Hyperinsulinemia and insulin resistance T2D 22

posted in: Diabetes, Health and Nutrition | 42

Insulin causes insulin resistance

Laura was only 25 when she was diagnosed with an insulinoma, a rare tumor that secretes abnormally large amounts of insulin in the absence of any other significant disease. This forces blood glucose very low causing recurrent episodes of hypoglycemia.

Laura was constantly hungry and soon began to gain weight. As insulin is a major driver of obesity, weight gain is consistent symptom of the disease. She noticed problems with concentration and coordination, as she had inadequate glucose to maintain brain function. One night, as she was driving, she lost control of her feet and narrowly avoided an accident. She had experienced a seizure related to hypoglycemia. Fortunately, the correct diagnosis was soon made and she had corrective surgery.

Laura’s symptoms may appear severe, but they would have been much worse, if her body had not taken protective steps. As her insulin levels increased, insulin resistance increased in lock step—a protective mechanism and a very good thing. Without insulin resistance, the high insulin levels would rapidly lead to very, very low blood sugars and death. Since the body doesn’t want to die (and neither do we), it protects itself by developing insulin resistance— demonstrating homeostasis. The resistance develops naturally to shield against the unusually high insulin levels. Insulin causes insulin resistance.

Surgical removal is the preferred treatment and dramatically lowers the patient’s insulin levels. With the tumor gone, insulin resistance dramatically reverses, as do associated conditions. Reversing the high insulin levels reverses insulin resistance. Exposure creates resistance. Removing the stimulus also removes the resistance.

This rare disease gives us a vital clue in understanding the cause of insulin resistance.

Homeostasis

The human body follows the fundamental biological principle of homeostasis. If things change in one direction, the body reacts by changing in the opposite direction to return closer to its original state. For instance, if we become very cold, the body adapts by increasing body-heat generation. If we become very hot, the body sweats to try to cool itself. Adaptability is a prerequisite for survival and generally holds true for all biological systems. Resistance is another word for this adaptability. The body resists change out of its comfort range by adapting to it. Exposure creates resistance. Excessively high and prolonged levels of anything provoke resistance by the body. This is a normal phenomenon.

Noise

The very first time you yell at somebody, they jump back and pay immediate attention. Incessant yelling, though soon negates its effect. In essence, they have developed ‘resistance’ to the yelling. The boy who cried wolf soon learned that the villagers became resistant to its effect. Exposure creates resistance.

Removing the stimulus removes the resistance. What happens when the yelling stops? If the boy who cried wolf stopped for a month. This silence resets the resistance. The next time he cries wolf, it will have an immediate effect.

Have you ever watched a baby sleep in a crowded, noisy airport? The ambient noise is very loud, but constant, and the baby sleeps soundly, as it has become resistant to its effect. That same baby sleeping in a quiet house might awaken to the slightest creak of the floorboards. This is every parent’s worst nightmare. Even though it is not loud, the noise is very noticeable, as the baby has no ‘resistance’.

Antibiotics

When new antibiotics are introduced, they kill virtually all the bacteria they’re designed to kill. Over time, some bacteria develop the ability to survive high doses of these antibiotics turning into drug-resistant “superbugs”. Superbugs multiply becoming more prevalent, until the antibiotic loses its effectiveness. This is a large and growing problem in many urban hospitals worldwide. Every single antibiotic has lost effectiveness due to resistance.

Antibiotic resistance is not a new phenomenon. Alexander Fleming discovered penicillin in 1928 and mass production began in 1942, with funds from the U.S. and British governments for use during WWII. In his 1945 Nobel lecture “Penicillin,” Dr. Fleming correctly predicted the emergence of resistance two years before the first cases were reported.

How did Dr. Fleming so confidently predict this development? He understood the fundamental biological principle of homeostasis. A biological system that becomes disturbed tries to go back to its original state. As we use an antibiotic more and more, organisms resistant to it are naturally selected to survive and reproduce. Eventually, these resistant organisms dominate, and the antibiotic becomes useless. Persistent, high-level use of antibiotics causes antibiotic resistance. Exposure causes resistance.

