Insulin Resistance and Type 2 Diabetes

What is Insulin Resistance?

There is no doubt that the level of type 2 diabetes has been increasing over the past 25 years or so. This situation, as it now stands is emerging as a major financial burden for our healthcare system, not to mention the general declining health of the people of our nation. Type 2 diabetes leads to systemic cardiovascular disease, high blood pressure, strokes and kidney failure. 

Initially, there are no outward signs of insulin resistance, but with time various metabolic adverse effects start to show up. Carbohydrates, especially in excessive amounts, are converted to fat, typically accumulating in the abdomen producing the classic "apple shape". High levels of insulin have adverse effects on the liver, which increases cholesterol and triglyceride levels. Insulin resistance, also known as metabolic syndrome, if not checked, will likely lead to type 2 diabetes

Too much sugar or too much fat?

Insulins role is to transport glucose into cells.  Insulin resistance comes about when levels of insulin are not high enough to shuttle glucose into the cells.  Persistently high levels of insulin over a prolonged period of time from eating too many sugary and carbohydrate foods leads to a decrease in the body’s sensitivity to insulin. 

On the other hand, some studies show that prolonged exposures to high amounts of fatty acids may lead to insulin resistance. Saturated fatty acids such as stearic and palmitic acid create oxidative stress, which modulate gene transcription and causes mitochondrial dysfunction and inflammation.  The beta cells of the pancreas increase the output of insulin in order to maintain a normal blood glucose, but eventually get burned out and unable to produce sufficient insulin.  At the same time, the insulin receptors on cell membranes become dulled and eventually stop responding to insulin.  The main source of saturated fats is red meat, but there is some in poultry especially the skin.

Probably the overall worst consequence of chronically elevated insulin is that it leads to chronic inflammation. Inflammation damages all bodily tissues and organs and is the underlying cause of many conditions such as cardiovascular disease, strokes, chronic renal disease, dementia and arthritis. 

Environmentally Induced?

At first glance, the exponential increase in type 2 diabetes would appear solely related to poor diet selection, weight gain and sedentary lifestyle. However, recent research has indicated that environmental toxins are also driving this increase. Persistent organic pollutants (POPs) include a multitude of toxic compounds that we all have been exposed to throughout our lifetime including organochlorine pesticides, dioxins, PCBs, food additives, plastic compounds, toxic metals and urban air pollution to name a few. Every patient I have tested has several types of toxic compounds stored in their body. Consider the correlation between type 2 diabetes and the introduction of GMO foods along with its partner Roundup (glyphosate) into our food supply.

For example, BPA is used to make certain plastics and epoxy resins used in a variety of common consumer goods including water and baby bottles, sports equipment, CDs, DVDs, sales receipts and the lining of food and beverage cans. People can absorb these compounds through food or the skin.

Animal studies have demonstrated exposures to POPs and BPA can induce diabetes and obesity. Human studies link higher levels of urinary BPA with an increase in diabetes and cardiovascular disease. Journal of the American Medical Association volume 300 No. 11, September 17, 2008.

If you want to prevent exposure, absorption and accumulation of BPA and other plastic compounds

  • Don't use plastic water bottles-use glass, porcelain or stainless-steel containers

  • Use BPA free baby bottles and sippy cups

  • Reduce your use of canned foods unless the liner is known to be BPA free

  • Minimally handle your sales receipts

  • If you can afford it, eat organic and less chemically contaminated and will foods as much as possible

Diets

The previously recommended low-fat-high carbohydrate diets for diabetes actually worsens insulin resistance. Instead, follow a moderately lower carbohydrate diet, focusing on low glycemic foods that are high in fiber. Eat at least 5 servings of non-starchy vegetables daily; try using vegetables with different colors. Have 1-2 servings of low glycemic fruits such as grapefruit, blueberries, cherries. A serving is only one-half cup. Choose healthy fats such as olive oil, nuts, avocados. Eat cold water fish such as wild Alaska salmon and sardines twice a week. Check out books on the Paleolithic, Mediterranean or Okinawa diet for menu plans, recipes etc.

Should I go on a ketogenic diet?

