Currently around 1 in 16 people in the UK suffer from diabetes with this ratio equating to a total of around 3.9 million people; these figures alone provide cause for concern. Our article this week is provided by Dr David Morris – a freelance General Practitioner in the NHS and a recent speaker at one of our Cytoplan seminars.
In the article below Dr Morris looks at how one of the fundamental problems with much of modern medicine’s approach to health is it’s constant failure to go back to basics and genuinely understand the first principles of the roots of health and illness; a clear example of this being the treatment of Type II Diabetes, where much of modern medicine targets lowering blood sugar without ever targeting the problem of insulin resistance.
One of the fundamental problems with much of modern medicine’s approach to health is the failure to go back to basics and genuinely understand the first principles of the roots of health and illness.
Nowhere is this more apparent than in the management of Type II Diabetes. Given the literally millions with this condition and the many millions more heading towards this condition with so-called “pre- diabetes” then this of incredible concern.
In this blog post I will set the scene explaining the issue of insulin resistance and in the next post explain how insulin resistance can be treated.
What is the concern at the heart of the management of Type II Diabetes?
It is as simple as this; doctors and patient’s alike know that running high blood sugars is bad for you – the excess sugar sticks to your cell proteins distorting and damaging them – try using your smart phone with candyfloss all over your fingers – the sticky sugar doesn’t exactly help!
BUT while doctors know that Type II diabetes is caused by insulin resistance – which leads to elevated insulin levels (alongside elevated blood glucose) – there appears to be an almost complete failure to understand that raised insulin is MORE harmful than raised blood sugar.
As a consequence all of the effort is targeted at lowering blood sugar without ever considering the elevated insulin and targeting insulin resistance.
Even worse – many of modern medicine’s approaches to lowering blood sugars actually worsen insulin resistance which leads to even higher levels of insulin with even more harm from this.
Research confirms that the outcomes from the current approaches to treating Type II Diabetes in this way is definitely failing:
1.If you have Type II Diabetes but you do not yet have symptoms then you are no better off being screened and having the diabetes treated –
It seems common sense that we should screen people for diabetes before they have symptoms so that they don’t end up with damage before they are diagnosed.
Unfortunately a large trial (1) screening thousands of people for diabetes showed that overall they did not do any better than people that were not screened.
Diabetes was identified successfully but the approach to treating it appears to be unhelpful –in fact the screened group had a higher death rate then the unscreened group. Although this was not “statistically” significant it is the opposite of what we expect.
In a large trial (2) of more than 10,000 patients the participants were randomised to intensive versus normal treatment i.e. “ok” sugar control versus “very good” sugar control.
The trial had to be halted after 3.5 years because “As compared with standard therapy, the use of intensive therapy to target normal glycated haemoglobin levels for 3.5 years increased mortality and did not significantly reduce major cardiovascular events.”
The use of insulin to treat Type II Diabetes in the UK has increased by 750 per cent over the last 20 years but the question is rarely asked whether it helps or not.
A large trial (3) of 84, 622 primary care patients measured the risk of first major adverse cardiac event, first cancer or death. It concluded that – “exogenous insulin therapy was associated with an increased risk of diabetes-related complications, cancer, and all-cause mortality”
So we can conclude from this that all is not well in the world of conventional diabetes treatment – to understate the issue!!
We MUST instead seek instead to understand the mechanism for developing Type II Diabetes and address this issue NOT simply address the consequence of raised blood sugar – of course if we do this then the raised blood sugar will resolve too.
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Returning to basics
What does insulin do?
It is clear that one of the roles of insulin is to lower your blood sugar – it “pushes” glucose inside your cells out of the blood stream and prevents the production of new glucose by the liver.
BUT this is only one of many, many roles of insulin…
Insulin and LIPID metabolism:
i.e. insulin MAKES YOU FAT!
Insulin and Protein metabolism:
i.e. insulin promotes muscle growth
Insulin and Detoxification:
Insulin and Atherosclerosis:
Insulin and Magnesium:
Insulin and Sex Hormones:
In men, insulin speeds up the action of the enzyme aromatase which increases the conversion of testosterone to oestrogen- not a good thing particularly as raised oestrogen levels appear to promote metabolic syndrome.
In women, high insulin speeds up an enzyme called 17,20-lyase, and this increases the production of testosterone leading to Polycystic Ovarian Syndrome- the number one cause of infertility.
Understanding Insulin Resistance
When receptors are constantly exposed to high levels of insulin they down regulate and THEY BECOME RESISTANT TO INSULIN.
