Physiologic Insulin Resistance. It's A Good Thing!
hpsnickers1
Posts: 2,783 Member
This is some really interesting information that I came across on an Intermittent Fasting Primer on Mark's Daily Apple Forums,
I think this may be clarity for a few people reading about IF, PK said it in another thread a while back:
The confusion here is more than understandable and arises from the fact that the term "insulin resistance" is used to apply to two fundamentally different states: a) you have elevated blood sugar levels which indicates hyperinsulinemia , or b) where you have elevated fasting blood glucose levels, and this one is termed "physiologic insulin resistance". State a) pretty much corresponds to your description above, so I'll just talk to "physiological insulin resistance", state b.
Physiologic Insulin Resistance
The first thing that needs to be understood is that "physiologic" is doctor speak for "normal". If your doctor performs a blood panel on you, they are hoping that all the readings come back in the "physiological range". This part is actually quite important because the "physiological range" is generally ascertained statistically, by observation. So, a very important question to answer is who have these doctors been observing? Chances are pretty good that it has been patients on the Standard American Diet (SAD).
If your doctor is a conventional one, she will also do a fasting blood glucose test and upon receiving your results, will draw you into her office and with a concerned look on her face tell you that your fasting blood glucose levels are quite high and indicative of a pre-diabetic condition. She will then advise a glucose tolerance test (GTT). If you happen to be on a Very Low Carbohydrate diet (VLC) you will also fail the GTT thereby concerning your conventional doc even further. If your doctor is observant, one thing that will nag at her is the fact that you seem to be quite lean, whereas in general, patients with your test results tend to be quite heavy, with a large amount of subcutaneous body fat. It probably won't bother her enough to make her change her assessment, it's just an interesting anomaly that will soon be forgotten.
So what is going on here? Well, the standard SAD patient is periodically ( continually? ) dousing their system in "healthy" carbs and "healthy" low fat, guaranteeing a strong insulin response and ensuring a blood sugar level that whipsaws throughout the day. When blood sugar levels crash, they crash hard, and the poor individual eating this way becomes ravenous and starts hunting around for the next hit of easily assimilated carbohydrate. A metabolism adapted to this kind of eating relies on glucose as an energy substrate because there are periodic large exogenous (from the outside) infusions of glucose administered. Consequently, when the anticipated glucose infusion fails to materialize due to fasting for a blood test, blood sugar drops fairly low because tissues have been consuming blood glucose for energy. The real tragedy here is that this state in conventional medicine has come to be defined as "normal" due to its prevalence.
For the VLC eater, because carbohydrates are not a significant part of the diet, the metabolism shifts towards fat burning, in order to spare glucose for those tissues that are incapable of meeting their energy needs from fat oxidation ( the brain, red blood cells ). So what happens when you fast prior to a blood test? Well, not much, really. Your tissues are adapted to deriving their metabolic needs from fat oxidation, and unless you are insanely lean, your body has plenty of adipose tissue around to feed itself during the 12 hour fast mandated prior to a blood panel. As a result, your blood sugar levels are higher relative to the pathology of the SAD eater. Unlike the SAD eater, though, the VLC eater has a much narrower band of blood sugar, that is, the blood sugar never strays much above fasting levels even after eating, thereby explaining their leanness to a large extent.
So how does this all relate to insulin resistance? Well, tissues express insulin receptors when they are energy deficient. If your system is constantly bathed in insulin, you need proportionally fewer receptors to achieve the same effect than if you had lower insulin levels, so, in the interest of efficiency, tissues express fewer receptors. But that means that over time for a given glucose load, your pancreas needs to secrete ever increasing amounts of insulin to have tissues respond. The pancreas secretes increasing amounts of insulin, tissue express fewer and fewer insulin receptors, and we have ourselves a nice metabolic arms race. Welcome to hyperinsulinemia and insulin resistence.
If you are VLC, your tissues rely on fat as an energy substrate, and if their energy needs are being met that way, they will also not express insulin receptors. The net effect of this is that those cells that cannot oxidize fat as an energy substrate will still express insulin receptors, and still rely on the relatively meager amounts of blood glucose for their energy. The bulk of your tissues, however, will be insulin resistant and that is precisely what you want. The last thing you need is to have large masses of tissue that really don't need glucose for survival competing with those relatively few tissues that absolutely require the glucose. Welcome to physiologic insulin resistance!
The above also explains why you will fail a GTT on a VLC diet. This test basically consists of administering 50g ( I think ) of glucose to a 12h fasted subject and monitoring blood sugar levels to see how quickly the glucose is assimilated. In the SAD, the entire body serves as a sink for glucose, and this amount of glucose is roughly equivalent to one Dunkin Donuts Coffee roll. So, for the SAD eater this is a trivial amount of energy to dispose of or assimilate. For the VLC eater, however, most of the body is satiated due to fat oxidation, not dependent on glucose, and therefore does not serve as a sink for glucose assimilation. Accordingly, it will take longer to dispose of this glucose, leading our earnest doctor to conclude that we have a pre-diabetic condition presenting.
