Insulin Resistance & Metabolic Syndrome

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1 Insulin Resistance & Metabolic Syndrome How to effectively understand, reveal, and treat people with insulin resistance using blood tests, calipers, diet & exercise. Returning to the FatBack Diet Richard Maurer, ND How does insulin resistance look? At 45 years old your lifetime risk of developing DM2 is 8% if your baseline BMI below normal 14% if your baseline BMI low normal** 25% if your baseline BMI high normal** 45% if your baseline BMI slightly above normal 59% if your baseline BMI obese **1 in 3 with normal BMI will develop DM in life Based upon data from : Diabetes Care June 2007 vol. 30 no How does insulin resistance look? At 18-years old the lifetime risk of developing DM2 is 8% if your baseline BMI below normal 16% if your baseline BMI low normal* 28% if your baseline BMI high normal* 50% if your baseline BMI slightly above normal 68% if your baseline BMI obese *44% of Normal BMI teenagers are at risk of DM in life Based upon data from : Diabetes Care June 2007 vol. 30 no What causes Insulin Resistance (IR) Genes Take a good history! Different prevalence of diabetes in ethnic groups Type 2 diabetes in the direct family Adiposity Lifestyle Fitness Measurement of blood tests & body fat is critical Discussion of exercise habits Assess weight fluctuations throughout life What conditions result from IR Cardiovascular Disease Type 2 Diabetes Essential Hypertension Polycystic Ovarian Syndrome Non-alcoholic Fatty Liver Disease Some Cancers Tests for Metabolic Syndrome Liver Enzymes: AST/ALT should be <40 Fasting Blood Glucose: is optimal Fasting Serum Insulin: 3-8 is Optimal HgbA1C: Optimal is </= 5.5 Lipid Panel: Optimal TG:HDL is close to 1 1

2 Uric Acid: If >5.5, assume some insulin resistance CRP: Assesses generalized inflammatory burden Lipid Panel Triglyceride : HDL ratio A ratio of greater than 3 indicates metabolic syndrome. A ratio of less than 2 is normal A ratio of less than one implies insulin sensitivity A ratio of greater than 3 or 4 implies elevated insulin. Either fasting or post-prandial Hgb-A1C Look at the patient and lifestyle and diet then assess the A1C. Does it match what is expected? is normal. <5.5 is optimal indicates prediabetes >6.5 indicates diabetes Insulin Fasting Insulin: Should be between 3 and 8 If Elevated: Early Type 2 Diabetics are often >10. The body is trying to put the glucose away There will usually be excess torso/abdominal bodyfat storage Less than 3 implies a catabolic state. Seen in under-eating/anorexia/ overexercise/ or inappropriate Low carb dieting Kids during Growth Years are often >10 but <20. This is a normal response to promote growth. Glucose and Insulin HOMA-IR: Insulin Resistance value used in research settings. [Homeostatic Model Assessment of Insulin Resistance] Insulin x Glucose divided by 405 Reference range: Those greater than 2.8 are deemed insulin resistant. Practical values the closer to one the better Essentially as Glucose goes up the body s ability to respond to insulin is going down. Thus, resistance. Insulin and High Blood Pressure Insulin induces sodium retention at the Kidney Excess fluid retention follows Insulin has a role in storing magnesium Insulin Resistance results in Impaired Magnesium uptake into the cells. Low tissue magnesium causes tighter arteries - Increase in blood pressure When Insulin compensates upward Dyslipidemia TG elevations or Elevated TG:HDL ratios HDL-C LDL particle diameter: becoming small & dense They are then more vulnerable to oxidation Some degree of glucose intolerance abnormal fasting glucose abnormal post-meal glucose (GTT) 2

3 When Insulin compensates upward Elevation of Uric Acid Patients who have had an MI have higher uric acid Insulin prevents the removal of uric acid at the kidney Insulin affects the ovaries in women elevating testosterone Triggers infertility/physical changes/pcos Insulin alters sodium regulation at the kidney Indirectly increases blood pressure Assess Your Insulin-Gluc. Balance Goals in health, weight management, prevention of illness require an assessment for insulin responsiveness or resistance. Blood tests Past medical history Family history Body fat distribution "What gets measured gets managed Introduction to Body Fat Calipers Reason to use calipers Compares locations of body fat: Abdominal vs leg/arm Helps allocate importance of diet and exercise in order of importance Tracks compliance of diet separate from exercise Takes the emphasis off of the cursed scale Triceps body fat is greater Means Overall Metabolism is Slow/Efficient First, assure thyroid is well evaluated TSH & FT4 Anti-TPO Assess exercise log on a regular basis Assure very regular exercise with aerobic & anaerobic components Build a lifestyle of activity 10,000 steps perhaps Caliper measurement of Triceps To Correct Triceps Get Metabolism Moving 6 days per week Aerobic to 75% of maximum HR minutes duration Last 5-10 minutes of workout should be with an anaerobic push Weights, increased resistance of any kind OR Try lactic load workouts 3