A way to understand this is to think of the experience when you are in a room when someone is vacuuming – your ears adjust to the noise and screen it out – and then you suddenly notice it has gone quiet when the vacuum is switched off.
The consequence of this lack of response leads to a vicious cycle as your blood glucose rises then…. then insulin levels rise further leading to more stimulation and then more resistance etc, etc
So if we put ourselves in a situation where our cells are constantly exposed to insulin eventually we trigger this vicious cycle of rising insulin BUT the consequences of this are more complex than we might think.
There are three problems that arise:
Failure to respond to insulin ie resistance
The most obvious consequence of this is rising blood sugars – insulin is unable not only to push glucose into cells (potentially starving them of an important energy source) but also cannot stop the liver from making new glucose and releasing it into the blood stream – hence we have raised blood sugar even on waking after overnight fasting.
A further consequence is that insulin is unable to push magnesium into cells- magnesium is vital for the production of energy in our cells and lack of magnesium leads to cellular fatigue. Magnesium is also required for muscle relaxation and so insulin resistant muscle cells do not relax fully.
While we might think of muscles as biceps and quads etc. of more significance is the muscle layer around all of our arteries – lack of relaxation of this leads to raised blood pressure with all of its potential consequences.
The problem with differential rates of organs development of insulin resistance.
Having taken a snapshot of some of the many actions of insulin and understood why the failure to respond to insulin leads to harm, we also need to consider the impact of overstimulation due to high insulin levels because resistance does not develop equally in all cell types.
Roughly speaking it appears that organs develop resistance to insulin in this order:
Pancreas, Brain, Liver, Muscles then finally Adipose (fat) tissue.
It is not even as straight forward as this, as some cellular functions never become resistant to insulin and so this leads to constant over stimulation if insulin levels are high.
The pancreas obviously secretes insulin (from beta cells in the islets of Langerhans) but also secretes the hormone glucagon. Glucagon essentially does the opposite of insulin with respect to sugar- it makes your liver produce more glucose amongst other actions.
Insulin and glucagon in part inhibit each other’s release –if your body needs to lower blood glucose it makes sense to lower the production of the hormone that raises it. BUT with chronically high levels of insulin, the cells that produce glucagon (alpha cells in the islets of Langerhans) become resistant to the insulin signal and start to release glucagon despite high levels of blood glucose. Clearly this is the last thing that you require as this now contributes to even higher levels of circulating glucose.
The brain is particularly vulnerable to any problems with sugar metabolism because it consumes disproportionate levels of glucose and oxygen – it is 2% of body weight but uses 20% of the body’s glucose and oxygen.
Evidence show us that people with dementia develop problems with the uptake of glucose in the memory parts of the brain up to 20 years before developing Alzheimer’s Disease (4) and also shows us that patients with advanced AD show higher blood but lower cerebrospinal fluid insulin (5) -this correlates with the dementia severity and indicates that the brain is no longer taking in insulin i.e. it has become insulin resistant.
Insulin secreted by the pancreas first passes through the liver so it is most exposed to high levels.
Once your liver is resistant to the insulin signal it will continue to make new glucose and also breakdown glycogen stores to release more glucose despite blood levels being high. You can see how the vicious downward spiral is further triggered.
Muscle develops resistance after the liver and this leads to poor uptake of glucose and reduced glycogen (glucose storage) formation in muscles. It also leads to muscle wasting due to lack of amino acid uptake to make protein.
Magnesium intake is also reduced alongside reduced glucose uptake so exercise ability rapidly plummets – the low energy and wasting leads to less exercise leading to more insulin resistance!
Adipose (Fat) Tissue
Eventually adipose tissue becomes resistant to insulin but up until that point there is a continuous insulin driven drive to lay down more fat. While people do not get fatter and fatter indefinitely the stimulation on fat cells by insulin continues long after other cell types have become resistant.
Blood Vessel Lining (Endothelial cells)
Endothelial tissue never becomes resistant to insulin. The ongoing rise in intracellular glucose leads to very high levels of damaged proteins (Advanced Glycaemic End Products AGE’s). This means that elevated insulin leads to continuously high levels of inflammation and atherosclerosis
There is a specialised protein called FOXO that acts by regulating the levels of other cellular proteins that are responsible for cleaning up cellular garbage. The action of FOXO is inhibited by insulin BUT insulin regulation of FOXO is completely normal in muscle in pre-diabetes and diabetes individuals – i.e. FOXO does not become insulin resistant.
In healthy individuals, insulin levels are only elevated for a short time each day, leaving FOXO active to clear garbage from the cell the rest of the time. If insulin levels are constantly high then the detoxification pathways remain persistently switched off.
