Total and LDL cholesterol are a poor marker of cardiovascular health. The cholesterol profile of elevated triglycerides and low HDL is a more predictive marker of cardiac risk and a reliable marker of insulin resistance. In fact, the QRISK calculator, used to estimate the 10-year risk of CVD does NOT use LDL cholesterol but uses a total cholesterol/HDL ratio instead.

Preventing insulin resistance in young men would prevent 42% of myocardial infarctions, a larger reduction than correcting hypertension (36%), low high-density lipoprotein cholesterol (31%), body mass index (21%), or low-density lipoprotein cholesterol (16%).

Consumption of fat induces satiation and when compared to the other macronutrients such as protein and carbohydrates, and comparatively fat has the least impact on blood glucose and insulin production. Excessive insulin production and subsequent insulin resistance is the precursor to type 2 diabetes.

A meta-analysis of the evidence available prior to the 1977 US change in dietary guidelines did not support the dietary fat restrictions. Despite the lack of scientific consensus, these guidelines advised limiting total fat to 30% of calorie intake and saturated fat to 10% of calorie intake, creating the low fat craze and a national experiment on diet-induced metabolic dysfunction.

Chances are you already know that eating too much sugar isn’t good for you. Yet you’re probably still overdoing it. Sugary drinks, candy, baked goods, and sweetened dairy are the main sources of added sugar. Added sugars can be hard to spot on nutrition labels since they can be listed under a number of names, such as corn syrup, agave nectar, palm sugar, cane juice, or sucrose.No matter the name, sugar is sugar, and it can negatively affect your body in many ways. Here’s a closer look at how sugar can affect your health negatively.

What effect of sugar makes it harmful?

The amount of sugar a person should consume varies, depending on their sex and age. Sugar appears in our food in many forms, including sucrose, lactose, and fructose. Sweet as it is, it sometimes has a negative impact on our health. Let’s have a look at some of these:

1. Can Cause Weight Gain- Rates of obesity are rising worldwide and added sugar, especially from sugar-sweetened beverages, is thought to be one of the main culprits. Sugar-sweetened drinks like sodas, juices and sweet teas are loaded with fructose, a type of simple sugar.
2. Can drain your energy -Because your glucose levels spike and plummet, the unstable blood sugar can leave you experiencing mood swings, fatigue, and headaches. It also contributes to cravings, which begins the cycle of false hunger. By contrast, those who avoid sugar report having fewer cravings while feeling more emotionally balanced and energized.
3. Sugar affects cognition in children.-Let’s not forget about our little ones! When New York City public schools reduced the amount of sugar in their lunches and breakfasts, their academic ranking increased by 15.7% (previously, the greatest improvement ever is seen had been 1.7%).11 The study also eliminated artificial colors, synthetic flavoring, and two preservatives, showing the importance of natural ingredients for children.
4. Increases Your Risk of Type 2 Diabetes- There is a clear link between excessive sugar consumption and diabetes risk. Obesity, which is often caused by consuming too much sugar, is considered the strongest risk factor for diabetes.Additionally, prolonged high-sugar consumption drives resistance to insulin, a hormone produced by the pancreas that regulates blood sugar levels. Insulin resistance causes blood sugar levels to rise and strongly increases your risk of diabetes.
5. Your immune function can be affected by sugar.-As if being sick wasn’t bad enough, studies have shown that sugar can interfere with the way your body fights disease. Bacteria and yeast feed on sugar, so excess glucose in the body causes these organisms to build up and cause infections.
6. A high-sugar diet can lead to chromium deficiency.-Chromium, a trace mineral that helps regulate blood sugar in the body. While it can be found in meats, seafood, and plant foods, 90% of Americans still don’t get enough chromium because of refining searches.6 Other carbohydrates can also rob foods of their chromium supplies, so limiting your carbs is your best bet for increasing those mineral levels.
7. Sugar accelerates aging.-While you probably know that sugars can affect your body composition, they can also mess with your skin by contributing to wrinkles and sagging. After sugar hits your bloodstream, it attaches to proteins. The mix of these proteins with sugar causes the skin to lose elasticity and leads to premature aging.
8. Sugar causes tooth decay.-With all the other life-threatening effects of sugar, we sometimes forget the most basic cosmetic damage it does. When it sits on your teeth, sugar causes decay more efficiently than any other food.8 It’s important to brush your teeth at least twice a day to stop sugars from fueling plaque and bacteria.
9. Sugar can cause gum disease, which can lead to heart disease.-Increasing evidence shows that chronic infections, like those that result from dental problems, play a role in the development of heart disease. It is believed that a connection stems from the body’s inflammatory response to infection. Luckily, this works both ways. Maintaining a healthy lifestyle will decrease your risk of common illnesses, which reduces the chance that they’ll become a more serious condition later on.
10. Sugar takes the place of important nutrients.- According to USDA data, people who consume the most sugar have the lowest intakes of essential nutrients––especially vitamins A, C, B-12, and calcium. This is because the body needs these vitamins to process the sugar which results in the body using up its reserves and therefore “negative calories” and loss of vitamins occur.The trade-off is especially dangerous for children and teens, because they simultaneously consume the most sugar and need the most nutrients.
11. May Increase Your Risk of Heart Disease.-High-sugar diets have been associated with an increased risk of many diseases, including heart disease, the number one cause of death worldwide. Evidence suggests that high-sugar diets can lead to obesity, inflammation and high triglyceride, blood sugar, and blood pressure levels — all risk factors for heart disease.Additionally, consuming too much sugar, especially from sugar-sweetened drinks, has been linked to atherosclerosis, a disease characterized by fatty, artery-clogging deposits.
12. Can cause Acne. Foods with a high glycemic index, such as processed sweets, raise your blood sugar more rapidly than foods with a lower glycemic index. Sugary foods quickly spike blood sugar and insulin levels, causing increased androgen secretion, oil production, and inflammation, all of which play a role in acne development.
13. May Increase Your Risk of Cancer.-Eating excessive amounts of sugar may increase your risk of developing certain cancers.First, a diet rich in sugary foods and beverages can lead to obesity, which significantly raises your risk of cancer.Furthermore, diets high in sugar increase inflammation in your body and may cause insulin resistance, both of which increase cancer risk
14. Can Accelerate the Skin Aging Process.-Wrinkles are a natural sign of aging. They appear eventually, regardless of your health. However, poor food choices can worsen wrinkles and speed the skin aging process.
15. Increase kidney disease risk.-Having consistently high blood sugar levels can cause damage to the delicate blood vessels in your kidneys. This can lead to an increased risk of kidney disease.
16.  Increase the risk of developing gout. Gout is an inflammatory condition characterized by pain in the joints. Added sugars raise uric acid levels in the blood, increasing the risk of developing or worsening gout.
17. Accelerate cognitive decline: High-sugar diets can lead to impaired memory and have been linked to an increased risk of dementia.

