To continue the trend of going against the grain and being unpopular I am going to be the devils advocate and make a case for insulin and insulin resistance. Say What? I know. I am a sucker for punishment.
While it is true that having chronically high insulin prevents fat from leaving fat cells and the term “Insulin Resistance” or “IR” is all the rage and blamed for all the problems of society, insulin is actually critical and insulin resistance is something that is meant to save our lives. Yes it’s true. Let me explain.
First lets look at insulin and why it is necessary.
The largest bit of evidence of insulin being good is type 1 diabetes. Without insulin we die. Glucagon runs wild and converts muscle and fat to sugar and ketones. This is called ketoacidosis and is deadly. Insulin is necessary to prevent death.
The next reason that insulin is critical is because it is the only thing that can push nutrients into cells. Without insulin we can’t build any tissue and can’t get adequate nutrition.
Without adequate insulin glucose stays in the circulation too long at at too high levels. This is when we start to see higher levels of HbA1c. HbA1c is a measure of how much cells have been glycated or how long they have been soaked in glucose basically. A normal level of HbA1c is 4% to 5.6%. 5.7% to 6.4% is considered pre-diabetic and 6.5% and up is diabetic. These are predictors as to the average blood glucose level and your level of insulin resistance.
When is insulin bad?
Well clearly if you are constantly spiking insulin by eating every 2 hours then you are likely to get fat but not even in all cases. In order to get fat from eating constantly you have to be eating carbs and fat together. if you are eating pure carbohydrate you will not be storing any fat so it is highly unlikely that you will get fat. It is technically possible but I have tried it and it is pretty damn hard. I actually lost weight eating very high carb and very low fat. It was almost impossible to over eat.
It is also bad if you are already “insulin resistant” but more on that later because it is not what you think it is.
Why is Insulin Resistance a good thing?
This comes down to a basic misunderstanding of what is and why it happens.
To get an idea of what it really is lets look at what we all love. Keto. When you are in ketosis you are “Insulin Resistant”. Wha???? How can something that makes us healthy cause something that is associated with obesity?
Well that is because insulin resistance is actually a very diverse function that is actually meant to ensure optimal function and survival. IR in keto is only in certain tissues. Other tissues are perfectly sensitive to inulin.
In keto muscle is insulin resistant but fat cells are not.
By making the muscle cells insulin resistant it prevents them from using glucose. This is necessary to preserve glucose for the cells that absolutely need it. This is critical in ketosis since we have little to no glucose intake and if the muscles continued to be insulin sensitive then the body would make more glucose and that would have to come from lean tissue (muscle) and this would result in a much more rapid death.
If fat cells were also to become insulin resistant then fat would not be able to cycle in and out easily and fat consumed would not leave circulation if not used for energy. It has to constantly flow in and out of cells for proper metabolic health. We would soon suffer from hypertriglyceridemia.
So here we can see not only that IR is critical to survival but it can be active in select cells under different circumstances.
Another example of when IR is positive is when saturated fat, especially stearic acid, is high and unsaturated fats are low. Saturated fats, usually only longer chain fats though, cause mitochondria to release molecules of superoxide that tell the body to do several things. One of them is to make muscle cells more insulin sensitive and fat sells insulin resistant. This allows fat cells to not take anything in at all and muscles to burn more substrate. If glucose is in the diet then they will burn more glucose and none will go into fat. When fat cells become insulin resistant they also start burning more fat internally and start acting like brown adipose rather than white. White adipose is primarily inert and just stores fat. Brown adipose tissue is very metabolically active and is highly involved in body heat. This Browning of white adipose is the reason that when some people eat very high saturated fat their body heat increases dramatically. The fat is burning high rates of fat internally and generating lots of heat. Babies have more brown adipose tissue than white and is why they don’t tend to shiver when cold. Shivering is the muscles trying to increase body heat by shaking and generating friction.
These positive examples are often referred to as peripheral insulin resistance.
So that is how insulin resistance is a good thing. Lets look at what the prevailing theories are about insulin resistance are and why they might be bad.
The negative association of IR comes from obesity/type 2 diabetes characterized by high blood glucose levels and high fasting insulin levels. These are circumstances are referred to as pathological insulin resistance and are signs of dysfunction and a disease state.
My preferred theory is Personal Fat Threshold. This theory states that each person has a level of fat storage and once they reach that capacity the cells just can’t take on any more glucose and glucose builds up in the blood. This would also explain why triglycerides rise as well as glucose. If glucose can’t get in neither can trigs. Insulin then rises as the pancreas increases output which either enlarges or grows new fat cells which again brings glucose under control. This process continues until the pancreas can no longer put out enough insulin to increase fat cell storage capacity. At this point the individual will need exogenous insulin injections. The injections then facilitate the growth/proliferation of fat cells. This study showed that fat cell enlargement was a good predictor and possible contributor to insulin resistance.
The other popular theory is that exposure to insulin itself causes insulin resistance. There is not much supporting evidence for this from what I can tell. It is a chicken egg scenerio. High insulin is present in insulin resistance so it is associated but what makes the insulin high is another story. I point back to the personal fat threshold theory. Proponents of this theory say that just stimulating insulin often causes the body to become “numb” or “deaf” to insulin signals over time. To me, this would indicate that everyone who eats high carb diets would have to be insulin resistant and unfortunately there are billions of high carb eaters that are just stubborn and won’t develop any signs of IR. How dare them.
So I have shown several instances where insulin resistance is saving our lives and presented two theories of why this pathological state occurs. We can maybe see why IR gets a bad rap when it is not at all meant to be the bad guy.
Finally let’s take a look at a case study where the goal was only to get someone off of insulin in an attempt to heal them and why this is a very shortsighted approach.
Over a 4 month period the patient was fasted 24 hours three times a week. Over the 4 months the patient lost 17.8% of his bodyweight and was able to stop taking his insulin despite being on insulin for 10 years. Success right? This was the best possible treatment and the patient was saved right?
Well sadly no.
The part that makes this not the best treatment is that the patients HbA1c was only dropped from 7.7% to 7.2%. He is still very much diabetic and has very poor glucose control. With this level HbA1c he still has a huge risk of disease and mortality. So yes he lost weight and got off insulin but he is still at very high risk.
Why didn’t this work? Remember before when I talked about personal fat threshold and how the pancreas would increase output until it was no longer able to make enough insulin? Well this process burns out the cells in the pancreas so they no longer make enough insulin on their own. This lack of insulin secretion is sometimes referred to as brittle diabetes.
So the patient at the clinic is not taking his insulin anymore but since his pancreas is not making adequate amounts, he is still glycating his cells and keeping his risk high. This is the mistake that is being made by those that think insulin is the bad guy and getting off of it is the solution.
The better solution would be to respect the power of insulin and properly manage the insulin to reduce the HbA1c and reduce mortality risk. Not just to get the person off of insulin.
Thanks for sticking with me on this one. I know it can be a rough read but it is so very important that we properly understand all the underlying players in this game that is insulin resistance.