Removing the stimulus removes the resistance. Preventing antibiotic resistance requires severe restrictions on their use. Many hospitals have developed Antibiotic Stewardship Programs where antibiotic use is monitored for appropriate use only. This preserves the effect of the most powerful antibiotics for life-threatening situations. Unfortunately, the knee-jerk reaction of many doctors to antibiotic resistance is to use more antibiotics to “overcome” the resistance—which backfires. This only creates more resistance.

Viral resistance

Resistance to viruses like diphtheria, measles, chicken pox or polio develops from the viral infection itself. Before the development of vaccines, it was popular to hold ‘measles parties’ or ‘pox parties’, where unaffected children would play with a child who was actively infected with measles or chicken pox. Having measles once protects a child for life. Exposure causes resistance.

Vaccines work this exact principle. Edward Jenner, a young doctor working in rural England, heard the common tale of milkmaids developing resistance to the fatal smallpox virus because they had contracted the milder cowpox virus. In 1796, he deliberately infected a young boy with cowpox and observed how he was subsequently protected from smallpox, a similar virus. Through being inoculating with a dead or weakened virus, we build up immunity without actually causing the full disease. In other words, viruses cause viral resistance.

Drug resistance

When a drug, such as cocaine is taken for the first time, there is an intense reaction—the “high”. With each subsequent use of the drug, this ‘high’ becomes progressively less intense. Drug abusers may start taking larger doses to achieve the same high. Through exposure to the drug, the body develops resistance to its effects—a condition called tolerance. People can build up resistance to many different types of drugs including narcotics, marijuana, nicotine, caffeine, alcohol, benzodiazepines, and nitroglycerin. Exposure creates resistance.

Removing the stimulus removes the resistance. In order to restore sensitivity of the medication, it is necessary to have a period of low drug use. If you stop drinking alcohol for a year, then the first drink afterwards will have its full effect again.

Mechanisms

Resistance develops through many different mechanisms. In the case of noise, stimulus fatigue is the mechanism of resistance. The human ear responds to changes rather than absolute noise levels. In the case of antibiotics, the natural selection of resistant organisms is the mechanism. In the case of viruses, the development of antibodies is the mechanism of resistance.

In the case of drug resistance, cell receptors become down regulated via constant exposure. To produce a desired effect, drugs act upon receptors on the cell surface. Morphine, for example, acts upon opioid receptors to provide pain relief. When there is a prolonged and excessive exposure to drugs, the body reacts by decreasing the number of receptors. Hormones, like insulin also act upon cell receptors, and show the same phenomenon of resistance.

While the mechanism may differ, the end result is always the same. Exposure creates resistance. This is the point. Homeostasis is so fundamental to survival that the body will find many different ways to develop resistance. Survival depends on it.

Insulin causes insulin resistance

Let’s recap:

Loud noise creates resistance to loud noise.

Antibiotics create resistance to antibiotics.

Viruses create resistance to viruses.

Narcotic use creates resistance to narcotics.

Alcohol use creates resistance to alcohol.

The prime suspect in causing insulin resistance is insulin itself!

Proving it experimentally is quite simple and luckily, all the experiments have already been done. A forty-hour constant insulin infusion into a group of healthy young people caused 15 percent greater insulin resistance. A ninety-six-hour constant intravenous infusion of insulin reduced insulin sensitivity by 20 to 40 percent even though levels were physiologic. The implications are simply staggering. With normal but persistent amounts of insulin alone, these healthy, young, lean men can be made insulin resistant. Insulin causes insulin resistance. I can make anybody insulin resistant. All I need to do is give enough insulin.

In type 2 diabetes, large doses of insulin create insulin resistance. In one study, patients initially not taking insulin were titrated up to 100 units of insulin per day. Blood glucose was low. But the higher the insulin dose, the more insulin resistance they developed—a direct causal relationship, as inseparable as a shadow is from a body. Even as blood glucose got better, the diabetes was getting worse! Insulin causes insulin resistance.

Persistence creates resistance

High hormonal levels by themselves cannot cause resistance. Otherwise, we would all quickly develop crippling resistance. We are naturally defended against resistance because we secrete our hormones—cortisol, insulin, growth hormone, parathyroid hormone or any other hormone—in bursts. High levels of hormones are released at specific times to produce a specific effect. Afterwards, the levels quickly drop and stay very low.