How can you reduce your sugar intake?

Because excessive added sugar has many negative health effects and consuming small amounts now and then is perfectly healthy, you should try to cut back on sugar whenever possible. Simply focusing on eating whole, unprocessed foods automatically decreases the amount of sugar in your diet has huge gains.

Tips on how to reduce your intake of added sugars:

• Swap sodas, energy drinks, juices and sweetened teas for water or unsweetened seltzer.
• Drink your coffee black or use Stevia for a zero-calorie, natural sweetener.
• Sweeten plain yogurt with fresh or frozen berries instead of buying flavored, sugar-loaded yogurt.
• Consume whole fruits instead of sugar-sweetened fruit smoothies.
• Replace candy with a homemade trail mix of fruit, nuts and a few dark chocolate chips.
• Use olive oil and vinegar in place of sweet salad dressings like honey mustard.
• Choose marinades, nut butter, ketchup and marinara sauce with zero added sugars.
• Look for cereals, granolas and granola bars with under 4 grams of sugar per serving.
• Swap your morning cereal for a bowl of rolled oats topped with nut butter and fresh berries, or an omelet made with fresh greens.
• Instead of jelly, slice fresh bananas onto your peanut butter sandwich.
• Use natural nut butter in place of sweet spreads like Nutella.
• Avoid alcoholic beverages that are sweetened with soda, juice, honey, sugar or agave.
• Shop the perimeter of the grocery store, focusing on fresh, whole ingredients.
• Eating fruit can help ensure a person gets enough fiber, vitamins, and minerals. However many fruits are high in natural sugars and may not be suitable for those looking to lower their sugar intake. Some low-sugar fruits include strawberries, peaches, blackberries, lemons, limes, honeydew melon, oranges, and grapefruit.

Should we stop taking sugar?

Sugar is not unhealthful in itself. However, having excess sugar in the diet can cause a range of conditions, including heart disease, weight gain, and diabetes. To be aware of added sugars in food products, it is important to read labels carefully. Also, eliminating sugar from the diet can help prevent weight gain, diabetes, heart disease, and other problems. For these reasons, added sugar should be kept to a minimum whenever possible, which is easy when you follow a healthy diet based on whole foods.

If you need to cut added sugar from your diet, try some of the small changes listed above. You will slowly realize that you don’t need as much sugar as you once did.

References

Healthline(2018):11 Reasons Why Too Much Sugar Is Bad for You. Retrieved from https://www.healthline.com/nutrition/too-much-sugar#section2
Atkins (2019): 10 Reasons Why Sugar Is Bad for Your Health, Retrieved from https://www.atkins.com/how-it-works/library/articles/10-ways-sugar-harms-your-health
WebMD: How Does Too Much Sugar Affect Your Body? Retrieved from https://www.webmd.com/diabetes/features/how-sugar-affects-your-body
Medical News Today (2019): 5 reasons why sugar is bad for you. Retrieved from https://www.medicalnewstoday.com/articles/324854.php

Insulin is a vital hormone that controls the levels of sugar in our bodies. In a nutshell, it removes excess glucose from the blood through a process known as glycogenesis.

However, problems with insulin are at the heart of many medical conditions. Insulin resistance occurs when your cells stop responding to insulin. This means that the effects of insulin cannot be appreciated leading to a buildup of sugar in the bloodstream. About 100 million Americans are affected by insulin resistance. Fortunately,   dietary and lifestyle changes can dramatically improve this condition.

This article explains all you need to know about insulin and insulin resistance.

What Is Insulin?

Insulin is a hormone that is produced by beta cells in the pancreas. Its main function is to regulate the amount of glucose circulating in your bloodstream. However, it also affects fat and protein metabolism. When you eat a slice of bread, which definitely contains carbohydrates, the amount of sugar in your blood increases. Consequently, the beta cells in your pancreas are stimulated to produce insulin. The insulin is released to your bloodstream, where it removes the sugar and stores it in cells. This process results in reduced blood sugar levels.

However, cells sometimes become less sensitive to insulin. When this happens, sugar begins to build up in the bloodstream. Your pancreas produces even more insulin to lower the blood sugar levels. This leads to high insulin levels in your blood, which is referred to as hyperinsulinemia.

Diabetes type 2 occurs when your cells become increasingly resistant to insulin, resulting in a rise in both insulin and blood sugar levels. If this persists for long, your beta cells may become damaged, leading to decreased insulin production.

Insulin resistance is the main cause of type 2 diabetes.

What About Insulin Sensitivity?

Insulin sensitivity is just the opposite of insulin resistance. When you have insulin resistance, it also means that you have low insulin sensitivity. While insulin resistance is harmful to your health, insulin sensitivity is beneficial.

What Causes Insulin Resistance?

Insulin resistance is caused by many factors.

A number of studies have shown that high amounts of free fatty acids in your blood can cause insulin resistance. This is caused by eating too many calories. Being overweight or obese is also linked to insulin resistance. Visceral fat that mostly accumulates around your waist can release free fatty acids into your blood and trigger inflammation. However, even people with moderate weight can develop insulin resistance, possibly due to genetic predisposition.

Other possible causes of insulin resistance include:

• High sugar diet. Artificial sugars have been linked to inflammation and insulin resistance.
• Inactivity. Regular physical activity can reduce insulin resistance by stimulating weight loss.
• Gut microbiota. A disruption in the bacterial environment of your digestive system can cause inflammation and insulin resistance.
• Genetic factors: African American, Hispanic, and Asian peoples are at higher risk for insulin resistance.

What Are The Complications Of Insulin Resistance?

Insulin resistance is the precursor for diabetes type 2 and metabolic syndrome. Metabolic syndrome is a group of risk factors associated with type 2 diabetes and heart disease.

By the time a person is diagnosed with type 2 diabetes, they are likely to have developed chronic insulin resistance. It is estimated that by the time a diagnosis is made, 50% of insulin-producing cells may have lost function. This means that the person is not only resistant to insulin, but they are also unable to produce adequate amounts of insulin.

Insulin resistance is also strongly associated with heart disease, which is the leading cause of death in the US.

