‘WHAT ARE THE EFFECTS OF A RAISED INSULIN LEVEL?’
‘What are the effects of a raised insulin level?’
Dr Schoonbee answers your questions
I’ve been thinking back to my days as a young GP in the early Eighties. I remember consultations about morbid obesity in, perhaps, a child. Often, the parents’ explanation was that the child’s condition was due to a ‘gland’ problem and a ‘hormonal imbalance’.
In the back of my mind I would wonder: what is the name of this ‘hormone’ or ‘gland’? I believed the child was probably eating too much and exercising too little: the calories-in and calories-out theory.
I know now that the parents were right. Obesity, in most cases, is caused by a hormone and a gland: insulin, secreted by the pancreas. Understanding the role of insulin in the development of obesity and metabolic syndrome makes it so much easier to follow a lifestyle in which the main aim is to keep the insulin level in your blood as low as possible. The key factors are:
DIET: A diet high in refined carbohydrates and sugars (especially fructose) over a long period causes blood-sugar spikes, which the body tries to counteract with extra insulin. INSULIN RESISTANCE: This condition causes the body’s cells to become resistant to the effect of insulin. The cells do not get enough glucose to meet their energy needs so the pancreas produces more insulin to try to overcome this.
MEDICATION: Certain diabetes medications stimulate the pancreas to release more insulin. When oral medications are not able to normalise blood sugar in patients with type 2 diabetes insulin injections are prescribed. Other medications that increase blood sugar and thereby insulin include cortisol (prednisone/steroids) and anti-psychotic medication.
What are the effects of a raised insulin level?
OBESITY: As insulin is responsible for fat storage it also prevents the breakdown of fat stores. Excess blood sugar gets stored in fat cells, muscles and the liver.
SATIETY: There is evidence that a high insulin level suppresses the working of the satiety hormone leptin produced by fat cells and you therefore stay hungry and eat more, making the problem worse.
INFLAMMATION: Chronic inflammation causes insulin resistance, which contributes to the development of conditions such as Alzheimer’s disease, heart disease, cancer and arthritis, as well as autoimmune diseases. METABOLIC SYNDROME:
This is a collection of symptoms – abdominal obesity, hypertension, high triglycerides, low HDL, fatty liver and atherosclerosis – that cause insulin resistance, which eventually leads to type 2 diabetes.
To lower your insulin level follow a low-carbohydrate, healthy-fat lifestyle. Exercise – hiking, light weights, swimming and cycling are great – for about 30 minutes a day. Aim for eight hours of sleep a night and, if possible, avoid medications that increase insulin or blood sugar.
Are there downsides to going into ketosis? One of the catchwords of low-carb eating is ketones. I’ve had some queries about ketones so I’d like to settle some concerns.
Ketones are water-soluble molecules that are formed in the liver when fat (fatty acids) is broken down and released into the bloodstream. This process is triggered when there is a low level of glucose in the blood.
Under normal circumstances the body uses glucose as its main source of energy. During certain conditions, such as fasting, being on a very low-carb diet or during extended, intensive exercise, the glucose level drops and the body stimulates the fat cells to release stored triglycerides to be broken down to ketones, which are used as an alternative source of energy by the organs. As the ketone level in the blood rises it gets excreted by the kidneys where it can be detected in the urine by using a ketone screening strip or it can be detected as a sweet, fruity odour (acetone) on the breath.
Because of a medical emergency known as ‘diabetic ketoacidosis’ some people are alarmed by the presence of ketones in the blood. It is therefore important to know the difference between ketoacidosis and ketosis.
KETOACIDOSIS: This condition develops in patients with type 1 diabetes and type 2s who need insulin injections due to the burnout of insulin-producing cells. In these patients it can develop during illness (such as severe infection) or if the patient doesn’t use enough insulin to control blood sugar. In these cases these patients have a very high level of ketones in their blood and a lower pH (more acid in the blood, hence the term ‘acidosis’). Their blood sugar level is high, they are dehydrated and acutely ill and need to be hospitalised to be treated with intravenous fluid, insulin injections and for any underlying infection.
Symptoms and signs of ketoacidosis are dry, flushed skin, thirst, rapid breathing, abdominal pain, loss of appetite, and confusion, which can lead to diabetic coma and death.
KETOSIS: During ketosis the ketone level in the blood is five to 10 times lower than in people with diabetic ketoacidosis. The blood sugar is low and the insulin is normal. This is not a medical emergency. Plus, the body has systems in place to prevent the level of ketones from increasing too much. If they do, more insulin will be produced to stop the breakdown of fat.
Ketones at normal levels, in other words, are a good source of energy for the body in the absence of glucose. Some organs prefer ketones as their energy source. There is no danger of ketoacidosis in normal, healthy individuals, even when they follow the ketogenic diet or intermittent fasting.