Does all that make sense?
http://www.marksdailyapple.com/forum/thread28459-6.html
I got exactly what I should have when I gave myself that OGTT at home. It was really stupid. And this very thing happens even when I ingest much smaller amounts of carbs - sugar of course is a much stronger reactive hypo response. What is nice to know is that the crash that happened means my body did manage to produce enough insulin to the point that it overcompensated. I'm happy it's still producing.
I did have the crash issues when I was following the "healthy" SAD of whole grain high-carb and low-fat. So I know there is some genetic resistance there. But the really bad response to the OGTT Was actually perfectly normal for a fat-burning body.
I think this may be clarity for a few people reading about IF, PK said it in another thread a while back:
The confusion here is more than understandable and arises from the fact that the term "insulin resistance" is used to apply to two fundamentally different states: a) you have elevated blood sugar levels which indicates hyperinsulinemia , or b) where you have elevated fasting blood glucose levels, and this one is termed "physiologic insulin resistance". State a) pretty much corresponds to your description above, so I'll just talk to "physiological insulin resistance", state b.
Physiologic Insulin Resistance
The first thing that needs to be understood is that "physiologic" is doctor speak for "normal". If your doctor performs a blood panel on you, they are hoping that all the readings come back in the "physiological range". This part is actually quite important because the "physiological range" is generally ascertained statistically, by observation. So, a very important question to answer is who have these doctors been observing? Chances are pretty good that it has been patients on the Standard American Diet (SAD).
If your doctor is a conventional one, she will also do a fasting blood glucose test and upon receiving your results, will draw you into her office and with a concerned look on her face tell you that your fasting blood glucose levels are quite high and indicative of a pre-diabetic condition. She will then advise a glucose tolerance test (GTT). If you happen to be on a Very Low Carbohydrate diet (VLC) you will also fail the GTT thereby concerning your conventional doc even further. If your doctor is observant, one thing that will nag at her is the fact that you seem to be quite lean, whereas in general, patients with your test results tend to be quite heavy, with a large amount of subcutaneous body fat. It probably won't bother her enough to make her change her assessment, it's just an interesting anomaly that will soon be forgotten.
So what is going on here? Well, the standard SAD patient is periodically ( continually? ) dousing their system in "healthy" carbs and "healthy" low fat, guaranteeing a strong insulin response and ensuring a blood sugar level that whipsaws throughout the day. When blood sugar levels crash, they crash hard, and the poor individual eating this way becomes ravenous and starts hunting around for the next hit of easily assimilated carbohydrate. A metabolism adapted to this kind of eating relies on glucose as an energy substrate because there are periodic large exogenous (from the outside) infusions of glucose administered. Consequently, when the anticipated glucose infusion fails to materialize due to fasting for a blood test, blood sugar drops fairly low because tissues have been consuming blood glucose for energy. The real tragedy here is that this state in conventional medicine has come to be defined as "normal" due to its prevalence.
For the VLC eater, because carbohydrates are not a significant part of the diet, the metabolism shifts towards fat burning, in order to spare glucose for those tissues that are incapable of meeting their energy needs from fat oxidation ( the brain, red blood cells ). So what happens when you fast prior to a blood test? Well, not much, really. Your tissues are adapted to deriving their metabolic needs from fat oxidation, and unless you are insanely lean, your body has plenty of adipose tissue around to feed itself during the 12 hour fast mandated prior to a blood panel. As a result, your blood sugar levels are higher relative to the pathology of the SAD eater. Unlike the SAD eater, though, the VLC eater has a much narrower band of blood sugar, that is, the blood sugar never strays much above fasting levels even after eating, thereby explaining their leanness to a large extent.
So how does this all relate to insulin resistance? Well, tissues express insulin receptors when they are energy deficient. If your system is constantly bathed in insulin, you need proportionally fewer receptors to achieve the same effect than if you had lower insulin levels, so, in the interest of efficiency, tissues express fewer receptors. But that means that over time for a given glucose load, your pancreas needs to secrete ever increasing amounts of insulin to have tissues respond. The pancreas secretes increasing amounts of insulin, tissue express fewer and fewer insulin receptors, and we have ourselves a nice metabolic arms race. Welcome to hyperinsulinemia and insulin resistence.
If you are VLC, your tissues rely on fat as an energy substrate, and if their energy needs are being met that way, they will also not express insulin receptors. The net effect of this is that those cells that cannot oxidize fat as an energy substrate will still express insulin receptors, and still rely on the relatively meager amounts of blood glucose for their energy. The bulk of your tissues, however, will be insulin resistant and that is precisely what you want. The last thing you need is to have large masses of tissue that really don't need glucose for survival competing with those relatively few tissues that absolutely require the glucose. Welcome to physiologic insulin resistance!