Other diseases linked to insulin resistance include:

• Non-alcoholic fatty liver disease (NAFLD)
• Cancer
• Polycystic ovarian syndrome (PCOS)
• Alzheimer’s disease

How To Reduce Insulin Resistance

Weight loss is one of the most effective ways of reducing insulin resistance. Making drastic dietary changes is also necessary so that you are consuming more of the beneficial foods and less of the harmful ones. Exercise also helps to shed off extra weight and maintain health. Lastly, doing away with harmful habits such as smoking and excessive drinking also plays a significant role.

• Engage in regular exercise such as brisk walking or jogging for 30 minutes each day.
• Lose belly fat
• Stop smoking
• Reduce intake of artificial sugar, such as from artificially sweetened beverages
• Increase intake of omega-3 fatty acids

For more on improving insulin sensitivity with dietary changes, read our previous article here.

The bottom line

Insulin resistance is responsible for a number of chronic health complications. Often it can go on undetected for a number of years without causing alarm. When insulin resistance is not detected early enough, it is likely to wreck a person’s health. Fortunately, a number of things can be done to prevent or stop the progression of insulin resistance. If insulin resistance can be prevented we will definitely have millions of people living healthier and more fulfilled lives that are free of disease.

References

1.   NCBI (2005): Dose-response effect of elevated plasma free fatty acid on insulin signaling. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15919784

2.   CDC (2017): New CDC report: More than 100 million Americans have diabetes or prediabetes. Retrieved from https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html

3.   NCBI (2005): Dose-response effect of elevated plasma free fatty acid on insulin signaling. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15919784

4.   NCBI (2013): The Role of Gut Microbiota on Insulin Resistance. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705322/

Flour is hard to avoid during meal times. Breakfast options mainly consist of toast, bagels, cereal, and pancakes. A convenient lunch is sandwiches, wraps, pasta or pizza. Dinner might come with its own temptations too. As a result, the average American now eats 10 servings of refined grains each day. What effect do these refined grains have on your health? Do consuming refined grains predispose you to Type 2 Diabetes? In this article, we will have a look at factors that could put you at risk.

1. What Is the Difference Between Whole Grains and Refined Grains?

While whole grains are very high in dietary fiber, refined grains are much lower in fiber and micronutrients.

Whole grains consist of three main parts:

1. Bran: The hard outer layer, containing fiber, minerals and
2. Germ: The nutrient-rich core, containing carbs, fat, protein, vitamins, minerals, antioxidants and plant compounds.
3. Endosperm: The middle layer, containing mostly carbs and small amounts of protein.

The bran and germ are the most nutritious parts of whole grains. They contain high amounts of many nutrients, such as fiber, B vitamins, iron, magnesium, phosphorus, manganese, and selenium.

During the refining process, the bran and germ are removed, along with all the nutrients they contain. Removing the nutrients from the grain has implications. On the upside, it makes things like bread doughy and spongy — textures we like and have come to crave. On the downside, the nutritional value of the food is severely compromised, and these striped grain products actually deplete our body’s reserves of important vitamins and minerals.

The nutrient content of refined flour is determined by the ‘extraction rate’ (the proportion of the grain retained after milling). Refined flour produced in Australia is milled to an extraction rate of 78-80% resulting in higher nutrient content (prior to fortification) than flour produced in countries using a lower extraction rate (e.g. 73-75% in the USA).

This leaves almost no fiber, vitamins or minerals in the refined grains. What’s left is rapidly digested starch with small amounts of protein.

2. What are the effects of consuming refined grains on our health?

• Blood sugar spikes: Because flour is easily digestible, it causes our blood sugar to spike, which could lead to a rise in insulin. The pancreas has to crank out a lot of insulin to metabolize the glucose in flour-rich foods, which can set the body up for insulin resistance, diabetes, and bodywide inflammation.Refined grains have a higher glycemic index, which is how quickly the body turns food into fuel or glucose.  A carbohydrate in wheat, called amylopectin A, is more easily converted to blood sugar than most other carbohydrates. Two slices of bread made with whole-wheat flour could raise blood sugar higher than six teaspoons of table sugar and higher than many candy bars.

• Overeating and Obesity: Obesity is the leading factor in Insulin resistance, Type 2 diabetes, and other chronic diseases. Eating too many refined carbs may be one of the main culprits. As they are low in fiber and digested quickly, eating refined carbs can cause major swings in blood sugar levels. This can contribute to overeating.
• As we have discussed above, foods high on the glycemic index promote short-term fullness, lasting about one hour. On the other hand, foods that are low on the glycemic index promote a sustained feeling of fullness, which lasts about two to three Blood sugar levels drop about an hour or two after eating a meal high in refined carbs. This promotes hunger and stimulates parts of the brain associated with reward and craving.
• These signals make you crave more food, and are known to cause overeating. This constant eating leads to obesity, a pre-diabetic state, and eventual diabetes.
• Slower Metabolism: Research shows that the body may shift nutrients into fat storage and away from muscle burning in the presence of high-glycemic-index foods. In 2004, Ludwig and his colleagues at Harvard conducted a study, published in the journal Lancet, in which they fed rats diets with identical nutrients, except for the type of starch. By the end of the study, rats in both groups weighed roughly the same, but those eating a high-glycemic diet had 71 percent more fat than the low-glycemic-index group.
• Inflammation: A diet high in grains stokes inflammation. When blood sugar spikes, glucose builds up in the blood. When glucose drifts in the blood, it could attach itself to nearby proteins. The result is a chemical reaction called glycation, a pro-inflammatory process that plays a role in a host of inflammatory diseases — everything from Type 2 diabetes to arthritis to heart disease.
• GI Disorders: Studies show that the lectins in grains inflame the lining of the gut and create fissures between cells. Also, when whole-kernel grains are refined, 80 percent of the fiber is lost, and gut health suffers. Without the fiber, you end up with rapid-release carbs in these grains, which is a bad thing for the gut. Fiber helps sweep the gut of debris and supports the body’s critically important elimination and detoxification processes, which also play a role in keeping high cholesterol and inflammation at bay.
• Food Allergies/Intolerances: Wheat, in particular, is one of the biggest dietary triggers of food allergies and intolerances. While the exact reason is unclear, many experts blame the higher gluten content of modern wheat varieties. A type of protein found in many grains, including wheat, gluten gives dough elasticity, trapping air bubbles and creating a soft texture. Because soft is considered desirable, wheat today is bred to have more gluten than ever before.
• Acid-Alkaline Imbalance: The body has an elaborate system of checks and balances to keep its pH level at a steady 7.4. A diet high in acidic foods, such as grains, forces the body to pull calcium from the bones to keep things on an even keel. When researchers looked at how the diets of more than 500 women affected their bone density, they found that a diet high in refined grains, among other nutrient-poor foods, was linked to bone loss. A highly acidic diet also chips away at our cellular vitality and immunity in ways that can make us vulnerable to chronic disease. Grains are the only plant foods that generate acidic byproducts. Wheat, in particular, is among the most potent sources of sulfuric acid, a powerful substance that quickly overcomes the neutralizing effects of alkaline bases.