Consider the body’s daily circadian rhythm. The hormone melatonin, produced by the pineal gland, is virtually undetectable during the day. As night falls, it increases to peak in the early morning hours. Cortisol levels spike just before we awaken then drop down to low levels. Growth hormone is secreted mostly in deep sleep then drops to undetectable levels during the day. Thyroid-stimulating hormone peaks in early morning. This periodic release is essential in preventing resistance.

Hormone levels usually stay very low. Every so often, a brief pulse of hormone (thyroid, parathyroid, growth, insulin—whatever) comes along to create maximum effect. After it passes, levels are very low again. By cycling between low and high levels, the body never gets a chance to adapt. The brief pulse of hormone is over long before resistance has a chance to develop.

Remember that baby in the quiet room? What our body does, in effect, is to continually keep us in a quiet room. When we are momentarily exposed to a sound, we experience the full effect. We are never have a chance to get accustomed to it—to develop resistance.

High levels alone cannot create resistance. There are two requirements—high hormonal levels and constant stimulus. Consider the experiment described earlier that used constant infusions of insulin. Even healthy young men quickly developed insulin resistance with normal levels of insulin. What changed? The periodic release.

Normally, insulin is released in bursts, preventing the development of insulin resistance. In the experimental condition, the constant bombardment of insulin led the body to down regulate its receptors and develop insulin resistance.

The Knee-Jerk Reaction

The knee-jerk response to the development of resistance is to increase the dosage. However, this behavior is clearly self-defeating. Since resistance develops in response to high, persistent levels, raising the dose in fact raises resistance. It’s a self-reinforcing cycle—a vicious cycle. Exposure leads to resistance. Resistance leads to higher exposure. And the cycle keeps going around. Using higher doses has a paradoxical effect.

For example, in the case of antibiotic resistance, we respond by using more antibiotic. We use higher doses or newer drugs to try to ‘overcome’ the resistance. And it works, but only for a short while. As more antibiotics are used, more resistance develops. This only leads to even higher doses of antibiotics. In the end, this vicious cycle is self-defeating.

Cocaine addicts know well the response to drug resistance. Each ‘hit’ of cocaine evokes a progressively weaker response as the body becomes resistant to cocaine’s effects. Their knee-jerk reaction is to increase the dose of drugs to maintain the same ‘high’. This works to overcome the resistance but only temporarily. As doses escalate, the resistance becomes more severe. Which leads to even higher dosages, in a vicious cycle.

Alcohol abusers suffer the same vicious cycle. As they develop resistance to alcohol’s effects, they drink more and more to get the same effect. This works to overcome resistance, but only temporarily.

When we yell at somebody for the first time, it has a great effect. As the effect wanes, we yell even louder to overcome this ‘resistance’. This works, but only temporarily. Pretty soon, we are constantly yelling with little effect.

In the same manner, insulin resistance induces the body to produce even more insulin to “overcome” the resistance. But unfortunately, hyperinsulinemia drives itself in a classic self-reinforcing, or vicious cycle. Hyperinsulinemia leads to insulin resistance, which only lead to worsening hyperinsulinemia. This also drives weight gain and obesity.

The cycle keeps going around and around, one element reinforcing the other, until insulin is driven up to extremes. The longer the cycle continues, the worse it becomes—that’s why obesity and insulin resistance are so time dependent. People can be stuck going around this vicious cycle for decades, developing significant insulin resistance. That resistance leads to high insulin levels that are independent of that person’s diet.

But the story gets worse. Insulin resistance, in turn, leads to higher fasting insulin levels. Fasting insulin levels are normally low. Now, instead of starting the day with low insulin after the nightly fast, we are starting with high insulin. The persistence of high insulin levels leads to even more resistance.

Slowly, this idea is gaining widespread acknowledgement. Dr. Barbara Corkey, a researcher at Boston University’s School of Medicine was awarded the 2011 Banting Medal for Scientific Achievement. This is the American Diabetes Associations highest scientific award. In her Banting Lecture, she wrote, “hyperinsulinemia is the root cause of insulin resistance, obesity and diabetes”, with evidence that “hypersecretion of insulin can precede and cause insulin resistance”.