I would offer a cautionary opinion on the ketogenic diet. I think the ketogenic diet works great for weight loss, but long-term use can be risky since it has been reported to increase uric acid and cause high cholesterol and kidney stones, but I have other concerns. One is that metabolism of saturated fats involves an oxidative process that increases the production of free radicals and inflammatory mediators. That's why it's essential to eat sufficient fruits and vegetables to counteract the oxidative/inflammatory process. My other concern is high-protein meat-based diets can increase levels of homocysteine if you don't eat enough fruits and vegetables or are deficient in methylated B vitamins, especially if you have an MTHFR mutation. If you decide that keto is the way to go, you should monitor your oxidized cholesterol to be sure you are getting enough antioxidant protection and that your homocysteine level doesn't get too high.

What about exercise?

Exercise is essential to help reverse the adverse effects of insulin resistance.  Walking 30 minutes 5 days a week would be sufficient. Vigorous exercise 30-45 minutes 4-5 days a week would be even better.  Studies have shown that strength training a minimum of twice weekly is as good as aerobic exercise for improving insulin response.  You don't have to join a gym because you can see improvements with simple home exercises such as squats, pushups, coronary exercises and light weights. The combination of both aerobic and weight training would be best. 

Supportive Supplements

  • Resveratrol 500-2000 mg. Recent study showed that resveratrol improves insulin sensitivity and post meal glucose in patients with impaired glucose tolerance.  This was a convincing double-blind placebo-controlled study.  American Journal Clinical Nutr, 2014 June.

  • Berberine 500 mg 3 times a day. Studies have shown that compared to metformin berberine exhibited identical effects on the regulation of glucose metabolism.  Journal of Clinical Endocrinology Metabolism 2008; 93 (7).

  • Chromium picolinate 200-1000 µg daily-dose depending on how advanced the condition is. Diabetes Technological Therapeutic 2006 December 8 (6).

  • Alpha Lipoic Acid 600-1200 mg daily. Double blind placebo-controlled study documented decreased fasting glucose, hemoglobin A1c and lipid peroxidation in diabetic patients.  Benefits improved on dose-dependent manner.  Asia Pacific Journal Clinical Nutrition 2/1/12, 21 (1).

  • Coenzyme Q 10 100-300 mg

  • Magnesium glycinate 500-1000 mg daily; most people need more magnesium.

External Enhanced Counterpulsation

EECP stands for external enhanced counterpulsation. It is a safe noninvasive outpatient treatment for heart disease. It is used to treat both angina and heart failure. During EECP treatments blood pressure cuffs are wrapped around your legs, which squeeze and release in sync with your heartbeat. This promotes blood flow throughout your body particularly to the heart, where it bypasses blockages. 

A study published in the Journal of Applied Physiology (Volume 112, 5 March 2012, 68-876) was done to evaluate the effects of EECP on a group of type II diabetic patients. The controlled study specifically monitored glucose tolerance, fasting glucose, insulin levels, arterial function and capillary density in patients with abnormal glucose control. The results were quite impressive. The results showed that EECP therapy (35 sessions) did the following:

  • Lowered fasting glucose

  • Increased insulin sensitivity

  • Decreased markers of insulin resistance

  • Lowered plasma glucose after glucose tolerance testing

  • Muscle biopsies showed increased capillary density leading to improved blood flow

  • Increased plasma nitric oxide levels, which improves circulation

  • Decreased levels of lipid peroxides (free radicals)

  • Increased vascular endothelial growth factor, which creates new blood vessels

  • Increase in glucose transporter 4 protein expression (GLUT 4), which facilitates transport of glucose into cells

What Else Does EECP Do?

In my opinion, EECP is the ultimate in preventive health maintenance because of the incredible amount of its positive effects including:

  • Reduces arterial stiffness

  • Prevents plaque buildup

  • Strengthens the heart muscle

  • Inhibits development of arteriosclerosis

  • Improves exercise tolerance

  • Longevity-antiaging effect

  • Increases collateral circulation

  • Increase oxygen levels

  • Creates new blood vessels

  • Anti-inflammatory effect

  • Stimulates release of nitric oxide

  • Antioxidant effect

  • Improves kidney function

  • Entire vascular system treated- all organs

  • Improves blood flow to the brain

  • Increases blood vessel stem cell lines

  • Stress reduction

  • Decreases anxiety and depression.

  • Improves sleep

  • Detoxification effect

  • Increases lymphatic circulation

  • Noninvasive, totally safe

  • Scientifically sound and proven to work

  • Same benefits of one-hour aerobic exercise