3. How can we have grains in their most healthy form?

Whole grains deliver fiber, healthy fats, vitamins, minerals, plant enzymes and hundreds of phytochemicals. For those seeking a dense source of carbohydrate energy, they can be a healthy choice — but only if they are unrefined and minimally processed. Here are a few steps toward upgrading your own grain options:

• Choose whole-kernel grains when possible.
• Try sprouted grains.
• While baking, replace part of the flour with nut or seed meals.
• Stick with truly whole-grain flours.
• Don’t overdose on gluten-free foods.
• Try going flour-free.
• Consider a grain sabbatical.

4. Are refined grains a culprit in Insulin resistance and Type 2 Diabetes?

When ground into flours, most grains act like sugar in the body, triggering weight gain, inflammation, and blood-sugar imbalances. Studies show that high consumption of refined carbs is linked with insulin resistance and high blood sugar levels. These are some of the main symptoms of type 2 diabetes.

Refined carbs also increase blood triglyceride levels. This is a risk factor for both heart disease and type 2 diabetes. It is therefore advisable to keep our refined grain consumption at a minimum and if we do indulge, check that what we are having is fortified.

References

1. Grains & legumes Nutrition Council (2019): Refined grains. Retrieved from https://www.glnc.org.au/grains/grains-and-nutrition/refined-grains/

2. NCBI (2002): Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11976158

3. Popsugar (2019): 4 Reasons to Eat Whole Grains Instead of Refined. Retrieved from https://www.popsugar.com/fitness/Why-You-Should-Eat-Whole-Grains-Instead-Refined-18361716

4. Healthline (2017): Why Refined Carbs Are Bad For You. Retrieved from https://www.healthline.com/nutrition/why-refined-carbs-are-bad

5. Experience Life (2019): The Truth about Refined Grains. Retrieved from https://experiencelife.com/article/the-truth-about-refined-grains/

In previous articles, I have discussed the role of metabolic Inflammation in obesity and diabetes. Today, we will narrow down to the specifics of what insulin resistance is, its effects and how metabolic inflammation increases the chances of one developing it.

1. What is Insulin resistance?

Approximately 30% of Americans, and up to 50% in the 60 years and over the bracket, have a silent blood sugar problem known as insulin resistance. Insulin resistance increases the risk for prediabetes, Type 2 diabetes and a host of other serious health problems, including heart attacks, strokes, and cancer.

What therefore is Insulin Resistance? It is when cells in your muscles, body fat and liver start repelling or ignoring the signal being sent out by the hormone, insulin—which is to take glucose from the bloodstream into our cells for breakdown or storage. Glucose, commonly called blood sugar, is the body’s main source of fuel.

1. How does Insulin Resistance Develop?

Some factors that determine insulin resistance are aging and ethnicity but the driving forces seem to be excess body weight, too much belly fat, a lack of exercise, smoking, and even sleep depravity.

With time, and as the insulin resistance develops, more insulin is produced by your body as it tries to fight back. After an accumulated period of time, several years even, the beta cells in your pancreas get worn out because of all the extra work and can no longer keep pace with the increased demand for insulin. Then – years after insulin resistance stealthily started – your blood sugar may spike and you may manifest prediabetes or type 2 diabetes. You are also at risk of developing the non-alcoholic fatty liver disease (NAFLD), a condition that increases your risk for liver damage and heart disease.

2. What are the Signs and Symptoms of Insulin Resistance?

Insulin resistance does not always manifest to the naked eye but here are some signs to look out for:

• A large waist. Experts say the best way to tell whether you’re at risk for insulin resistance involves a tape measure and moment of truth in front of the bathroom mirror. A waist that measures 35 inches or more for women, 40 or more for men (31.5 inches for women and 35.5 inches for men if you’re of Southeast Asian, Chinese or Japanese descent)6 increases the odds of insulin resistance and metabolic syndrome, which is also linked to insulin resistance.
• You have additional signs of metabolic syndrome. According to the National Institutes of Health, in addition to a large waist, if you have three or more of the following, you likely have metabolic syndrome, which creates insulin resistance.
• High triglycerides. Levels of 150 or higher or taking medication to treat high levels of these blood fats.
• Low HDLs. Low-density lipoprotein levels below 50 for women and 40 for men – or taking medication to raise low high-density lipoprotein (HDL) levels.
• High blood pressure. Readings of 130/85 mmHg or higher, or taking medication to control high blood pressure
• High blood sugar. Levels of 100-125 mg/dl (the prediabetes range) or over 125 (diabetes).
• High fasting blood sugar (or you’re on medicine to treat high blood sugar). Mildly high blood sugar may be an early sign of diabetes.
• You develop dark skin patches. If insulin resistance is severe, you may have visible skin changes. These include patches of darkened skin on the back of your neck or on your elbows, knees, knuckles or armpits. This discoloration is called acanthosis nigricans.8

3. Chronic low-grade inflammation and the development of insulin resistance

As early as the 1950’s, there was epidemiological evidence suggesting a correlation between inflammation and insulin-resistant states such as obesity, but the mechanistic links were unknown. In the last decade, however, it has become increasingly evident that obesity and the concomitant development of inflammation are major components of insulin resistance. Studies in human obesity and insulin resistance have revealed a clear association between the chronic activation of pro-inflammatory signaling pathways and decreased insulin sensitivity. For example, elevated levels of tumor necrosis factor-α (TNF), interleukin-6 (IL-6) and interleukin (IL-8) have all been reported in various diabetic and insulin-resistant states. In addition, the inflammatory marker C-reactive protein (CRP), a non-specific acute phase reactant, is commonly elevated in human insulin-resistant states. Also, experiments in naturally occurring rodent models of obesity, knockout and transgenic mice, as well as detailed studies of insulin signaling at the molecular level have begun to elucidate the mechanistic links between obesity-induced inflammation and insulin-resistant states.

4. What Health Conditions are Related to Insulin Resistance?

An estimated 87 million American adults have prediabetes; 30-50% will go on to develop full-blown type 2 diabetes. In addition, up to 80% of people with type 2 diabetes have NAFLD. But those aren’t the only threats posed by insulin resistance.

