Insulin resistance

Question 1

What is insulin resistance?

Answer 1

Definition of insulin resistance - There is a when there is a less than expected biological effect for a given concentration of insulin in the blood.

Basically, the body is resisting the effects of insulin.

Two broad categories of presentation –
* Type A – Genetic - anti-insulin antibodies are absent, genetic category.
* Type B – Acquired - arises due to presence of anti-insulin antibodies, acquired category. The largest category.
* There is also a Mixed category.

Epidemiology of insulin resistance
* Sex – Slight tendency for insulin resistance to occur in women more than men
* Race – Overall tends to be higher in white populations
* Age – type A (genetic) occurs in younger adults, type B (acquired) around middle age

Lifestyle, environmental and socio-economic factors may affect the above

Question 2

What causes insulin resistance?

Answer 2

Acquired is often caused by:
* Sedentary lifestyle - the main baddie with
* Poor diet - pancreas, stomach, liver
* Ageing
* Hyperglycaemia
* Certain medications

Genetic - Tends to arise from mutations of the following. Hard to mitigate the cause but can support the symptoms
* Insulin receptor proteins - where the insulin docks
* Glucose transporter proteins - where the glucose gets moved around
* Signalling proteins - the communication system

The role of inflammation
* Pro-inflammatory cytokines arising from excess adipose tissue negatively affect insulin action by promoting chemical activity in the intracellular environment that directly opposes insulin receptor signaling.
* This is perhaps the most useful aspect of insulin resistance, apart from diet, for herbalists to approach support and treatment.
* Salicylate containing plants may be most
beneficial here (see the paper ‘Inflammation and Insulin Resistance’ J Clin Invest. 2006 Jul 3; 116(7): 1793–1801.)”

Question 3

What is the pathophysiology of insulin resistance - Signalling?

Answer 3

Pathophysiology of insulin resistance -Signalling pathway to start

• Elevated blood sugars = cause
• Release of Signal mediators = cause
• Insulin secretion from beta cells, to start to lower the glucose levels

Signal mediators might be: Fatty acids, Glucose, Hormones, Autonomic nerves

What happens if the signals or beta cells fail? We end up with
* Inadequate insulin concentrations to reduce blood sugars
* Impaired fasting glucose - you should be able to maintain a normal range of fasting glucose, yet you can’t
* Impaired glucose tolerance - if you ate something, you may over-respond/hyperglycemia
And ultimately, Type 2 diabetes

Question 4

What is the pathophsyiology of insulin resistance - Binding?

Answer 4

When a signal goes to a cell, something has to bind to a recpeto to make something happen

Usually

• INSR - receptors, binding happens
• IRS - insulin receptor substrate
• Signalling effectors
• Insulin response

Decreased receptors, mains a failure of binding

Question 5

What are the social factors that influence insulin resistance - acquired?

Answer 5

Social factors – why? Peer pressure can also contribute

Educational background:
- Understanding health information
- Habits of eating and exercise initiated in the educational setting

Employment and income:
* Sufficient/insufficient income for healthy eating
* Time and money for active leisure pursuits

Consider accessible and simple ways to introduce lifestyle changes – no cost exercise (e.g. free apps, walking, outdoor team
games for children)

Also low cost easy diet substitutions and time saving changes (e.g. batch cooking)

Question 6

What are the dietary factors that influence insulin resistance - acquired?

Answer 6

Problematic foods:
- Ultra-processed e.g. ready meals, store
bought cakes and biscuits, highly processed meats
- High sugar: e.g. confectionery, undiluted
fruit juices, high sugar squash, some breads

Problematic cooking methods:
- Deep frying: introduces extra fats, inflammatory effects of burnt foods
- Boiling: reducing nutritional value of
vegetables
- Using polyunsaturated fats in cooking: potential damaging changes to the oil’s structure during cooking

Beneficial foods:
- The ‘Mediterranean diet’: vegetables, fruits, wholegrains, beans, nuts, olive oil, fish
- Low glycaemic index foods: e.g. porridge
oats, sourdough bread, sweet potatoes

Beneficial cooking methods:
- Roasting with minimal added fats
- Stir frying/steam frying
- Grilling
- Braising

Herbals:
* Consider bitters - benefically stimulating for digestive functions
* Herbs which are hypoglycemic such as cinnamon, and
* GIT demulcents which can soothe the gut.