The above also explains why you will fail a GTT on a VLC diet. This test basically consists of administering 50g ( I think ) of glucose to a 12h fasted subject and monitoring blood sugar levels to see how quickly the glucose is assimilated. In the SAD, the entire body serves as a sink for glucose, and this amount of glucose is roughly equivalent to one Dunkin Donuts Coffee roll. So, for the SAD eater this is a trivial amount of energy to dispose of or assimilate. For the VLC eater, however, most of the body is satiated due to fat oxidation, not dependent on glucose, and therefore does not serve as a sink for glucose assimilation. Accordingly, it will take longer to dispose of this glucose, leading our earnest doctor to conclude that we have a pre-diabetic condition presenting.
Does all that make sense?
http://www.marksdailyapple.com/forum/thread28459-6.html
I got exactly what I should have when I gave myself that OGTT at home. It was really stupid. And this very thing happens even when I ingest much smaller amounts of carbs - sugar of course is a much stronger reactive hypo response. What is nice to know is that the crash that happened means my body did manage to produce enough insulin to the point that it overcompensated. I'm happy it's still producing.
I did have the crash issues when I was following the "healthy" SAD of whole grain high-carb and low-fat. So I know there is some genetic resistance there. But the really bad response to the OGTT Was actually perfectly normal for a fat-burning body.
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This is an extremely valuable post! I'm really glad you shared it. It is something I will tuck away in the back of my mind for when I have bloodwork done next time I have physical.
I think it also shows that once someone embarks on this lifestyle and then falls off to have a treat, why they have such a negative reaction to that cupcake or cookies when in the past they could have consumed a greater quantity without realizing the adverse effects.0 -
You're welcome. I thought about posting in the regular forums but I figured more people would "get it" here.0
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I'm sure if you posted this in the regular forums, someone would find a way to twist it around in order to rake you over the coals.
It's a negative place, those regular forums.0 -
Love this post! It gave me a lot to think about.
I also agree that the regular forums are somewhat negative...they say us Primal eaters are on a radical diet! No, we are just eating what nature intended, not processed crap from a package.0 -
Yeah. Radical, extreme, fad, zealot. I don't understand it at all. Eating real food is a fad now I guess. And if I see one more time: "our ancestors didn't live past 40!". They seem to miss that 40 is the AVERAGE AGE.
It does seem to be a little more popular than it used to be, though.0 -
Yeah. Radical, extreme, fad, zealot. I don't understand it at all. Eating real food is a fad now I guess. And if I see one more time: "our ancestors didn't live past 40!". They seem to miss that 40 is the AVERAGE AGE.
It does seem to be a little more popular than it used to be, though.
I think Primal / Paleo is gathering steam. I did not even know what it was a couple months ago.
The "fad" comments crack me up. Millions of years of one diet and 10,000 of of the other. Which one looks more like a fad in that context?0 -
Yeah. Radical, extreme, fad, zealot. I don't understand it at all. Eating real food is a fad now I guess. And if I see one more time: "our ancestors didn't live past 40!". They seem to miss that 40 is the AVERAGE AGE.
It does seem to be a little more popular than it used to be, though.
I think Primal / Paleo is gathering steam. I did not even know what it was a couple months ago.
The "fad" comments crack me up. Millions of years of one diet and 10,000 of of the other. Which one looks more like a fad in that context?
Well, at least if people think it's a fad diet they'll be more willing to try it. The only thing that worries me is that most people will try it without doing any real research and as soon as they feel the effects of carb-flu they will give up. Kind of like that wonderful 3-week study that put Paleo at the bottom of the Worst Diet List. the study stopped just short of the time when your body usually starts to switch over to fat-burning. That's just a funny coinkydink!!0 -
Very Interesting!!
I agree. I don't see how eating whole foods that have to be prepped and cooked is a fad. It is a lifestyle change and I think people feel good putting it down and calling it a fad is due to laziness and just not wanting to give up their addictive junk food.0 -
I found a better way to describe the insulin resistance that comes with VLC. Pathological insulin resistance is a bad thing. Physiological resistance is a good thing. I think it's better to describe it as the insulin receptors on the cells that don't require glucose retract the since glucose needs to be preserved and the cells prefer to take up fat for fuel.
They aren't resistant. They're just "turned off".0 -
I found a better way to describe the insulin resistance that comes with VLC. Pathological insulin resistance is a bad thing. Physiological resistance is a good thing. I think it's better to describe it as the insulin receptors on the cells that don't require glucose retract the since glucose needs to be preserved and the cells prefer to take up fat for fuel.
They aren't resistant. They're just "turned off".
So in essence when I was labelled a full blown diabetic and only my morning readings were high, physiological insulin resistence was the real issue?0 -
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