Thanks to years of high insulin levels followed by an onslaught of cell-damaging high blood sugar, people with insulin resistance, prediabetes, and type 2 diabetes are at high risk for cardiovascular disease. Insulin resistance doubles your risk for heart attack and stroke – and triples the odds that your heart attack or ‘brain attack’ will be deadly, according to the International Diabetes Federation.

Meanwhile, insulin resistance and metabolic syndrome are also linked with higher risk for cancers of the bladder, breast, colon, cervix, pancreas, prostate and uterus.11, 12  The connection: High insulin levels early in insulin resistance seem to fuel the growth of tumors and to suppress the body’s ability to protect itself by killing off malignant cells. 13

Research has also found a strong association between insulin resistance and memory function decline, increasing the risk of Alzheimer’s disease.

5. Can understand the causes of Insulin Resistance aid in future preventive approaches?

As obesity-associated chronic low-grade inflammation is responsible for the decrease of insulin sensitivity, obesity is a major risk factor for insulin resistance and related diseases such as type 2 diabetes mellitus and metabolic syndromes. The state of low-grade inflammation is caused by over-nutrition which leads to lipid accumulation in adipocytes.

Obesity might increase the expression of some inflammatory cytokines and activate several signaling pathways, both of which are involved in the pathogenesis of insulin resistance by interfering with insulin signaling and action. It has been suggested that specific factors and signaling pathways are often correlated with each other; therefore, both of the fluctuations of cytokines and the status of relevant signaling pathways should be considered during studies analyzing inflammation-related insulin resistance.

References

1. NCBI (2007): Inflammation and Insulin Resistance. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2246086/
2. Scientific American(2009): Does Inflammation Trigger Insulin Resistance and Diabetes? Retrieved from https://www.scientificamerican.com/article/inflammatory-clues/

3. NCBI (2006): Inflammation and Insulin Resistance. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1483173/
4. org (2008): Skeletal muscle insulin resistance: role of inflammatory cytokines and reactive oxygen species. Retrieved from https://www.physiology.org/doi/full/10.1152/ajpregu.00561.2007
5. Hindawi (2015): Mechanisms Linking Inflammation to Insulin Resistance. Retrieved from https://www.hindawi.com/journals/ije/2015/508409/

6. Endocrineweb(2019): Insulin Resistance Causes and Symptoms. Retrieved from https://www.endocrineweb.com/conditions/type-2-diabetes/insulin-resistance-causes-symptoms

The modern diet contains a large number of simple sugars. From bread to donuts, to carbonated drinks to chocolate, cookies, and candy, everywhere you look, temptation abounds. The potential impact on the health of diets rich in free sugars, and particularly fructose, is of major concern. Does the sugar we take have an impact on insulin resistance and obesity? In this article, we look at this risk and the effects of insulin resistance.

1. Sugar and Insulin resistance….

Sugar has a bittersweet reputation when it comes to health. It occurs naturally in all foods that contain carbohydrates, such as fruits and vegetables, grains, and dairy. Consuming whole foods that contain natural sugar is safe. Plant foods also have high amounts of fiber, essential minerals, and antioxidants, and dairy foods contain protein and calcium.

Where does the problem with sugar come about? Added sugar, which is usually extracted or synthesized ……

There is plenty of evidence to suggest that consuming too much sugar can have a negative effect on our metabolic health. Regular sugar consumption produces a constant release of the hormone insulin. Over a period of time, it can lead to serious problems, such as the synthesis of triglycerides, insulin resistance, fatty liver disease, type II diabetes, an increase in very-low-density lipoprotein (the bad kind of cholesterol), and the accumulation of fat on all tissues.

Added sugar intake may contribute to and certainly does exacerbate insulin resistance. For example, added sugar intake is associated with higher blood pressure, inflammation, weight gain, fatty liver disease, health issues that can lead to insulin resistance, and further exacerbation of these issues. Added sugars cater to particularly energy-hungry but metabolically inefficient cells, including senescent cells, cancerous cells, and even quickly proliferating pathogenic bacteria in the gut.

Several genetic and lifestyle factors can contribute to how likely you are to develop insulin resistance. But even if you have a genetic risk, you can help yourself with regular exercise, a balanced diet, avoidance of added dietary sugars, healthy sleep patterns, and stress reduction activities.

Risk factors for insulin resistance and prediabetes include:

• Obesity
• Aging
• physical inactivity
• high cholesterol
• blood pressure
• sleep disorders or circadian rhythm disruption

It is said that one in three Americans—including half of those age 60 and older— have insulin resistance.

2. What exactly is Insulin Resistance?

Insulin resistance is when cells in your muscles, body fat, and liver start resisting or ignoring the signal that the hormone insulin is trying to send out—which is to grab glucose out of the bloodstream and put it into our cells. Glucose, also known as blood sugar, is the body’s main source of fuel. We get glucose from grains, fruit, vegetables, dairy products, and drinks that bring break down into carbohydrates.

3. How does Insulin Resistance develop?

While genetics, aging, and ethnicity play roles in developing insulin sensitivity, the driving forces behind insulin resistance include excess body weight, too much belly fat, a lack of exercise, smoking, and even not getting enough sleep.

As insulin resistance develops, your body fights back by producing more insulin. Over months and years, the beta cells in your pancreas have been working so hard to make insulin get worn out and can no longer keep pace with the demand for more and more insulin. Then – years after insulin resistance silently began – your blood sugar may begin to rise, and you may develop prediabetes or type 2 diabetes. You may also develop non-alcoholic fatty liver disease (NAFLD), a growing problem associated with insulin resistance that boosts your risk for liver damage and heart disease.

4. What are the Signs and Symptoms of Insulin Resistance?

Insulin resistance can be triggered by a combination of factors linked to weight, age, genetics, being sedentary, and smoking.

– Polycystic ovary syndrome (PCOS): Insulin resistance can worsen the symptoms of PCOS, which can include irregular menstrual cycles, infertility, and periods that cause pain.

– A large waist. Experts say the best way to tell whether you’re at risk for insulin resistance involves a tape measure and a moment of truth in front of the bathroom mirror. A waist that measures 35 inches or more for women and 40 or more for men (31.5 inches for women and 35.5 inches for men if you’re of Southeast Asian, Chinese, or Japanese descent) increases the odds of insulin resistance and metabolic syndrome, which is also linked to insulin resistance.