The consequences are dire. The fat get fatter. As insulin resistance becomes a larger and larger part of the problem it can become, in fact, a major driver of high insulin levels. Obesity drives itself.

The hallmark of type 2 diabetes is elevated insulin resistance. By rearranging our diagram, we can see that both obesity and type 2 diabetes are manifestations of the same underlying problem – hyperinsulinemia. Their close relationship has given rise to the term ‘diabesity’ which implicitly acknowledge that they are in fact, one and the same disease.

Obesity does not cause type 2 diabetes. That is the reason that researcher have been unable to find the causative link despite intensive research efforts. Instead, both diseases were caused by a single factor – hyperinsulinemia. It appears that we may have just found Dr. Reaven’s mysterious ‘X’ factor.

42 Responses

  1. what usually stimulates over production of Insulin ? and starts this vicious cycle of hyperinsulinemia?
    10X

    • Eating lots of sugar/starch rich foods and eating “constantly”. Your body never gets a break. When you eat very low carb foods and skip a few meals your body has a chance to reverse this condition.

      • Rajesh Pankaj

        I think you are right. However, that’s not 100%. There are other unknown underlying reasons for hyperinsulinemia(Please refer to last post regarding Syndrome X)

        • Correct! Not black and white at all! Dina, if you are new to this site, there is a TON of information here. Regardless of the causes, cutting sugar and carbs and skipping (fasting) meals is the best place to start.

  2. Les Walters

    Down with grazing! Beware of the temptation of frequent ‘nibbling’. I’ve found that intermittent fasting with a ketogenic diet (LCHF) is not only reducing my insulin resistance, but lowering my weight and my hunger/cravings. Many thanks to Dr Jason for his wisdom and commitment to public health.

    • In general, I think it is a huge mistake to readers to conflate low carb and ketogenic, Current guidelines are for a daily carb goal of 55% of total calories. If one were to have a 2000 cal/day diet that would be 1100 cal from carbs. This would be 275 g of carbs, at 4 cal/gram. If one were to take “low carb” as 50% or less of recommended carbs per day, low carb would be around 137g of carbs. For myself, I set a carb count threshold of 30% or 82g. A Keto diet is about an order of magnitude less than a low carb diet, think Atkins induction phase, <10g. Now, if you limit carbs to less than 80g/day and eliminate (or reduce) refined carbs and starches which, btw, are the real issue, you still accomplish goals set by Dr Fung's recommendations as set forth in OC and CGtF, without conflating those goals with an Atkin's style diet. But insulin resistance isn't caused by high carbs, it's caused by persistent and high carbs, the worst being sugars and refined flour products.

  3. Insulin resistance and homeostasis are two vital processes important to our survival, but when it when they become too prominent over decades, they are obstacles difficult too overcome.

    As 66 year old woman with decades long weight issues and T2 Diabetes first diagnosed 15 years ago, battling this 2 headed Hydra has been a constant challenge to my perseverance. I have been losing and gaining the same 10 lbs for 6 months, despite LCHF, short term fasts, and even 5 and 7 day fasts.

    Right now, I am on a losing streak again. Recently, I have found the Insulin Index to be very helpful. The insulin index is like the glycemic index, but compares the increase in insulin levels of foods compared with white bread. I found that eggs, bacon and oily cold water fish like herring and mackerel increase insulin levels less than do cheese, beef, and tuna.

    I also discovered that not all carbs are the same, and that I lose more weight and have better BG levels eating kale rather than green beans. I eat about 1/2 cup in total of whole flax seeds per day. This helps tremendously with regularity. I am hoping that using this new strategy my body will eventually overcome this frustrating plateau.

    Two other things, which are not diet related, but I believe help lower my cortisol levels by improving my quality of sleep: I wear a black eye mask to block out all light when I sleep and I take melatonin 1 to 2 hours before I go to bed.

    I hope that this will help some other people with their IR issues.

