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Insulin Resistance

TheAwfulToad profile image
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26 Replies

Time for something meaty, and I don't mean pictures of my meals.

The concept of "insulin resistance" is key to understanding why people get fat and why LCHF works. Unfortunately, there is an awful lot of nonsense written about it, mostly by people who don't understand basic physics and physiology.

UC Davis appear to be the thought leaders in this field. Various departments there crimp off regular lengths of BS about insulin resistance: their core belief is that insulin resistance is a disease state, and that it's caused by saturated fat blocking the insulin receptors, a statement so stupid that a double facepalm is probably appropriate. The first reason it's false is pretty damn obvious: if fat blocks insulin receptors, then we'd all be dead within the first few days of our life, not least because our bodies use saturated fat as a primary storage mechanism. There would therefore be no human life on earth - or, at best, natural selection would weed out those with this disastrous malfunction.

If you enjoy mocking people with PhDs, as I do, have a look at the website of UC Davis, eg., here:

ucdintegrativemedicine.com/...

Here's the more complicated reason why it's false.

We're all aware that insulin is the 'master switch' for anabolic processes and energy management. But how does that work exactly? When you eat a bowl of rice, what happens to it as it passes through your intestinal wall as glucose?

The uptake rate (which you can visualize as power) is essentially uncontrolled. It happens as fast as glucose can diffuse into your bloodstream, which in turn is related to the physical composition of whatever is in your intestine. If you have eaten starch and little else, the power flow peaks at around 3-4 times your basal metabolic rate (ie. 3-4METs). Your body must therefore reroute ~70% of that power flow, or blood sugar will rise to unhealthy levels. Your pancreas ramps up insulin output, telling everything that might be interested that glucose is available for uptake.

In fact, insulin+glucagon (a complex-valued control signal) has a wide range of meanings, but we'd best not go there. Let's stick with the glucose issue: it should be obvious that, since there is no mechanism for your pancreas to tell your liver to take this much and your fat cells to take that much, then every organ must decide for itself how energy is apportioned. And yet ... these organs can't communicate with each other to co-ordinate an optimum power split. There are two distinct but related metabolic features that solve this problem.

Glucose is transported across a cell membrane via micromachines called glucose transporters; there are 14 different types, GLUT1-GLUT14, and they're exposed through the cell membrane via molecule-sized tubular structures ('GLUT Storage Vesicles', GSVs) that can be withdrawn inside the cell, thereby preventing glucose from entering, or (in some cases) from being pumped out; for example, the bidirectional GLUT2 allows your liver to send out glucose (from glycogenolysis or gluconeogenesis) under conditions of low blood sugar.

Some receptors are more 'aggressive' in their operation than others; that is, they have various levels of affinity for glucose and various power capacities (maximum rates of glucose transport). For example, GLUT3, expressed within neurons, will scavenge all the glucose that it can, because your brain relies heavily on glucose. That's the first level of power partitioning.

The second level involves insulin resistance. Insulin resistance is not a malfunction. The idea that evolution would have gifted us with a complicated mechanism that does absolutely nothing except cause diabetes is so utterly foolish that I'm amazed that it even needs refutation. Still, here goes.

Insulin resistance is a tuning mechanism. It is analogous to the way neurons alter their connection strengths in response to firing rates, in order to achieve some desired goal state. When insulin is present, GSVs respond instantly to present glucose transporters outside the cell membrane. When the cell has taken what it needs, the GSVs are withdrawn, and the thresholds for mobilization and withdrawal are tweaked, slowly and continuously, depending on the downstream rate of energy utilisation (all energy sources - not just glucose). That is insulin resistance. Under normal circumstances, this distributed tuning process allows each organ to take an optimal fraction of available energy.

The precise mechanism of insulin resistance is still not completely characterized and it appears there may be other adaptive processes at work, but this one is fairly well-understood.

Each cell in any given organ will have a range of different thresholds for GSV presentation and withdrawal. The net result is that the organ as a whole has a 'soft' threshold for glucose, even though individual cells have a 'hard' (on/off) threshold.

As long as the peak power-handling capacity of all cells, in aggregate, is higher than the peak power entering your bloodstream from your intestine, it should be obvious that all will be well. Nothing will "overflow", and glucose can be maintained in the bloodstream at an appropriate level by the 'master switch', insulin.