– You have additional signs of metabolic syndrome. According to the National Institutes of Health, in addition to a large waist, if you have three or more of the following, you likely have metabolic syndrome, which creates insulin resistance.

• High triglycerides. Levels of 150 or higher, or taking medication to treat high levels of these blood fats.
• Low HDLs. Low-density lipoprotein levels below 50 for women and 40 for men – or taking medication to raise low high-density lipoprotein (HDL) levels.
• High blood pressure. Readings of 130/85 mmHg or higher or taking medication to control high blood pressure
• High blood sugar. Levels of 100-125 mg/dl (the prediabetes range) or over 125 (diabetes).
• High fasting blood sugar (or you’re on medicine to treat high blood sugar). Mildly high blood sugar may be an early sign of diabetes.

– Acanthosis nigricans: This skin condition can develop in people with insulin resistance. It involves dark patches forming on the groin, armpits, and the back of the neck.

5. What health conditions are related to Insulin Resistance?

The most common health condition related to Insulin Resistance is prediabetes and the resultant Type 2 Diabetes. Insulin resistance also doubles your risk for heart attack and stroke – and triples the odds that your heart attack or ‘brain attack’ will be deadly.
Insulin resistance and metabolic syndrome are also linked with a higher risk for cancers of the bladder, breast, colon, cervix, pancreas, prostate, and uterus. This is because the high insulin levels early in insulin resistance seem to fuel the growth of tumors and suppress the body’s ability to protect itself by killing off malignant cells.

Furthermore, research has found a strong association between insulin resistance and memory function decline, increasing the risk of Alzheimer’s disease.

6. Can you prevent or reverse insulin resistance?

The good news is that, yes, insulin resistance can be prevented and also reversed in some cases. Here is what you can do:

• Get recommended amounts of physical activity and structured exercise
• Get adequate sleep
• eat when the sun is up(we are more insulin resistant at night and after a night of poor sleep, due to disrupted circadian rhythms that help regulate our metabolic state)
• Reducing stress and, therefore stress-related inflammation
• Maintaining a healthy weight
• Increasing your plant fiber intake.

All of the above can help improve your insulin sensitivity. It has been shown that combining both diet and exercise have the most impact on insulin sensitivity.

In a fascinating University of New Mexico School of Medicine, study published in the International Journal of Obesity, overweight people who lost 10% of their weight through diet plus exercise saw insulin sensitivity improve by an impressive 80%. Those who lost the same amount of weight through diet alone got a 38% increase. And those who simply got more exercise, but didn’t lose much weight, saw almost no shift in their level of insulin resistance.

Intermittent fasting is also another way in which you can reverse your insulin resistance. This is because it gives your body a break from insulin and glucose signaling pathways that promote cell proliferation and inflammation and may help increase insulin sensitivity.

7. What, therefore, is the relationship between sugar and Insulin Resistance?

There is an association between diets high in sugars (predominantly sucrose) and the risk of disease, and experimental studies have shown that high intakes of fructose (over 100 g/d) can reduce insulin sensitivity. However, somewhat lower intakes may affect serum TG. The mechanisms for such associations or effects have not been convincingly demonstrated.

References:

1. NCBI (2016): A review of recent evidence relating to sugars, insulin resistance, and diabetes. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5174139/

2. Endocrineweb (2019): Insulin resistance causes and symptoms. Retrieved from https://www.endocrineweb.com/conditions/type-2-diabetes/insulin-resistance-causes-symptoms

3. Medical News Today (2019): What to know about insulin resistance. Retrieved from https://www.medicalnewstoday.com/articles/305567.php

4. The Sugar Movement (2016): Sugar vs Fat. Retrieved from https://thatsugarmovement.com/sugar-vs-fat/

5. Harvard Health Publishing (2017): The sweet danger of sugar. Retrieved from https://www.health.harvard.edu/heart-health/the-sweet-danger-of-sugar

6. NCBI (2014): Weight Loss, Exercise, or Both and Cardiometabolic Risk Factors in Obese Older Adults: Results of a Randomized Controlled Trial https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835728/

We have extremely limited glucose storage as glycogen, or as circulating glucose.

Glycogen:

Glycogen is a large branched polymer of glucose, stored mainly in the liver and the skeletal muscle.  Stored  glycogen can be mobilized to circulating glucose during fasting periods and to the muscle cells during muscle contraction, a process called glycogenolysis.  The total body glycogen storage capacity, in a fasted healthy 70kg human, is  100 g in the liver, and 400 g in the muscle.  The total available calorie output from glycogen reserves is approximately 2,000 calories.

Circulating glucose:

Our blood stream normally carries less than 1 1/2 teaspoons of circulating glucose at any given time (less than 5 g of glucose circulates in the blood of a 70kg human).  The total available calorie output from circulating glucose is 20 calories.

The exact circulating glucose calculation:

Average blood volume for an adult is 70ml/kg.
Assuming a 70kg male=4,900 ml=49 dl or 4.9l
1 liter is 10dl, therefore we have 50dl.
A nondiabetic glucose concentration is <100mg/dL.
Therefor 100mg/dl multiplied by 49dl equals 4900mg of circulating glucose.
4900mg equals 4.9 g of circulating glucose, where each tsp =4.2gm
Total circulating glucose=1.16tsp

As a comparison, 1 gummy bear contains 1.3g of usable sugar.  Consuming 4 gummy bears could double the available circulating glucose, but for the fact insulin rapidly shuttles the glucose out of the circulation and into fat stores.

We have nearly unlimited fat storage capacity, and the primary role of insulin is to remove circulating glucose and convert it to fat storage.  Circulating glucose rapidly oxidizes, undergoing a non-enzymatic Maillard reaction, which results in spontaneous glycation, which we measure as HgBA1C.  The Maillard reaction was initially used to describe the browning and crisping of bread.  This glycation effect changes the cell membranes to a less fluid status, interferes with protein and enzyme function, and often deforms receptor and channels.  The end result of excessive glucose is sticky and nonfunctional cells.

Other advanced glycation end-products are measured as fructosamine.  Excessive circulating glucose is also rapidly excreted through the kidney above levels of 180 mg/dl, creating excessive urination or polyuria.  Glucose metabolism is tightly regulated because it can quickly oxidize and damage cell walls, wreaking havoc on our enzymatic pathways.

What is glycemic index?

How Much Sugar Can My Body Handle? – Reversing Diabetes
The GI assigns a score to how quickly glucose from a specific food enters the bloodstream.  Foods are ranked on a scale of 0 to 100, with glucose having a value of 100. The lower a food’s glycemic index, the slower the blood sugar rises after eating that food. In general, cooking and processing foods makes the GI higher for that food. The higher the GI of a food, the greater the insulin release, and therefore the greater the conversion of circulating glucose to fat storage.

