Insulin Resistance

Taking a ride on the Sugar Land Express is likely a one-way trip to “Illsville.”

For decades now, as medical consumers and medical professionals, we have been trained to look at certain parameters to measure our health status. We all know about getting our blood pressure or cholesterol checked. We’ve been told time and again to keep our weight under control and to get some exercise, some of us even keeping track of our percent body fat. We’ve been coerced into getting a mammogram, PSA test and/or a colonoscopy on a regular basis.

We also get our fasting blood glucose checked when we have a physical exam (which may not be often enough for some of us), the results of which we rely on to tell us whether or not we have diabetes. Unfortunately, it may be that the standard we use as “acceptable” for blood sugar is actually too high… and it seems that there is another blood test that should be much more frequently used called hemoglobin A1c (HbA1c).

Currently, the HbA1c test is only routinely done for established diabetics as a long-term measure of their blood glucose. Sugar absorbed through the digestive system circulates in the bloodstream. When there is too much circulating sugar, some of it attaches to the hemoglobin in the red blood cells, forming hemoglobin A1c. Red blood cells live for 90 to 120 days, meaning that once the sugar combines with the hemoglobin, the HbA1c stays in the blood for 3 to 4 months. So measuring HbA1c tells us about high blood sugar levels over the past 3 months. It is not affected by the immediate diet, so no fasting is required.

Unfortunately, the only people who get their HbA1c tested are those already identified with a sugar problem. The sad fact is that it can take 10 years or more of having “sugar issues” before someone actually makes the diagnosis of diabetes. Furthermore, during those 10 years all sorts of other biochemical changes are happening as a result of the high sugar levels (and the consequent increased insulin levels that it causes) in our blood. This leads to other diseases that we have not yet adequately attributed to high blood sugar levels… heart disease, hypertension, high cholesterol and cancer, whose treatments are the source of countless prescriptions, tests and other costly interventions.

Here are some sobering facts concerning disease and death rates in the United States:

• A total of 63% of men and 55% of women over the age of 25 are either overweight or obese, and more than 280,000 deaths are ascribed to this.
• More than 60 million people have one or more types of cardiovascular disease, which represents the leading cause of death, more than 40% of all deaths.
• 50 million people are hypertensive.
• 10 million people have type 2 diabetes.
• 72 million adults maintain total cholesterol/HDL ratios of 4.5 or greater.

So what is the common link between all of these chronic diseases or conditions? You guessed it… our body’s inability to properly handle sugar. This particular set of circumstances is known as Syndrome X or Metabolic Syndrome.

Here is what happens in the body… we eat food that contains sugar and complex carbohydrates (chains of sugars connected together). These sugars are converted into glucose by enzymes in the G I tract. In the following two hours the glucose is rapidly absorbed and elevates plasma glucose concentrations. The resulting “hyperglycemia,” along with other chemicals secreted in the gut, causes the pancreas to secrete insulin, resulting in an immediate rise in plasma insulin concentrations, hyperinsulinemia.

Insulin’s job is to tell muscle, liver, fat and endothelial cells (cells that line the blood vessels) to take up the glucose molecules and use them for energy or replenish storage. When these cells resist this process (insulin resistance) then the sugar stays in the bloodstream and causes the pancreas to release more insulin, thus making the hyperinsulinemia worse.

The degree to which hyperglycemia and hyperinsulinemia occur depends upon the glycemic index and the glycemic load of the carbohydrate ingested. Glycemic Index is a measure of a food’s ability to increase blood glucose levels quickly and the glycemic load of a particular food is the glycemic index multiplied by the carbohydrate content per serving size.

This concept of glycemic load is important to understand. There may be a high glycemic index food, like a baked potato (glycemic index = 97) which has a glycemic load of only 18.4, because of the relatively low amount of carbohydrate within a serving of baked potato. Contrast this with a seemingly harmless rice cake, which has a glycemic index of 82 (lower than the potato) but a glycemic load of nearly 67. Think about all of those diet plans that have you eating rice cakes as snacks… you might as well go ahead and have the Snickers bar, at least the candy bar would be enjoyable!

The historical facts are undisputable… sugar and processed/refined carbohydrate consumption was nearly non-existent a mere 200 years ago. After the Industrial Revolution these foods became available to the masses in large quantities, and thus began the sad story of chronic disease as we know it today. High glycemic load foods comprise 36% or more of the daily energy in the Standard American Diet (SAD).

A high glycemic load diet combined with certain “susceptibility” genes allows for a hormonal cascade of events (starting with insulin, which is a hormone) that leads to the unregulated or enhanced growth of many tissues in the body. This effect is particularly directed towards body tissues with a rapid turnover rate, like the epithelial cells. Ultimately, this process leads to all of the diseases mentioned above.

So, finally we have come to the actual likely cause of all of the heart disease, hypertension, high cholesterol and certain cancers. It is interesting to note that other health conditions and trends have also been linked to or explained by this process, including: increased height, puberty occurring earlier in girls, earlier onset of near-sightedness, acne, ovarian cysts, skin tags, skin discolorations and male baldness. All of these diseases have genetic components, but what allows for the specific genes to express themselves in the worst possible manner is the biochemical changes that occur because of too much insulin circulating around in bloodstreams.

Now that we are armed with some accurate “cause and effect” information, how do we begin to make changes that will finally lead to better health? Well, the obvious answer is to get the sugars and refined/processed carbohydrates out of the diet. That is something that should start right away and you will reap the rewards for years to come. And please note that breads and cereals are included, not just cakes and candies.

Along those lines, it would be very helpful to have your hemoglobin A1c done so that you can know what your average blood sugar has been over the past 3 months. I can not stress enough how important this is and also how much more useful this is than the fasting blood glucose test that is typically done… we want to know what has been happening with your blood sugar 24/7 for the past 3 months, not just a snapshot at one time on one particular day.

When you do get the results, please ignore what the labs, and apparently the medical community at large, deem as “good” results. An HbA1c of 7% is considered “good,” which coordinates to an average blood sugar of 140… and that is just ridiculous. We want to shoot for an average blood glucose level of 110 at the very highest, and would be that much healthier if it were even lower. An HbA1c of 6% equates to blood glucose of 110 and 5% to 80.

If you have any of the health conditions I’ve mentioned already, or a family history of such (and I want to meet the person who can answer no to that) then this is likely the most important information you have ever seen. Am I saying to stop taking your prescription medicines? No, of course not. But I am saying that the best possible way for you to eliminate the need for those medicines is to get your body’s response to sugar and your body’s overproduction of insulin under control.

And the really exciting news is that you no longer need the “permission” of your doctor to check your HbA1c. A home test is now available, and affordable, so that you can monitor this most important of parameters all by yourself. As far as I’m concerned, this is the opportunity for you to finally take the reins of responsibility for your own healthcare firmly into your own hands, and begin to get healthier and continue to prove what I’ve been saying all along…that illness truly is optional!
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