What happens if more glucose continues to flood into your bloodstream, long after your fat cells, muscle, and liver have stopped accepting it? Well, your pancreas will not be happy, because its setpoint for blood glucose has not been reached. It therefore performs its own tuning process, pumping out more insulin in response to incoming glucose, forcing your body's organs to up their game. And up to a point, they can respond by enhancing their power-handling capacity. Your fat cells, for example, can get larger. New fat cells can be created (although unfortunately they tend to get stuffed into places where they really shouldn't exist). If you become more active, your muscles will be capable of absorbing a higher peak power than they otherwise would.

The key phrase here is "up to a point". When there is no mathematical solution to the problem - when it is physically impossible for your body's organs to match the rate of incoming power, even after performing some adaptations, the whole thing starts to fall to pieces. Insulin resistance and insulin output are cranked up and up and up in a pointless war of attrition, eventually pinning both in a dysfunctional state: diabetes.

Fortunately, this doesn't mean your body is broken. It just means it's horribly out of calibration. Those adaptive mechanisms are still working: they're just locked up. When someone is overweight and prediabetic, LCHF works by releasing the pressure to adapt in the wrong direction.

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26 Replies
Cosmo501 profile image
Cosmo501

Thank-you for such an informative post. I always enjoy reading the "meaty" stuff!

Suhavard profile image
Suhavard

Thank you!

Hi TheAwfulToad I’ve been on LCHF since May and I’m still on some diabetic medication but I’ve stopped my insulin and one tablet. And I’m 1lb away from 4 stone loss.

All my life I’ve been fat not just fat but morbidly obese. It’s the first time I’ve ever eaten this way and it works. 🍏🍎

BridgeGirl profile image
BridgeGirl in reply to

That really is a wonderful outcome. What does your GP/healthcare team think about it? Do they know what's brought about your success?

Fruitandnutcase profile image
Fruitandnutcase in reply to

Very well done to you. You must be so proud of yourself. LCHF is definitely the way to go. At that rate you will need to change your name to Ihavedoneit22 soon.

in reply toFruitandnutcase

Thank you yes I’ve got a lot more to go.🍏🍎

TheAwfulToad profile image
TheAwfulToadAmbassador in reply to

It's so good to hear these success stories. You must be over the moon about putting illness and obesity behind you.

A family friend was in a similar position to you (advanced, undiagnosed T2D with onset of neuropathy). A year later she's lost a load of weight and is taking no medication at all. LCHF diet, of course.

Also curious to know how your healthcare team have responded to your results? Were they the ones who suggested LCHF?

Hi when I started this new eating plan it was in lock down. I was having phone called from my diabetic nurse when I told her that I’ve cut my insulin she wasn’t happy. She said I really should of called her. She is now quite amazed and she did say last week she now wants me to have a blood test which will be my first since starting my weight loss journey. So that’s going to be next month.

But I was so amazed in the weight loss it started coming off, I was a sweetener taker so for me now to only drink herbal teas and two coffees with cream a day is something I would never have believed before May.

No I was given a book all about diabetic food but it was definitely not LCHF I find watching Dr David Unwin was a game changer plus people on here the support is amazing it’s really helped me and kept me focused. 🍏🍎

BridgeGirl profile image
BridgeGirl in reply to

I hope at some point you'll point out to your diabetic nurse that you've reversed your condition in the face of conventional advice, not because of it. And bombard her with Dr Unwin :)

in reply toBridgeGirl

The one thing I’ve done is write everything I eat down from all meals and drinks. I packed up smoking a while ago and I couldn’t believe how things tasted different, I’ve also noticed that my taste has changed again since being on this eating plan. I could never eat pain natural yogurt but now I love it I have 3 tablespoons of it after my main meal of the day it’s so nice and full fat too🍏🍎

BridgeGirl profile image
BridgeGirl in reply to

I eat all sorts of things, now, that I've spent decades say I "don't like"

in reply toBridgeGirl

I love vegetables and my hubby makes a great veggie curry Ive been known to have curry for breakfast lol🍏🍎how much weight have you lost if you don’t mind me askin

