Hi everyone. I Want to take a minute and talk to you today about insulin resistance. This is a blood sugar issue. If you're not familiar with what insulin is, first of all, I'm going to go over basics of blood sugar. When we eat something, especially something that has a significant carbohydrate content, or a significant refined carbohydrate content, or we just have something with sugar in it, like we drink a soft drink or something, then our blood sugar goes up. We digest that, it gets absorbed into our bloodstream and then our blood sugar starts to come up. Normal fasting blood sugar's probably going to be, about 75 to 90 maybe, somewhere in that range. Depending on who you talk to, it's 70 to 90, or 70 to 85, or 75 to 95. It varies a little bit, but it's in that range; below 90 and above 70, probably.
But when we eat something or drink something that has sugar in it, that blood sugar number's going to go up dramatically. When it does, our pancreas creates insulin to take some of that out of the blood and put it into storage as fat. We don't want blood sugar to be too high, so we have that mechanism to control it. We have a mechanism to control low blood sugar too. If you don't eat for a while, and your blood sugar drops too low, you release a hormone called glucagon and that tells the liver to release stored glycogen, which is one of the ways we store sugar; small amounts in the muscle tissues and in the liver. That releases glycogen, brings our blood sugar back up, and that's supposed to do some fine tuning when it gets too low. That cutoff is different for different people, and in some people, that mechanism doesn't function well, and that's why they get low enough blood sugar that they get symptoms. They get shaky and grumpy, one of those, "I have to eat, or I'm going to have trouble", kind of feelings.
Those are kind of the highs and lows, how we are designed to handle blood sugar. Now, we were never designed to consume the types of sugars we have available to us today. If you look back historically, we had some fruits that had sugar in them, we have some vegetables that have sugar in them; beets and carrots are relatively sweet. They're definitely higher carbohydrate. All of the tubers are going to be. Parsnips, beets, carrots, potatoes, rutabagas, those kinds of things, sweet potatoes. Your squash is a relatively high carbohydrate. But most of those are what we call complex carbohydrates. They have a fair amount of fiber in them, so they don't raise our blood sugar too quickly. But you get to honey and maple syrup, those kinds of things, they would raise it more quickly than that. Now what we have are truly refined sugars where we've taken things like beets or corn, which is where it's done most commonly now, and you basically concentrate all the sugars and remove everything else. Those really didn't used to exist.
You went back to, I don't know, two or three thousand years ago, even five or 600 years ago, they didn't exist like they do today. We have access to sugars that go well beyond our body's capacity to handle the onslaught of blood sugar we get from those. Now it's more difficult for us than it ever used to be. But, that being said, you now understand the basic mechanisms.
What is insulin resistance? Well, when your insulin receptors, the things that receive insulin's signal and do the work of lowering your blood sugar, when those receptors have heard so much insulin for so long that they feel it's damaging to them, they kind of reset their sensitivity and go a little bit deaf. What I explain to patients is, we've all had, likely, the experience of going to a fairly loud concert, and when you walk out of that concert, you think, "Oh my gosh, my mom was right. I've lost my hearing. I can't hear anything." People talk to you and it's all muffled, and whatever. Your ears were bombarded with so much sound, that they reset their sensitivity, and now that you don't have that much sound, they're less sensitive and you have a hard time hearing. It's a protective mechanism, and it happens in all kinds of places in our body, but insulin receptors are one of the most notable, where we develop insulin resistance.
If you eat a lot of sugar all the time, and you're constantly making a lot of insulin, after a while, those insulin receptors say, "You know, that's too much for me to listen to. I'm going to reset my sensitivity." Well, once they do that, it then requires more insulin to get the job done, so they dial back their sensitivity even more, so you make more insulin. They dial it back more. Now, you're just an insulin production machine. Well, insulin is not without its problems. Insulin is a growth promoter. It's a storage promoter. It can be inflammatory in certain cases. It can do damage to tissues, like nerve tissue, eye tissue, blood vessels. You don't want gobs of insulin floating around.
There's also a theory that if you do that long enough, your pancreas finally says, "You know what? Can't make any more. I'm done." And now you become more of a Type I diabetic where you just can't make insulin. You have to take insulin shots.
Insulin resistance, if it goes on long enough, leads to Type II diabetes. You eat sugar, you make massive amounts of insulin, but it's still not enough to get your blood sugar under control, and then your blood sugar starts to come up.
Blood sugar elevating is not the first sign of Type II diabetes. It's probably the last sign of Type II diabetes, because that's when all other efforts to control your blood sugar have kind of failed you, and then the blood sugar starts to come up. Being told, "Hey, your fasting blood sugar is normal. You don't have a problem", not necessarily true.
How do you know if you have insulin resistance? Okay, that's one of the big things I want to discuss today. And there's a whole long list of criteria put out by several different organizations. Interestingly enough, the criteria rarely matches between one organization and the other, however there are some general guidelines.
If we're looking at body measurements, for anybody, if you have a BMI, body mass index ... And you can Google a calculation for that. It's basically a height/weight calculation. Not the most accurate thing, but used by insurance companies quite a bit. If your BMI is greater than 25, then you likely have insulin resistance. If your waste circumference, that's around the waist, if you're a male, if your waist circumference is great than 102 cm, or that equates to about 40 inches, then you likely have insulin resistance. If you're a female and your waist circumference is greater than 88 cm, which I think comes in at about 35 inches, then you likely have insulin resistance.
Those are body measurement indicators. I can also tell you, if you're one of those people ... and we talked about it in the fasting videos a couple of weeks ago ... that, "Hey, I can't go two hours without eating", or, "I can't go three hours without eating. I get shaky and I break out in a cold sweat and I get headaches", or what, you're probably insulin resistant. Right? You're having trouble managing your blood sugar at that point. You're going down that road, at least, and it needs to be handled.
