as well as other systemic effects from gluten, wherein the affected parts of the torso are the only indications that there’s a gluten sensitivity. So, what if some of these cochleovestibular weather condition are the only manifestation of someone’s hyperinsulinemia? Because, remember, nosotros are talking most individuals who receive got normal fasting blood glucose, normal A1c, as well as a normal reply to an OGTT. (All of which await alone at glucose.) But if they are hyperinsulinemic, you’ve got to think the glut of insulin is wreaking havoc somewhere inward the body, no? And maybe, exactly maybe, the only house it’s doing so is the inner ear. On the same theme, for individuals alongside normal BG as well as normal A1c, perhaps hypertension, or infertility, or BPH, or reduced GFR [glomerular filtration charge per unit of measurement -- an indicator of kidney function], is the only manifestation of insulin resistance.
This is an surface area supremely ripe for enquiry employing low-carb or ketogenic diets as therapy, for the same argue they are so the role of insulin inward fuel partitioning as well as the rule of adipose tissue. So that’s where we’ll travel next.
P.S. In instance it wasn’t clear from our give-and-take of erectile dysfunction, ticker disease, kidney failure, Alzheimer’s, loss of vision, as well as inner-ear disorders, BEING THIN DOES NOT AUTOMATICALLY MEAN YOU ARE HEALTHY!! For sure, millions of thin people receive got Alzheimer’s, tinnitus, vertigo, ticker disease, kidney failure, infertility, as well as more. Having been LUCKY plenty to not acquire obese does non imply yous do non receive got rip-roaring problems alongside glucose & insulin. Obesity is merely one manifestation of insulin resistance, but because it’s the ane nosotros tin see most easily, it’s the ane that everybody thinks is causing everything else. If nosotros could see someone’s serum triglycerides, someone’s renal tubules, someone’s arteries, or someone’s fasting insulin, all the fat-shamers out at that spot would SHUT UP PDQ. (Sorry...this is a huge, huge sticking dot for me, professionally and personally.)
Remember: Amy Berger, M.S., NTP, is non a physician as well as , LLC, is non a medical practice. The data contained on this site is non intended to diagnose, treat, cure, or forestall whatever medical condition.
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