4 Go until you can t Rest until you can. EXERCISE Why the anaerobic push?? In a 2006 study in Norway, found oxygen uptake doubled with higher intensity exercise for the same duration. The American Heart Association now states for those with Metabolic Syndrome Short bursts of high-intensity exercise, rather than longer spells of moderateintensity, exercise may improve the health of people with metabolic syndrome. Caliper measurement of Hip Body Fat is Greater in the Hip Assume excess Insulin Check Diet History carefully Ask about diabetes family history Assure a good run of blood tests to assess placement continuum of Insulin Resistance TG:HDL, Liver Enzymes, FBG, A1C, Fasting Insulin If Abdominal bodyfat is excess Emphasize dietary intervention first Low Glycemic Load Diet Low carbohydrate Note this does NOT mean whole grain White bread* 75±2 Whole wheat/whole meal bread 74±2 Moderate Protein High Fats Reduce alcohol intake Avoid artificially sweetened beverages Carbohydrate Intake The world is not a fair place The greater the insulin response to carbohydrate The greater the fatty weight gain The greater the insulin response to carbohydrate How do we then eat these necessary foods and not trigger insulin excess Four Insulin triggers in the diet 1. Carbohydrate intake 2. Protein (amino acid) intake Things that taste sweet Stretching the stomach Protein Intake As amino acids increase in the bloodstream: Insulin and Glucagon are secreted. Insulin lowers blood sugar and enhances the muscle uptake of amino acids Glucagon raises blood sugar in a presumed attempt to allow proteins to make tissue, while allowing the elevated glucose to be burned as energy post-meal In studies: just 25g of pure protein was enough for significant release of insulin 4

5 Protein Intake Diets that are greater than 50% protein are considered significantly high protein Diets that are about 25% - 30% protein are considered normal protein diets The world health organization considers about 15% as a basis requirement Overeating GASTRIC NEURO-HORMONAL RESPONSE The stomach has stretch receptors that signal hormone and digestive secretions and motility. One of the hormone secretions: Glucose-Dependent-Insulinotrophic Pepetide: GIP stimulates insulin secretion. Things that taste sweet It is not accidental that all phenomena of human life are dominated by the search for daily bread.... Precise knowledge of what happens to food entering the organism must be the subject of ideal physiology, the physiology of the future. Ivan Pavlov, Nobel Lecture, 12 December 1904 Things that taste sweet Over 100 years after Pavlov Eating artificially sweetened foods has been shown to cause increase total caloric intake Drinking artificially sweetened beverages is associated with obesity even when controlling for caloric differences It is postulated that Non-caloric sweet tasting foods and beverages cause a Pavlovstyle cephalic insulin response What s Left? If carbohydrates are best limited and protein shouldn t be over 30% of the dietary intake of calories WHAT IS LEFT? FATS Fats in the Diet? From WebMD Heartwire March 29 th, 2010 Dr Dariush Mozaffarian (Harvard University, Boston, MA) told heartwire... a recent meta-analysis of prospective epidemiologic studies showing that there was no significant evidence that dietary saturated fat is associated with an increased risk of coronary heart disease or cardiovascular disease [2]. Glycemic Index or Why the glycemic index of individual foods is moot The glycemic index of individual vs. meal-bound foods F:1 Glycemic index of single and mixed meal foods among common Japanese foods Conclusions about mixed meals on GI Among mixed meal foods, the combination of carbohydrate foods with vinegar, dairy 5

6 36 37 products, and bean products significantly decreased the GI value of white rice of 20-40%. Sugiyama M, Tang AC, Wakaki Y, Koyama W. Eur J Clin Nutr Jun;57(6): F:1 Barley Bread Containing Lactic Acid Improves Glucose Tolerance at a Later Meal in Healthy Individuals Conclusions about Lactic Acid: when the barley bread with lactic acid was given as a breakfast. At 45 min after the lunch meal, the insulin level was significantly lower (-21%, P = 0.045) after the lactic acid bread breakfast, Ostman EM, Liljeberg Elmstahl HG, Bjorck IM. J Nutr Jun;132(6): F:2 The glycemic index: importance of dietary fiber and non-glucose parts of a food Conclusions about Fiber Content: the higher dietary fiber content with low-gi foods add to the metabolic merits of a low-gi diet. An LGI barley (GI 53) meal rich in fiber improved gluc. tolerance from evening to breakfast, whereas an evening meal of pasta (GI 54) had no effect Bjorck I, Elmstahl HL. Proc Nutr Soc Feb;62(1):201-6 [Proceedings of the Nutrition Society] Note: This study indicates it is the SOLUBLE fiber F:3 Glycemic Index and Dietary Fat Stimulates the hormone cholecystokinin (CKK). CKK inhibits gastric activity, thereby allowing time for nutrients in the duodenum to be digested and absorbed without excessive stomach activity. Enhances pancreatic enzyme secretion and activity. Dietary Fat via CCK: Lower the glycemic index of the meal due to a slower pace of gastric emptying. Three F - Conclusions Fat- All foods should have their original fat content intact. Fiber meals should contain a fiber-rich food, preferably a concentrated (cooked) dark green vegetable Fermentation lactofermented food such as yoghurt and sauerkraut Thank You FatBackDiet.com --- CoastalNaturalHealth.com 6