If we're looking at blood work or blood values, triglycerides, which are part of the cholesterol panel, if your triglycerides are greater than 150 ... And again, there's a little bit of variability on this; 140 according to some, 170 according to others. But triglycerides greater than 150, you need to consider you may have some insulin resistance. If your HDL, which is considered the good cholesterol ... Again, whole darn video to talk about cholesterol and good and bad, and whether that's true, or not. HDL of less than 40 in men, or less than 50 in women is likely indicative that you have insulin resistance, or that you're going down that road. Obviously, the more of these you stack up, the more evidence there is. You could have one or two of these without the rest, and probably not have a big deal.
Fasting glucose, we talked a little bit about that. If your fasting blood sugar is greater than 110, some criteria say greater than 120, but if you're in that range, you need to consider you may have insulin resistance already. Hemoglobin A1c, or HbA1c, you'll hear it referred to just as A1c. It's glycosylated hemoglobin. It's kind of a number of what percentage of red blood cells currently circulating are sugar-coated. Think of them like glazed donuts. Each time your blood sugar elevates, it can sugar-coat some of those red blood cells. If your A1c number is greater than 5.7, you probably need to be concerned that you're going down the road of insulin resistance. Once it's over 6.4, you've pretty much got insulin resistance, if not Type II diabetes, at that point. That's a decent number to watch.
Now, one of the extra things we do in our lab work is we do a fasting insulin sample. It's done along with everything else. You don't know the difference when they draw your blood, but it's on the report. If you've had your blood drawn through us for an annual physical panel, probably in the last two or three years, you'll see that there's an insulin level on there. Ideally, we want that below five, five and a half. It's good if it's below 10. If you're in the single digits, probably not much to worry about. But as that number goes up, we're talking about insulin here, that's a good sign that you're making too much insulin. That is a very early indicator of insulin resistance.
Blood sugars can look perfectly normal. You're not obese yet. But it's requiring more and more insulin than it should for you to maintain that. That's when you'll start to see your fasting insulin numbers elevate.
Now, there's a calculation you can do. Last thing I'm going to talk about with these numbers. There's a calculation called a HOMA-IR. H-O-M-A dash I-R. Now, that stands for Hemostatic Model of Assessment for Insulin Resistance. The IR is insulin resistance. The HOMA is like a Homeostatic Model of Assessment, something like that. I think they were just looking for something catchy to say, so HOMA-IR. Basically, you take your fasting glucose, multiply it by your fasting insulin, then divide that by 405. Fasting glucose times fasting insulin over 405. And then, the answer you get from that is your insulin resistance score. If you're below one, you're great. No problem at all, you're golden. Have a nice day.
If you're between one and 1.75-ish, kind of average. Not ideal, but not bad. 1.75 up to about 2.75, you're pushing your limits. You're starting to have trouble, you're going down that road. Once you get above 2.75, you've got insulin resistance, and likely pretty close to Type II diabetes. That's a nice little score to do. Almost every blood test you get at any point, if it has a chemistry profile, will have a fasting glucose on it. The insulin test is one that most doctors don't run. Don't know why. It's not an expensive test. It's easy to do. You're fasting anyway. But they just don't do it. Like I said, if you've had it done through me in the fast few years, you've probably got that on there. You can go back and calculate it.
If you're getting blood drawn at your family doctor any time soon, ob/gyn, whoever you see, for whatever reason, if they're drawing blood, ask them to include a fasting insulin test on there, and then you can do your own HOMA-IR calculation. And you can Google the HOMA-IR calculation if you want. You don't have to necessarily write it down if you're in the car, or whatever. That's a good sense of whether or not you've got, or are developing insulin resistance. It's a huge, huge problem in the United States right now. Almost epidemic proportions.
Insulin resistance or Type II diabetes used to be called Adult Onset diabetes. It didn't happen until you had challenged your body for years with this kind of stuff. Typically, it would happen in your 30s or 40s or 50s. Now, we're seeing Type II diabetes and significant insulin resistance in kids at 10, 11, 12 years old. It's just not uncommon. Late teens, early 20s, we see quite a bit of Type II diabetes developing, and it's a lifestyle disorder. I think the medical community still considers it kind of a chronic lifelong incurable disease, but it's pretty predictable how it develops, and if you quit doing that, it's pretty predictable that you quit manifesting that.
I'm not saying that we treat it or we cure it, but if we know that over-consumption of carbohydrates can lead to insulin resistance, quit consuming the carbohydrates and those insulin receptors kind of normalize. Back to the analogy of being at a loud concert, your hearing was not lost forever. When you went home and sat in a quiet room, your ears rang and bothered you, whatever. You woke up the next day, and your hearing was largely normal again. You quit bombarding it with that sound, and it reset the sensitivity to what it ought to be. Insulin resistance is not all that different. That's partly why, when we get people that are insulin resistant, we know how it happens, we take them off the large doses of carbohydrates. In many cases, we will have them fast ... Refer back to the last couple of weeks of blog posts ... and they start to become more sensitive to their insulin again. It's just understanding how the problem came about and removing the stimulus that made it happen. If their bodies normalize, then their bodies normalize. That's how we go about handling patients who have signs of insulin resistance.
We'll talk more about what to do about it, nutrients that are involved in the process and everything on the next blog post, but I wanted to go ahead and talk about insulin resistance today. As you've noticed, if you have questions and you ask them, I will answer them in the next blog post. Make sure you send me an instant message, get on Facebook. I usually post a shortened version of this on Facebook or Instagram, so put your comments in there with your questions, and I'll make sure I answer them next week when I do the blog post.
Until then, as I always say, eat for your health, train for performance, and life the life you love today.