    • @Birgit, have you read Dr Fung’s “Obesity Code” and “Complete Guide to Fasting”? Personally, I think there is a lot of overlap but they aren’t expensive to read both. I believe the key ‘take-away’ from either is diets fail, they all fail. A plateau is your body re-adjusting it’s metabolism to match the calories you are giving it. The key to preventing and relieving insulin resistance is break the persistent and high levels of insulin. I believe the key is to not over-think this. Years ago, the latest fad was “Fat, Sick, and nearly Dead”, which led to a fad diet of juicing. Maybe it’s still a thing. If one juiced for two full months they could loose n lbs. The problem was I believe only 2 people ever juiced for 60 day. The important thing is, from my perspective, is the fan club that ensued which degenerated into lay people giving incredibly bad faux medical advice to other lay people in direct opposition to medical advice given by their doctors. In short, it became a religion. As with all religions, by definition, they are faith based, not fact based.

      Something else to consider, as was asked of me when sent to see a dietitian, “what’s your primary concern, T2D or weight loss”? Other important books to read and research to do,
      “The 8 week blood sugar diet” by Dr Michael Mosley.
      Google and watch “Reversing the Irreversible” by Dr Roy Taylor.
      Google and read anything dealing with New Castle Magnetic Resonance Centre” and Taylor.
      Google and read any material on Dr Joseph Kraft.

      So, in the last year+, I’ve dropped 125lbs and lowered my A1C from 8.5 to 5.5, which has been very consistent now for 3 successive readings, ~ 12 months.
      Good luck on your journey.

      • Roy Taylor speech – https://campus.recap.ncl.ac.uk/Panopto/Pages/Embed.aspx?id=c3bef819-e5f4-4a55-876f-0a23436988ed&v=1

        • Hi Walt, congratulations on your weight loss , and I thank you for suggestions.

          Yes, I have read The Obesity Code, and Dr. Fung’s book on Fasting. I have done a lot of research on Intermittent Fasting, Ketogenic Diets, and general LCHF. I have learned from Phinney, Volek, Noakes, Attia, Westman, Eenfeldt, Eades, Taubes, Wortman, Rosedale, Malhotra and many others. As well, I frequently refer to the optimizing nutrition website for more specific information and many others. Not all of these people agree on the details. so I do a lot of experimenting, recording, and analysing to find what works for me. I also use the “eating to your meter” technique to determine what which meals are most effective for me.

          During this year, I have discovered that there are many factors, as Dr Fung has said, that affect weight loss and blood glucose levels.

          I do what I can to increase my overall health and decrease stress levels. I suffer from severe chronic pain 24/7. I cried myself to sleep each night and wanted to die because of the unbearable pain for many years. Up until 10 months ago, I was on prescribed opiods and powerful Nsaids to attempt to manage the pain. Sleep was a major problem, and my blood oxygen concentration often dipped below 85% at night.
          I no longer require Nsaids and opiods because of some unconventional wholistic methods I started last year. I have now got the pain mostly under control although I still have severe pain every day. All of these things take time, often many months, until you get results.

          As I mentioned, I am back to losing weight again. You may have noticed that I am a 66 year old woman with a 15 year history of diagnosed T2D. I also turn to the optimizing nutrition website very often because it is chock full of helpful information with a lot of research back up. I also mentioned that I have some other issues related to stress/cortisol. When I was younger I went on the Atkins diet and lost 120 lbs in a little over one year. That was then, this is now.

          You will notice that Dr Fung says that people who have been insulin resistant for decades need to more aggressive in their approach and that the desired effect will take longer to achieve. Hei also acknowledges that there are many other factors which contribute to insulin resistance, weight loss and high blood sugars.

          I wrote my post mainly to highlight what has worked for me in my struggle to overcome this weight loss plateau. And, to humbly give other people who may be facing the same situation some encouragement that they can eventually overcome this.

          What works for me will not work for everyone. Homeostasis is a powerful force in human metabolism, and in my experience, people who are having difficulty might try recording their macros, blood sugars and weight loss on a daily basis to provide a database that can be analysed to determine what works for them. also, try to identify what other factors might be involved, and seek out strategies to mitigate them.