The need to metabolise/breakdown the high levels of insulin.
Alongside the issues of all the signalling effects of insulin on cells, your body also has to breakdown the high levels of insulin.
This is a particular problem in the brain because the hallmark of AD is the development of beta-amyloid plaques. Insulin Degrading Enzyme (IDE) degrades insulin and beta-amyloid BUT preferentially degrades insulin.
So higher levels of insulin lead to less breakdown of beta-amyloid AND as a further complication Beta-amyloid will bind to insulin receptors -so high Beta-amyloid levels worsen insulin resistance!
What do current conventional medical approaches offer?
Dietary advice– eating lots of complex carbohydrates is still the mainstream advice – unfortunately this promotes higher levels of insulin and so is the last thing required. (More to follow in the next posting.)
This is actually helpful but not necessarily targeted in the most effective way. (Again more to follow.)
There have been a huge number of concerns with the safety of many of the drugs used to treat diabetes -while they all reduce blood sugar, they have other risk such as pancreatitis, heart failure, bladder cancer and a number have been withdrawn from use.
More pertinently, with the exception of metformin, they all act at least in part by elevating insulin levels so aggravate insulin resistance. You can see for yourself why using insulin injections directly shows such poor outcomes in Type II Diabetes.
Metformin does reduce insulin resistance but also inhibits the absorption of B Vitamins and raises the risk of heart failure so there are better options than this. (More to follow…)
In summary persistently raised insulin:
So if we fail to address insulin resistance but merely focus on lowering blood glucose it is clearly predictable that the outcome will be less than ideal.
David qualified as a doctor in 1994 and spent six years in hospital medicine – mostly in general adult medicine, but also in paediatrics and Accident and Emergency.
In 2000 David moved into family general practice and was a GP partner for many years. During this time he was also extensively involved in commissioning health care services. David also has significant training and experience in complementary therapies such as acupuncture and homeopathy, and ran a primary care based pain clinic for over a decade using acupuncture therapies. Dr Morris is a regular blogger – you can read more of his articles here.
With many thanks to Dr David Morris for this article. If you have any questions regarding the health topics that have been raised, or any other health matters please do contact me (Amanda) by phone or email at any time.
firstname.lastname@example.org, 01684 310099
Amanda Williams and the Cytoplan Editorial Team: Joseph Forsyth, Simon Holdcroft and Clare Daley
References are available upon request.
It states on the National Institute of Diabetes website that most people who are suffering from insulin resistance don’t realise that they have the condition until they eventually develop Type 2 Diabetes.
This is a scary thought when you consider that around 4 million people around the UK are currently suffering from Type 2 Diabetes, add to this the number of people who have undiagnosed insulin resistance and that number could, and almost certainly will, considerably rise in the near future unless there are drastic changes to the way that we each approach our individual health and well-being. So what should we be doing to recognise this condition early on and prevent it leading on to Type 2 Diabetes?
Well, the ‘good’ news is that much of science now points to our own lifestyle choices as being the main risk factors for the onset of insulin resistance, factors such as physical inactivity and poor dietary choices, that are wholly under our own control.
Our article this week is provided by Dr David Morris, who in the past few months has provided us with two blogs demonstrating how insulin resistance and Diabetes are clear examples of conditions that can be prevented and potentially reversed through a non-pharmaceutical and functional approach to treatment concentrating on dietary and lifestyle changes.
David’s most recent blog looked at Dietary Approaches to Reversing Insulin Resistance and this week he looks at the role of physical activity in potentially reversing insulin resistance.
Reversing Insulin Resistance – The Role of Physical Activity
Exercise is commonly promoted as a good way to lose weight but in isolation it is in fact extremely limited as an approach to weight loss – this is not surprising if we consider that, for the vast majority of us, in a 24 hour period we actually burn proportionally a far greater amount of calories while not exercising than we do while actually exercising.
For all their limitations, we can see from the so called calorie counters on exercise bikes etc. that the total amount of calories burned from a 20 minute fast jog is equivalent to one cookie! Hence the disgrace of Coca-Cola advertising their products alongside promoting exercise as if this counters the harmful effects of half a litre of carbonated treacle!
But I digress – there are in fact substantial benefits from exercising that are not simply about weight loss and it has been found to be an effective way to lower insulin resistance whether you are overweight or not.1
Why does exercise reduce insulin resistance?
If we cast our minds back to my previous post then we can remind ourselves that rising blood sugar leads to rising insulin leading to potentially chronically raised insulin and hence insulin resistance.
