Insulin Resistance - Underlying Cause of Common Health Problems
STEVEN SANDBERG-LEWIS N.D., DHANP
Syndrome X, metabolic syndrome, insulin resistance, prediabetes… many names for essentially the same condition. For simplicity, I will use the term insulin resistance to describe the underlying process for this very common phenomenon that plagues at least 25% of the population in the Western world.
Insulin is a hormone produced in the pancreas with major effects on blood sugar (glucose) regulation. It allows simple sugar to enter the cells that make up the various organs of the body. Think of insulin as a key that fits into a lock (the insulin receptor) on the outer cell membrane. This is an essential process because you shall see that sugar does us little good in the bloodstream. When it enters the cells, glucose gets to work fueling energy production by the microscopic “energy factories” called mitochondria.
In the case of insulin resistance, it is as if a locksmith has changed the lock and the insulin key no longer allows sugar to enter the cell - sugar starts to rise in the bloodstream. Over time the sugar binds to various tissue proteins, altering their functions. The hemoglobin A1c blood test (aka glycosylated hemoglobin test) is a measurement of this binding of glucose to the protein in hemoglobin. Hemoglobin is the oxygen carrying substance in red blood cells and is an easy way to measure the general tendency for excess blood sugar to bind to proteins.
Stress hormones that are out of balance are major factors behind the problems with glucose entry to cells, reduction in energy production and the constellation of problems that creates insulin resistance. Cortisol (produced in the adrenal glands) is essential for orchestrating the balance of mood, energy, blood sugar, cholesterol and triglycerides, blood pressure, wake/sleep cycles, libido, endurance, immunity and mental clarity. DHEA is its “sister” hormone – controlling all the same functions. But with a balancing/opposite effect. When cortisol and DHEA become imbalanced a host of common insulin resistance problems can occur.
Chronic physical and emotional stress often leads to a tendency toward higher cortisol and lower DHEA levels. This commonly leads to insulin resistance with the following patterns:
Elevated blood sugar and Hemoglobin A1c (hyperglycemia)
Increased waist circumference (apple fat or visceral adiposity)
Elevated blood pressure (hypertension)
Elevated blood triglycerides, total cholesterol and HDL cholesterol/reduced HDL cholesterol (hyperlipidemia)
Elevated blood insulin (hyperinsulinemia)
These common early patterns of insulin resistance are often treated with prescription drugs as distinct, unrelated diagnoses. Hyperglycemia and hyperinsulinemia will be treated with metformin (or ignored until it gets much worse); hypertension will be treated with beta blockers, calcium channel blockers, diuretics, ACE inhibitors or ARBs; hyperlipidemia with a statin; changes in mood and energy with SSRIs or benzodiazepines.
Next month I will discuss more details of my approach to insulin resistance with case examples of treatments that address the causes of this common issue.
Medicine Use and Spending in the U.S.: A Review of 2018 and Outlook to 2023, was prepared by the IQVIA Institute for Human Data Science. It points out that 87% of U.S. senior citizens take four or more prescription drugs at an annual national cost of $344 billion. When insulin resistance is seen and treated as multiple unrelated diagnoses rather than as a constellation of related issues, there is a bundle of money to be made. In addition, by not addressing the underlying causes and patterns, a host of chronic problems from heart attacks, strokes and congestive heart failure to chronic kidney disease become more likely. These medications may help control the various signs of insulin resistance, while causing nutritional deficiencies, side effects and often-additional new disease patterns. These drugs can be very helpful when used wisely when needed along with focused attention and correction of underlying causes of insulin resistance.
Steven Sandberg-Lewis, ND, DHANP, has been in clinical practice for 44 years, with a focus on functional gastroenterology. He has been a professor since 1985, teaching a variety of courses but primarily focusing on gastroenterology and GI physical medicine. In 2019, Dr. Sandberg-Lewis co-founded Hive Mind Medicine, continuing his specialization in gastroenterology with a focus on reflux, SIBO, inflammatory bowel disease and functional GI disorders. He is currently working on his latest book, Let's Be Real About Reflux: Getting to the Heart of Heartburn, written to help non-medical and medical professionals alike develop a better understanding of diseases affecting the gastrointestinal tract.
Hive Mind Medicine blog posts are for educational purposes only and are not intended as medical advice. Please consult with your health care practitioner for personalized guidance.