The rate of rise and peak glucose concentration after a meal is often expressed as Glycemic Index (GI).

Glycemic load (GL) measures both how quickly glucose enters the bloodstream (GI) and how much glucose per serving is present. Glycemic Load (GL) is a calculated number and gives a patient a better idea of the effect of a particular food based upon the typical serving size. Watermelon has a high glycemic index of 80,  but a serving of watermelon has so little carbohydrate, that its total glycemic load is only 5.

When glucose levels drop, insulin production also drops, resulting in a conversion of stored fat to circulating ketone bodies and circulating triglycerides.  Circulating ketone bodies are a fuel source, akin to glucose, that do not require insulin to access the cells.

The point of the discussion is that we have extremely limited circulatory capacity for glucose, about 5g glucose or about 20 calories only.  Our constant consumption of processed carbohydrate rich food is inconsistent with our human physiology; which attempts to quickly removes glucose out of circulation to prevent tissue damage.  The constant high exposure eventually overwhelms our clearance capacity, leading to metabolic inflammation, and eventual diabetes.

Wasserman D. H. (2008). Four grams of glucose. American journal of physiology. Endocrinology and metabolism, 296(1), E11-21. 10.1152/ajpendo.90563.2008

“…from a thermodynamic perspective, it is clear that obesity is generally the consequence of small cumulative imbalances of energy intake and expenditure.”

2017, Obesity Pathogenesis: An Endocrine Society Scientific Statement

calories in > calories out

We overeat

Too much food, too little physical activity

Overeating

(Energy in > Energy out)

Obesity and the obesity epidemic

1880s: Max Rubner demonstrates the laws of thermodynamics holds true for living organisms and establishes the isodynamic law of calories

1890s: Atwater and Benedict show thermodynamics holds true for humans and pioneer the science of calorimetry

1900s: von Noorden declares caloric imbalance as the cause of obesity

“The ingestion of a quantity of food greater than that required by the body leads to an accumulation of fat, and to obesity, should the disproportion be continued over a considerable period.”

Louis Newburgh’s revelation:

“All obese persons are alike in one fundamental respect—they literally overeat.”*

Therefore…

Obesity is caused by either a “perverted appetite” (eating too much) or “lessened outflow of energy” (insufficient expenditure).

Why don’t obese people compensate by eating less or exercising more, which, after all, are under conscious control, too? Because they suffer, says Newburgh, from various human weaknesses such as overindulgence and ignorance.”

Focus of attention? Full-Body Energy Balance

 

Energy Imbalance? How Much?

“Weight management is all about balance— balancing the number of calories you consume with the number of calories your body uses or `burns off.’”

The Centers for Disease Control

20 lbs/decade?

2 lbs/year

1 lb of fat ~ 3500 kcal

(2 * 3500 kcal)/365 days

19.2 Kcal/day

 

The average American consumes about 2700 kcal/day

Are we really talking about a .007 positive energy imbalance causing 2/3 of all healthcare expenditure in the United States????

The average American is now 30 pounds heavier than in 1960 — an average weight gain of .53 pounds per year.

5 kcal/day or a .002 positive energy imbalance

There are no stranger phenomena than the maintenance of constant body weight under marked variation in bodily activity and food consumption.

Eugene Du Bois, Basal Metabolism in Health and Disease, 1936

Eating less doesn’t work

Weight loss achieved in trials of calorie-restricted diets is “so small as to be clinically insignificant.”

Cochrane Collaboration, 2002

Exercising more doesn’t work

“It is reasonable to assume that persons with relatively high daily energy expenditures would be less likely to gain weight over time, compared with those who have low energy expenditures. So far, data to support this hypothesis are not particularly compelling.”

AHA/ACSM 2007, Physical activity guidelines

The fatal flaw with the energy balance hypothesis?

Remember this?

“The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended.”

The World Health Organization

an analogy? Wealth?

“The fundamental cause of wealth is a money imbalance between dollars earned and dollars spent.”

The World Economic Forum

dollars in > dollars out

The Alternative Hypothesis

Obesity is a disorder of excess fat accumulation

(Not energy balance, not over-eating, not sedentary behavior)

Gluttony and sloth are compensatory effects; they are not causes

German/Austrian hypothesis, pre-World War II

Gustav von Bergmann (1908), Julius Bauer

A hormonal/regulatory hypothesis

“Like a malignant tumor or like the fetus, the uterus or the breasts of a pregnant woman, the abnormal lipophilic tissue seizes on foodstuffs, even in the case of undernutrition. It maintains its stock and may increase it independent of the requirements of the organism. A sort of anarchy exists; the adipose tissue lives for itself and does not fit into the precisely regulated management of the whole organism… a lipomatous subject may die of starvation and still remain lipomatous.” Bauer, Archives of Internal Medicine, 1941.

“The effect after meals of withdrawing from the circulation even a little more fat than usual might well account both for the delayed sense of satiety and for the frequently abnormal taste for carbohydrate encountered in obese persons… A slight tendency in this direction would have a profound effect on the course of time.”

Russell Wilder, Mayo Clinic,1938

The hormonal/regulatory hypothesis

“…now more or less fully accepted, chiefly in Germany, by a number of leading investigators of metabolic diseases…”

Hugo Rony, Obesity and Leanness, 1940

“The current energy theory of obesity, which considers only an imbalance between intake of food and expenditure of energy, is unsatisfactory.”

“It is the distribution of energy in the body too which counts, not alone the rough imbalance between its intake and output.”

“The adipose tissue is not merely a passive storing place for reserve fat, but a living and active part of the body, with its own physiologic and pathologic processes.”

“An increased appetite with a subsequent imbalance between intake and output of energy is the consequence of the abnormal anlage rather than the cause of obesity.”

Bauer (1941)

The alternative hypothesis is another victim of World War II.

Insulin is “the principal regulator of fat metabolism.”

Rosalyn Yalow, Solomon Berson, 1965

Frayn, K.N. 2010. Metabolic Regulation: A Human Perspective, 3rd edition

Suppression of fat mobilization

The release of fatty acids from fat cells “requires only the negative stimulus of insulin deficiency.”

 

When insulin is secreted or chronically elevated, fat accumulates in the fat tissue.

When insulin levels drop, fat escapes from the fat tissue and the fat depots shrink.

We secrete insulin primarily in response to the carbohydrates in our diet.