          My main message is, do your ongoing research, recording and analysis to find what works for you. If you are having difficulty, try to figure out what factors other than what and when to eat might be hindering your weight loss and blood sugar control.

          • Thanks Birgit, that’s precisely what I’ve been doing since May of 2015. I am completely awed by the number of doctors and so-called dietitian that still maintain T2D is a chronic progressive disease. The final thing I forgot to mention about Dr Taylor is he definitively proved full islet / beta cell functionality is restored once you rid yourself of fatty liver and fatty pancreas. That IS new as the chronic/progressive came from by the time an autopsy would be performed, yes, the pancreas was shot and islets destroyed. But if you converse with someone not understanding the problem they can never understand the solution either.

      • Walt,
        I agree very much with your posting.
        I have dropped A1C from high of 7.2 to 6.1 and intend to drop below 5.5
        In effort to lower A1C I have lost approx 43 pds. I believe if I loose my final 25 pounds that my A1C will be in the very healthy range. Intermittent fasting is a big part of my strategy. I have also incorporated LCHF, Ketogenic, Atkins, but am never truly satisfied eating this way. I might do the 8 week blood sugar challenge – I agree with that strategy and that quick is perhaps better than slow weight loss.
        If you can share, how have you successfully lost 125 pounds, and can you say what you ‘typically’ eat?
        I am of the mindset that whole is good, and that going too LCHF or Ketogenic, might be keeping me stalled on this plateau I have been on for the last couple of months. Stubborn final 25.
        I also enjoy researching, particularly Dr Fung and other true advocates of lowering insulin.

      • Hi Linda, As much as I hate to admit it, especially here, the vast majority of that 125lbs was lost through diet and MFP. I am willing to stipulate the exercise regiment had little to do with the pure weight loss but I was trying to burn an extra 600 cal/day. 6 days/wk at the gym. The first 20lbs came off all by itself which led me to believe stress was a major factor in putting on most of it. It is not clear to me in the absence of MFP how much weight I would have lost simply by having retired (stopped working an extremely stressful job). Dr Roy Taylor’s work is pivotal as it does two things:
        1st) T2D is curable, esp if caught early.
        2nd) T2D is triggered by exceeding your body’s BMI set point which everyone has, independent of body weight. Dr Mosley, for example is self defined as TOFI, thin on the outside, fat on the inside. Once you breach that BMI setpoint going back down, your A1C will normalize and this could occur with as little loss as 30lbs.

        Frankly, I ate what I always ate. The bulk of that weight loss occurred before I even knew who Dr Fung was. We ate Prince Spaghetti on Prince Spaghetti Day, I have Raisin Bran for breakfast. It was only after my initial determination of T2D that my research led me to Dr Taylor, and later, Dr Fung. Post watching Dr Fung’s YouTube vids I merely eliminated sugar (pretty much already had) and refined flour, except for bread for my ham or turkey sandwich for lunch.

        I, frankly, don’t know how much effect any of what Dr Fung advocates has worked for me. It may well be it is in my A1C more than my total weight. I think my low weight was during an extended fast and once I broke that I gained back the water weight. So I, too, have that stubborn 20 or so lbs to go. I’ve fasted for just shy of 5 full days a couple of time and in the 4 day +/- several more. I think it nibbles around the edges causing, perhaps, some oscillation in my weight. I’ve done a lot of 24 hour fasts where i eat once a day. That doesn’t appear to do squat. Frankly, I am becoming skeptical. I see a lot of people talking about VLC diets as if they were just reduced carb diets but I’ve heard nobody on here say they hit their target and now they are strictly in maintenance mode. The idea behind a Diet is there is an end to it. There is a lot of money to be made in advertising the next successful diet, be it grapefruit, South Beach, Atkins, Zone or “will I lose weight if I stop eating?” Diets. As I’ve said on here in the past, I feel a lot like Fox Mulder (“I want to believe”) but I am seeing scant evidence of it. I just honestly don’t believe only eating two days a week, there’s a guy on here that has/is doing that, is what success looks like.