BridgeGirl profile image
BridgeGirl in reply to

I've lost 3 stones. From obese to juuuuuuust within the healthy BMI range, so I've re-joined the Maintainers' Club to keep me in order :D I was several pounds lighter in the first half of last year but have let it drift. I'd like to get back there again

in reply toBridgeGirl

Wow that’s amazing, my BMI started at 56 it’s now 48.3 that was 17th August. I was a bread monster and pasta but don’t have any now but I love my food more now. I feel I have learnt when I’m hungry and when I just need a drink. 🍏🍎

BridgeGirl profile image
BridgeGirl in reply to

That's just brilliant! What a turnaround :) You must be very proud of yourself and I bet people who know you are well impressed :)

I could never have imagined life without bread and spuds, and pasta was such an easy meal to do. The last time I bought bread was this time last year when I had visitors staying, and most of that ended up with the ducks. However, I have just bought some baby new potatoes for a recipe for Lytham's fish-off challenge, and now I'm wondering how I'm going to use the rest up. I couldn't find any loose so had to buy a small bag

in reply toBridgeGirl

My hubby eats like a horse and never puts a lb on. When I first started the plan I found it hard when he had toast or a biscuit but now I’m fine about it I can see how my body is changing I still see myself as massive even with the drop in clothing but I think when you have always been big it’s hard to see anything else. I put a sardine salad on that. I think it’s great doing Lythams challenges great fun🍏🍎

BridgeGirl profile image
BridgeGirl in reply to

Me too. It gives me a push to try something new

TheAwfulToad profile image
TheAwfulToadAmbassador in reply to

In your shoes I think I would have been a bit harsher with the diabetic nurse (something along the lines of "why would I seek advice about insulin from someone who clearly doesn't know what it does?"). However you seem to have made a convert there! I do hope she sees what you've achieved and starts preaching it to other patients.

We get quite a few new members who are diabetic or prediabetic, so please stick around and give them some encouragement. Your experience could be immensely helpful to them.

Dr Unwin is a star. I think it's fair to say that thousands of people are indebted to him for a new lease of life.

in reply toTheAwfulToad

I have asked why I was not told about LCHF it was said it’s the type of food in the book but I can’t see it.

I did say why is this not the diet for all diabetics it was again said I’m lucky that it works for me.

Well what I say is Dr David Unwin is the man to listen to I’ve said it before it’s down to the person on here that said to me listen to this. It was that man🍏🍎

in reply toTheAwfulToad

My diabetic nurse did tell me all diets work for different people 🌷

CautiousK profile image
CautiousK

Hi AwfulToad,

I felt extremely mentally inadequate when I read your article.

I was fascinated though and wondered if, with the knowledge you have, you could advise me on my position.

I produce no cortisol so am on hydrocortisone.

Does this affect me losing weight as it is really hard just to shed the odd pound.

My doctor told me that my Gabpentin makes it difficult to shift weight but I am determined.

If it isnt these things i am fighting against then it is my diet choice that isnt working for me, though i am embracing the LCHF diet.

Thanks

CautiousK

TheAwfulToad profile image
TheAwfulToadAmbassador in reply toCautiousK

As StillConcerned said, there are many interactions between hormones, and if you suffer from adrenal insufficiency there is really no exogenous dosing routine that can match what your body would normally do. However if you find that you're accumulating fat in odd places (particularly your face, neck and shoulders) your dose is probably too high and your doctor should tweak it downwards.

I have no idea about gabpentin! I assume this is for an unrelated condition?

The bottom line is that, whatever your drugs might be doing to you, LCHF will give you the best possible chance of avoiding obesity, so stick with it :)

BridgeGirl profile image
BridgeGirl

Hey, ho, indeed

CautiousK profile image
CautiousK

Thank you for the advice 😊

CautiousK profile image
CautiousK

Thank you AwfulToad,

I do intend to as it's the only diet that I havent felt hungry on. It has made me realise that I have developed a snacking habit as i was always hungry before on my low fat everything diet.

This is still embedded in my brain though and i am training myself out of it and avoiding the offer of biscuits and cakes at .my mum and dads daily 😊.

CautiousK

mudgiebananas profile image
mudgiebananas

Thank you

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