
According to the CDC, one in three people in the United States have prediabetes. Prediabetes is a term used to describe chronically elevated blood sugars not yet in the clinical range for type 2 diabetes. The driving agent behind prediabetes (and type 2 diabetes) is insulin resistance. But the effects go well beyond diabetes.
In his book Why We Get Sick, Dr. Benjamin Bikman makes the case that the majority of Western diseases (cardiovascular disease, cancer, dementia, infertility, hypertension, etc.) have insulin resistance at their root. In this post we will define insulin resistance, discuss what causes it, and look at the problem using the lens of Chinese medicine.
Insulin
Insulin is a hormone that is produced in the pancreas by specialized cells called beta cells. Without it, we would die. When in the blood stream, insulin binds to specific receptors that are on the surface of every cell in the body. This causes a cascade of events that increases the uptake of glucose molecules from the blood stream. In coordination with glucagon (another hormone that is produced by the pancreas which causes the liver to release glucose into the bloodstream), insulin maintains the body's blood glucose within a narrow range of 70-100 mg/dL all hours of the day. That is, in healthy individuals.
There are a few variables that challenge the body's ability to maintain glucose homeostasis: 1) Acute sickness and stress will temporarily raise blood sugars as the body releases cortisol; 2) A large bolus of carbohydrates from a meal will tax the body's ability to uptake glucose;
3) Insulin resistance will reduce the effectiveness of the insulin molecule, making it harder and harder for cells to uptake blood sugar.
Insulin Resistance
Insulin resistance is a decrease in insulin receptors on the surface of cells, the result being incomplete, or slowed activation of the glucose uptake pathways. An individual who is resistant to their own insulin will have elevated blood sugar levels as well as elevated blood insulin levels. If this physiological state occurs for a prolonged time, the result is type 2 diabetes. If you remember from the autoimmunity post, type 1 diabetics lack the ability to produce their own insulin, but this doesn't protect them from developing insulin resistance. The opposite is also true. People with type 2 diabetics can become dependent on exogenous insulin when their pancreatic beta cells, due to the high demand for insulin production, become depleted and die off.
Several factors contribute to insulin resistance: 1) Acute sickness and stress, increases cortisol which blunts insulin sensitivity; 2) Dietary patterns high in processed carbohydrates and fats; 3) Insufficient physical activity; 4) Suboptimal sleep; 5) Mineral deficiencies. The body may be able to deal with one or two of these categories being off every once and a while, but when multiple factors come together, the result is insulin resistance. Consider the typical American lifestyle--sedentary, chronically stressful, inadequate in sleep, and laden with fast food--and it is no wonder why we find ourselves in a pickle.
The Root of all Disease
The specifics of how insulin resistance reeks havoc in the human body are still being uncovered, but we'll detail a few here. First off, insulin resistance leads to an increase in circulating blood insulin levels, called hyperinsulinemia. Excess insulin in the bloodstream has proinflammatory properties (which are beneficial in times of acute sickness) that cause damage and oxidation of the tissues that are in the blood stream. This includes both the blood cells and components of serum that are in circulation, and the structures of the circulatory system itself. Insulin damages blood vessels directly and indirectly, which causes the body to mount a response to repair the damage by creating plaques made of platelets and cholesterol. This is the leading root cause of cardiovascular disease.
Not all cells can develop insulin resistance though, and this leaves them particularly susceptible to the effects of hyperinsulinemia. Ovaries are one such cell type. In a woman with systemic insulin resistance, her ovaries will continue to uptake glucose at an increased rate. This cases one of the most common patterns of infertility--polycystic ovarian syndrome (PCOS). Cancer is another cell type that benefits greatly from an environment rich in glucose and insulin and will grow rapidly under these conditions.
In the posts on dementia and mental health, we discussed the connection between insulin resistance and dementia. We won't go into great length on that here other than to mention the importance of metabolic health on mental health. If our cells are unable to efficiently utilize energy, in the form of glucose and other substrates, then they cannot perform at their optimum and will eventually develop disease.
The Cure of All Disease
Fight the resistance. There are a few fundamental truths in biology and insulin sensitivity being linking to better health outcomes is one of them. If we were to reverse engineer the causes of insulin resistance, we would get the solution for increasing insulin sensitivity:
1) Keep chronic stress low
2) Eat a diet rich in whole foods, avoiding processed carbohydrates
3) Exercise regularly with a focus on cardiovascular and muscular strength
4) Prioritize sleep
5) Address mineral deficiencies
Multiple diabetes medications exist for enhancing insulin sensitivity, including metformin and the class of GLP-1 agonist drugs that are reaching popular new heights in the weight loss world. While these can be effective adjuncts to healthy lifestyle changes, they do not replace them. In biology there are no easy solution, only tradeoffs. The work that goes into establishing good habits pays dividends in the long run, but it is work initially.
Insulin and Chinese Medicine
Insulin is one of the most anabolic hormones in the human body. It is deeply linked with the process of eating food and transforming that food into energy. In Chinese medicine (CM) this is a function of the Spleen system, which in some translations is referred to as the Spleen/Pancreas system. Remember the pancreas is the organ that creates insulin. The Spleen is also responsible for maintaining the body's muscular system, which is an integral part in maintaining insulin sensitivity.
In the lens of CM insulin resistance is viewed as stagnation in the Spleen, Heart, Kidney, and Liver systems. This can manifest as food stagnation, rebellious Stomach qi (i.e. reflux, heartburn), accumulation of dampness or phlegm (i.e. PCOS, cholesterol plaques), and heat (i.e. inflammation in general). The Chinese define the etiology of insulin resistance as an excess of empty calories, and a deficiency of the Spleen (exercise and nutrition).
From a psychological perspective, the Spleen is responsible for managing the intellect and the the emotion of worry. It is no coincidence that a culture that spends excess hours engaged in activities of the mind and too few in pursuits of the body and spirit would develop issues in the Spleen.
Conclusion
Whether or not you agree with the assertion that insulin resistance is at the heart of most modern patterns of disease, you cannot ignore the enormous implications expressed therein. Insulin affects every major system in the body, and managing its effects is paramount to living a healthy and long life. The implicit concordance between the advice for increasing insulin sensitivity and pretty much every time-tested lifestyle advice is unavoidable. The process of fighting the resistance is a simple, but not easy, one. Evoking the advice and support of others is always advisable. The more that you are able to share this knowledge, the better everyone becomes
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