‘WHAT ARE THE EF­FECTS OF A RAISED IN­SULIN LEVEL?’

‘What are the ef­fects of a raised in­sulin level?’

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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.

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