        Linda, I am thinking the answer to your situation as well as mine, is resistance training…aka build muscle mass. I’ve been doing primarily cardio. Fat has a very slight caloric footprint compared to lean mass (muscle). Eat no more than you are now but focus on shoulders, upper arms, legs and abs and that will raise your metabolism so you should see the weight loss resume.

        Oh yes, and I tried juicing for a while there as well until I realized it was ridiculously expensive and not a long term solution to anything. So, if something looks like a belief, sounds like a belief, is it fact? I don’t know. I’ve asked way too many unanswered questions on here.

        Finally, people are way too hung up on body image. Maybe the goal should really be to not be diabetic. After that goal is reached move to the next, if there is a next.

        • Thank you Walt.
          I also am skeptical of LCHF & Ketogenic – plus find it too hard to follow daily. But I do agree with the intermittent fasting, and with a re focused effort, am planning to eat just one meal per day within an hour window. Perhaps eating twice on the weekends. My goal has always been to drop my A1C to below 5.5, but it did drop in accordance with some weight loss. I got that benefit at least. Body image is only important to me as to how I feel. And I do feel a whole lot better being lighter!
          OMAD meal will include some carbs, just not the sugary and refined types. I am thinking the one spike per day in insulin will do the trick, more like a meditteranean way of eating, one that is enjoyable and not too restrictive. Ketogenic causes me to crave all those foods I am ‘not supposed to have. And I don’t have time to make my own breads etc, and they just don’t taste anything like bread…
          All the best

    • Phillip Actor

      Birgit, how high/low are your BGs, just out of curiousity? I wonder, as I also suffer physiological insulin resistance, if we really need to get to 4 mmol? I notice I plateau or gain when my FBG > 6.5 on a 7 day average, but I always lose when it is even only marginally lower. Just by NOT eating on a day my FBG is > 6.5, I seem to have killed my most recent plateau. Just two cents that may help!

    • Roger Bird

      Birgit,

      You might want to check out EWOT, exercise with oxygen therapy. I am on my 18th day, and it is fan-freaking-tastic. I won’t ever quit until I die, and I am not sure that that is ever going to happen. Seriously.

    • Martin Williams

      Birgit: Exercise isn’t mentioned much on this forum, because it’s known that you can’t burn off calories significantly with it. Moreover, the body can compensate by raising appetite. Nonetheless, Krista Varady says in her book that those of her subjects who exercised lost twice the amount of weight as non-exercisers on her EOD protocol. Varady’s method isn’t true fasting of course, but the science is there: it works. (Though I’m saying that without knowing about any replications by other labs, to be honest.)

  4. Birgit –

    How much melatonin do you take nightly?

    What’s a good source for an insulin index?

    What is your fasting blood sugar nowadays?

    Good luck to you!

    • Hi Allen,

      Melatonin requirements vary greatly from person to person, depending on natural light exposure during the day, and ambient darkness at night. Most doctors will recommend Melatonin when asked, and will tell you what dosage is right for you. I found that Melatonin plus wearing a black eyemask so that I sleep in Total Darkness was the optimal combination.

      There has not been a lot of work done on the Insulin Index, the main research was done at Sydney University by Kristine Bell.

      https://ses.library.usyd.edu.au/bitstream/2123/11945/2/Bell_KJ_thesis_2.pdf

      Optimizing Nutrition has an extensive detailed database of blogs here is a link to their take on insulin resistance

      https://ses.library.usyd.edu.au/bitstream/2123/11945/2/Bell_KJ_thesis_2.pdf

      I avoid all grains and use the insulin index mainly to choose which protein foods raise insulin the least. I generally choose foods whose insulin index score is less than 50.

      I do not think that knowing my blood sugar levels would be helpful to you, as this is very individualized.
      I would suggest the “eating to your meter” approach to lowering BG.

      In my daily log, I record Carbs, Fibre, Carbs Net of Fibre, Protein, and Fat. I also do a rough calculation of Insulin Load by adding 50% of Protein Grams to Net Carb Grams. I personally try to keep that number at around 50, but this is a very individualized value, and will differ from person to person.

      I wish you good luck as well.