In simple terms exercise counters this by –
Some good news:
One of the points also discussed in my previous blog post was the implications of insulin resistance developing in muscles leading to poor glucose uptake and hence low cellular energy – not exactly ideal for setting off on an exercise regime.
The good news is that while glucose uptake into resting muscle cells is dependent on an effective insulin response this is not the case with exercising muscle – the muscular contraction itself opens up the receptors allowing glucose in over and above that entering via insulin effects.
How should you exercise?
This is quite a crunch question – if you have a physical job then in many ways the problem is resolved for you. But what of the rest of us with sedentary jobs and busy lifestyles? If you have the time (and motivation!) to intensively exercise 4-5 times per week for at least 30 minutes as per government guidance then fair play to you – BUT if this is difficult to achieve for whatever reasons then there is no need to give up and resign to the couch.
Take a walk after eating
Studies have confirmed that exercising after eating with diabetes is better at reducing glucose raising effects than exercising the same amount before eating. Simply taking a stroll after eating raises metabolic rate and reduce glucose and insulin surges.2
Grandma’s advice never to exercise on a full stomach does appear to be slightly flawed although intensive exercise will of course interfere with digestion.
Stand up regularly
Having a sedentary lifestyle (i.e. prolonged sitting), EVEN IF people meet the current recommendation of 30 minutes of physical activity on most days each week, leads to potentially significant adverse metabolic and health effects. This goes back to my earlier point that most people spend proportionally a far greater time relatively inactive even if they are exercising for 20-30 minutes per day.
Simply standing up and briefly moving is the key and it appears that the change in posture is the most powerful signal – not the act of standing up. This is important to understand because it means that the answer is to interrupt your sitting frequently not doing lots of standing ups in one go.
In other words standing up 30 times at once will provide only a small percent of the benefit of standing up once every 20 minutes –so set your timer and stand every 20 mins! The benefit is significant with weight reduction, lowered blood glucose and lowered inflammatory blood lipids all found simply by breaking up sedentary time.3
High Intensity Interval Training (HIIT)
HIIT is characterized by relatively short bursts of intense exercise with all-out, one hundred percent effort followed by short periods of rest/low exercise. For example running as fast as you can for 1 minute and then walking for 2 minutes or even fast walking then strolling i.e. whatever your current fitness level allows. As fitness improves clearly the intensity will go up.
This form of exercise actually matches our evolutionary history far more than most other forms of exercise – as hunter gatherers there is lots of low level activity and then sudden bursts of extreme exercise – either as predator or to avoid becoming prey!
Simply 10 minutes per day of HIIT 3 times per week has been shown to reduce insulin sensitivity, weight loss and visceral fat even compared to both controls and those performing “steady state” exercise.4
Why is HIIT so beneficial?
The steady state exercise group in the above study had a significant improvement in cardiovascular fitness alongside the HIIT group BUT did not see the same metabolic benefits. In other words your dedicated regular runner might not be as metabolically fit as someone using HIIT for a total of 30 minutes a week i.e. 10 minutes alternate days!
The reason for this is that the high intensity component uses “super-fast muscle fibres” which are 10 times faster than “slow fibres.” Activating super-fast fibres triggers Growth Hormone which is associated with longevity and a reduction in insulin resistance. Given that our levels of Growth Hormone start to fall once we are in our twenties then HIIT is an excellent way to reverse this.
A FINAL WORD (for now!)
It clearly makes sense to adopt a holistic approach to managing insulin resistance -after all we are complex systems not a linear system. Hence the next post will discuss stress and supplements.
In the meantime exercise and dietary should go hand in hand – unsurprisingly research has shown that they are more than the sum of their parts. In fact it has been demonstrated that aerobic exercise ONLY reduced insulin resistance if used in conjunction with carbohydrate restriction and not if only used in conjunction with calorie restriction.5
Dr Morris qualified as a doctor in 1994 and spent six years in hospital medicine – mostly in general adult medicine, but also in paediatrics and Accident and Emergency.
In 2000 David moved into family general practice and was a GP partner for many years. During this time he was also extensively involved in commissioning health care services.
Dr Morris has significant training and experience in complementary therapies such as acupuncture and homeopathy, and ran a primary care based pain clinic for over a decade using acupuncture therapies.
With many thanks to David for this article, if you have any questions regarding the health topics that have been raised please don’t hesitate to get in touch with me via phone (01684 310099) or e-mail (email@example.com).
Amanda Williams and the Cytoplan Editorial Team: Clare Daley, Joseph Forsyth and Simon Holdcroft