“Carbohydrate is driving insulin is driving fat.”

George Cahill, 2005

 

“The most striking finding is that adipose tissue is exquisitely sensitive to the inhibitory effect of insulin on FFA release….”

“…insulin regulation of plasma FFA turnover/ oxidation is maximally manifest at low physiological plasma insulin concentrations….”

Bonadonna et al. 1990. Dose-dependent effect of insulin on plasma free fatty acid turnover and oxidation in humans. Am. J. Physiol. 259:E736-750.

Refined grains, starches and sugars

Dysregulation of insulin signaling

Metabolic Dysfunction: Excess fat accumulation, obesity, and the obesity epidemic, metal inflammation, pain, cellular degradation

So why does dieting fail…  statistically, only 1:167 patients succeed

“All diets that result in weight loss do so on one basis and one basis only: they reduce total calorie intake.”

Textbook of Obesity, 2012

Diets that work?

Insulin reduction?

Calorie restriction (with carbohydrate restriction)

Carbohydrate restriction (without calorie restriction — i.e., LCHF/Leto)

Intermittent Fasting (TRF)

Fasting…

Raymond Greene, The Practice of Endocrinology, 1951

Foods to be avoided:

1. Bread and everything else made with flour…
2. Cereals, including breakfast cereals and milk puddings
3. Potatoes and all other white root vegetables
4. Foods containing much sugar
5. All the sweets…

You can eat as much as you like of the following foods:

1. Meat, fish, birds
2. All green vegetables
3. Eggs, dried or fresh
4. Cheese
5. Fruit…except bananas and grapes

The AMA trivializes this science as a debate about fad diets.

“fat is mobilized when insulin secretion diminishes” and yet low carbohydrate diets are “bizarre concepts of nutrition that should not be promoted to the public as if they were established scientific principles.”

JAMA, June 4, 1973. Vol 224, No 10.

The pancreas is an exocrine gland that produces two key hormones involved in the regulation of blood sugar: Insulin and Glucagon. Beta cells are distinctive cells within the pancreas that are responsible for the production of insulin. Why should you know about beta cells? Beta cells are linked to diabetes which is a disease of insulin resistance. Located within the islets of Langerhans (part of the pancreas), they’re one among a minimum of 5 differing types of islet cells that secrete hormones directly into the blood.

What is the role of beta cells?

The main role of beta cells is to provide and secrete insulin into the bloodstream when needed. When blood sugar levels begin to rise (e.g. when you are having a meal), beta cells quickly respond by secreting insulin into the bloodstream to take up the glucose being produced and store it in cells. Beta cells also increase the production of the hormone insulin in response to rising levels of glucose in the blood. This fast response to a spike in blood sugar typically takes about 10 minutes.
In people with diabetes, however, these cells are either attacked or destroyed by the system (type 1 diabetes), or become resistant to the effects of insulin (type 2 diabetes).

What Are Amylin and C-peptide

In addition to insulin, beta cells also produce two other products: Amylin and C-peptide, a byproduct of insulin production.

• Amylin slows the speed of glucose coming into the blood, making it a short-term regulator of blood sugar levels.
• C-peptide prevents vascular neuropathy as well as preventing the damage of arteries. You may have noticed that people suffering from severe diabetes will have problems with their nerves and sensation as well as arteries. This is due to the loss of this molecule when beta cells are destroyed.
  C-peptide is secreted into the blood in equal quantities compared to insulin.

What Is The Role Of Beta Cells In Diabetes?

Type 1 Diabetes

In this type of diabetes, beta cells die from an immune attack; immune cells which normally fight harmful bacteria and viruses mistakenly destroys beta cells in the pancreas. How and why that happens isn’t clear, however, the results of a study published in early 2011 shows that these beta cells become stressed at the earliest stages of the illness.
In mice studies, cells respond to this stress by triggering a death pathway that leads to the loss of beta-cell function, and ultimately the loss of cell mass. In this case, stress on beta cells that results from an immune attack may be responsible for type 1 diabetes which mostly occurs in children. Type 1 diabetes has strong genetic links.

Type 2 Diabetes

In this type of diabetes, the body becomes immune to the effects of insulin, losing sensitivity to insulin over the course of time. Consequently, it tries to compensate by producing more insulin. Research has shown that chronically elevated blood sugar levels (chronic hyperglycemia) over a protracted amount of your time will result in beta cells burn out, which is also referred to as cell turnover. The exact cause of these is unclear; however, factors such as chronic low-grade inflammation could be contributing significantly.
Glucotoxicity which is the result of the accumulation of high levels of glucose is another factor as well. Other factors include the effects of lipoproteins, leptin, and cytokines which play a role in glucose regulation.

Insulin Resistance in Type 2 Diabetes

The beta cells of the pancreas work as extremely connected clusters called islets and their responses to rising blood sugar levels are coordinated by little groups of “leader cells.” Once blood sugar levels peak in blood, the leader cells are responsible for coordinating the other beta cells to initiate an appropriate response. It is possible that the leader cells are more metabolically active and more glucose-sensitive than the rest and they are the primary target for insulin resistance.

Insulin resistance in type 2 diabetes starts out with decreasing sensitivity to insulin which leads to an overproduction of insulin by the beta cells. Due to the increasing levels of insulin resistance, patients continue to suffer from elevated blood glucose levels with sweeping consequences. After a few years of sickness, internal insulin production dries up and patients need to start injecting insulin.

New Drug To Stimulate Growth of Beta Cells

Researchers from Mount Sinai Hospital have discovered a unique combination of medication that induces the growth of beta cells. The lead author of the study Andrew Stewart MD had this to say:

“We have discovered a drug combination that makes beta cells regenerate at rates that are suitable for treatment. The next big hurdle is figuring out how to deliver them directly to the pancreas.”

If beta cells can be stimulated to regenerate, then insulin resistance will no longer be an insurmountable obstacle for diabetics. If this new treatment is implemented it can provide the much-needed breakthrough in the treatment of diabetes.

• References

1. Mayo Clinic: Type 2 diabetes. Retrieved from https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193
2. Mayo Clinic: Type 1 diabetes. Retrieved from https://www.mayoclinic.org/diseases-conditions/type-1-diabetes-in-children/symptoms-causes/syc-20355306
3. NCBI (2008): Insulin signaling in the pancreatic beta-cell. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/18481923 
4. Science Daily (2018): Diabetes: New drug cocktail increases human beta cell proliferation at rapid rates. Retrieved from https://www.sciencedaily.com/releases/2018/12/181220111759.htm