Insulin resistance – what is it? How Does all this affect my health?

WHAT IS Insulin Resistance?

Why is it important, what does it mean for me, my health, my life , my joy?

When we understand to some degree what insulin does, it is easier to understand what insulin resistance is. Click the link to find out more about insulin. With this info we can start to understand to what metabolic dysfunction is , how it relates to us as individuals and how it affects our healthspan, life span and joy!

To be honest with you, insulin resistance is a complex idea and always shifting as new information is discovered but I will try and outline the basic concept here. Why? Because I think it’s easier to make changes to our lives when we understand why we are doing something.

Ultimately it is important to understand the concept because this idea is tied up in a lot of chronic disease, like:

  • High blood pressure
  • Type 2 diabetes
  • Pre diabetes
  • Angina and heart disease
  • TIA and strokes
  • Chronic kidney disease
  • Dementia
  • Osteoarthritis

We live with these illnesses but they can make life hard, uncomfortable, medication dependant and just make it harder for the joy to be felt.

Essentially having some form of insulin resistance means a specific tissue is no longer as sensitive to the effects of insulin. The tissues don’t respond as they should when exposed to the hormone. They don’t do as they’re told.

We can be transiently ‘insulin resistant’ which in certain situations is increasingly thought to be beneficial to us – for example in critical illness. Glucose is declined by some tissues so that it can be taken up by other tissues that need it more during these emergency situations.

This is ‘physiological insulin resistance’ which can also be noted in those on a low carb diet, is thought to exist to free up glucose for use by tissues that can’t or prefer not to use any other energy substrate eg ketones, fatty acids. We could call this glucose sparing to prevent confusion. Is persistent physiological insulin resistance good for us – that’s a great question that I don’t have the answer to.

When a person is chronically ‘insulin resistant’, insulin persistently doesn’t have the proper effect on the tissues it is destined to impact.

For example, an insulin resistant fat cell doesn’t let any more energy in to be stored!

An insulin resistant muscle cell doesn’t allow any more glucose in to be stored as glycogen.

Insulin resistance and high insulin levels impact kidney cells and how our blood vessels dilate which affects our blood pressure.

The end result is that the cell affected doesn’t function optimally. In the case of fat cells we end up with too much energy substrate floating around in the blood stream ( glucose and fat). More glucose and more fat than we need for what we are doing with our bodies.

A fat cell (adipocyte) that is too full, bursting at the seams with stored energy becomes resistant to insulin, because it literally can’t let anymore energy substrate in, there’s just no room. So, the insulin whose job here is to knock on the door and get the fat into the cell fails at its task = insulin resistance. In the first instance the cell is essentially trying to protect itself. ” I can’t take any more”. PLEASE STOP!

And indeed if we do stop adding energy, the insulin levels will lower and the cell will release some of its fat to be used by the body and then not be insulin resistant any more.

When there is lots of fat and glucose in the blood stream, the pancreas makes more insulin to try and shove the fat into the fat cell and keep it there, this increases the amount of insulin in the blood consistently, resulting in high baseline insulin levels. This is hyperinsulinaemia.

Agitated and angry, too full, the fat cell spews out some of its contents back into the blood stream. This inflammed angry fat tissue sends out lots of distress signals, causing all sorts of immune responses – the body sense an emergency and sends out the troops to fix things- white cells, cytokines, immune modulators, all good things in short time frames and small amounts, but they that can’t fix the inflammation, they keep coming, trying to help but it still doesn’t work, the inflammation becomes chronic, resulting in the inflammatory environment associated with many chronic diseases.

I am an angry fat cell. I make my neighbouring fat cells angry too

This cascade of events happens at our ‘Personal Fat Threshold’. A threshold that’s different in different people, different races. We all have varying abilities to store fat in our fat cells. And our fat cells have different levels at which they signal they are too full.

Once we meet that threshold the detrimental effects of having too much energy rolling in and then too much insulin around begin. This group of people may have a normal BMI, top end but normal waist circumferences and not fall under societies or medicines definitions of being ‘overweight’.

We start to see changes in our blood test – high triglycerides, high insulin levels, low HDL. We see our blood pressure start to creep up, we put on weight, our knees hurt. We feel just generally sub par, our sleep is impacted by the symptoms we have and the drugs we use to help the symptoms, and then our decision making skills, motivation for change and zest for life are all changed.

When we run out of room in our fat cells we start to store fat in places there should be no fat – around the organs in our abdomen, this is why waist circumference is a helpful tool, in our organs – Non alcoholic Fatty liver disease, around our heart.


(Infographic courtesy of Ted Naiman (www.burnfatnotsugar.com)

If there is more glucose and fat in our diet than our body needs, the effort of keeping the fat in the cells requires a high baseline of insulin.

Eventually this situation can result in disease states such as Type 2 Diabetes. In type 2 diabetes the insulin we make is it isn’t very effective anymore and the tissues just don’t respond to it and we make more and more insulin to try an counteract this. We make lots of it hoping that more inuslin will make things better. It doesn’t.

So now in our blood stream we’ve got excess sugar that can’t get into the cells and excess fat thats leaking out of them – bad news. Energy substrates aren’t meant to be hanging around in our blood stream.

Insulin resistance and hyperinsulinamia are now understood to be a baseline, very important mechanistic cause of many chronic diseases and wellness issues – type 2 diabetes, dementia, cancer, heart disease, strokes, erectile dysfunctions, mood disorders, gut disorders, joint pain- the list goes on.

Different cells can have different amounts of insulin resistance. Your muscles cells are generally the starting place for issues. Once they start refusing glucose we have problems. One tissue can be more or less insulin resistant than another – all show up have differently in tests that we do, but all are caused but the same thing resulting in different diagnoses.

Your insulin resistance is directly related to the SIZE of your adipocytes (fat cells).  The fatter and more chock full your adipocytes are – the more insulin resistant you will get.

A subset of people can make more fat cells. Little tiny fat cells ready to accept all the excess energy that we don’t use. These people can create an incredible amount of XS fat stores without evidence of metabolic dysfunction, that is without the excess triglycerides and glucose stuck in the blood stream, without the ectopic fat stores around the organs or in the liver. These people are NOT most people.

Those of us that don’t make more fat cells try and jam the fat in the cells we already have and exhibit the signs of metabolic dysfunction or metabolic syndrome

Image

The Personal Fat Threshold is different for us all. Signs of metabolic syndrome means we are at it!

The fast road to reaching your personal fat threshold is eating a combination of processed carbs and processed fat.

These types of hyperpalatable foods are designed to make it hard to stop eating. They activate dopamine receptors making us feel good, and leave us wanting more – they cause swings in blood sugars resulting in lots of hunger and they switch off satiety centres so we just don’t feel full. The result is excess energy that we don’t need , with very little nutrient density. Some processed foods have been specifically designed with this is mind – see ‘The Dorito Effect’.

‘Keeping intake to levels that support exercise but not body fat’ as Crossfit HQ supports is the key but we need some help to understand how to actually do that!

It is incredibly difficult in the current environment that supports, encourages and subsidises a highly processed diet, where food is delivered to our doors, and we can spend days walking barely to the kitchen and back.

Succeeding in this environment has little to do with will power. Some may be able to track caloties and eat what ever they like IF IT FITS THEIR MACRO’s but in my experience that is super tough. Satiety will be your greatest enemy, will power fatigues.

There are tools that we can use to overcome this. Where knowledge becomes power.

Normal Pregnancy- A State of Insulin Resistance

Hyperglycaemia in critically ill patients, the immune systems sweet tooth.