      I wish you good luck as well

  5. Ron Hunter

    So, which is worse – glycation end products or insulin? I’m a ketogenic diabetic and doing well but I do love an occasional glass of wine. Usually when I imbibe, my fasting blood glucose may be 180 to 200. My usual mode is to give myself about 15 units of Lantus when I see this. What’s the best course of action?

  6. Cheryl McMaster

    Hello Birgit,
    If you go to optimisingnutrition.com you will find charts that Marty has complied to help us find the correct foods for the insulin index with the highest nutritional values, one that top the charts is, as you have experienced , kale and spinach. Good luck You have found the correct sites for health improvement and information..

  7. Having measles once protects a child for life. Exposure causes resistance.

    Then why have I had measles 4 times, and chickenpox 2 times (pre-vaccine)? Since this time, I’ve had 2 MMRs, and plan on getting the shingles shot when old enough.

    Speaking of childhood illnesses, I’ve never had the flu, and never had a flu shot. Measles, I can do (it seems). Mumps, the flu, head lice, and other common childhood maladies are right out–never had them.

    • I’ve become increasingly sceptical about vaccines. The flu vaccine has been very ineffective for years and the number of people suffering side effects has far outweighed the benefits. When I was a child we built up what was usually lifetime immunity from measles, chicken pox and other viruses. There seems to be one scandal after another with fixed drug trials or fabricated reports. This is a sensitive subject, so I’d simply recommend that people investigate thoroughly before accepting vaccines. Here’s a short interview with one ER doctor.

      https://www.youtube.com/watch?v=5yNcaLjb45k&t=18s

      • Stephen T,

        Please stick to the topic on this forum, which is NOT A DISCUSSION ON THE PROS AND CONS OF VACCINES. This is a forum which talks about how Fasting in its various forms, and how low carb diets and along with healthy whole foods contribute to weight loss and blood glucose improvement for T2 Diabetics by reducing Insulin resistance.

        Please find another forum if you wish to discuss vaccines.

        • Birgit, I responded to a comment about vaccines by Wenchypoo, or didn’t you notice? It is not for you to close down discussion at the point that begins to irritate you. You are free to ignore or not to take part. Trying to close down the debate on vaccines is the problem and not the solution. No discussion is free of digression and people can decide whether they’re interested or not.

          • Stephen,
            You have the last word.

          • Correct Stephen T!! Dr Fung is dedicated to our health and well-being. I too am very, very skeptical about vaccines!! Point to be made is we all should look closely at what we allow into our bodies, both food and medicine. If a post doesn’t resonate with someone then just pass it by. Not every opinion works for every person. I think if there is one thing we have learned from Dr. Fung is there is a lot of money behind medicine and to be wary about it’s true value related to our health.

  8. Roger Bird

    I’ve done micro-nutrient rich ketogenic dieting. It is now a life-long habit. I’ve done intermittent fasting. It is now a life-long habit. I just started doing EWOT, or exercise with oxygen therapy, and I am making that a life-long habit.

  9. Cannot manage what you do not measure. How is insulin resistance measured? What lab tests should I track to measure insulin resistance? Thanks

  10. Richard S Stone

    I have been on a long term (over 6 years now) high fat, low carb diet. I lost weight at first, and then stopped losing weight. Obviously the diet “worked” for a while. I was never seriously overweight, maybe only 15 pounds over that I wanted to weigh. So far as I know I have never had a diabetes problem.

    I recently (about a year ago) discovered this site. I started fasting, first just not eating “breakfast” until 1pm or so, and now by doing that most of the time and occasionally, meaning 2-4 times per week, only eating once in 24 hours. That is plenty of time for the body to recover from a good meal and have very low insulin levels. It is long enough to get the fat out of the liver and to naturally and regularly induce autophagy.

    Reading this site and others makes me think that long term overproduction of insulin and the associated weight gain and other issues create their own issues and, although those issues are entirely reversible, the situation for those people is different from my own.

    But for me the idea is that simply delaying “breakfast” until 1pm or so produces good results and some weight loss. It is a good long term plan. Second, if I find myself eating an early breakfast, with friends perhaps, in the morning, I do it without guilt or worry, because I know that my body will produce the proper amount of insulin to deal with it and I will not have any bad response. The next day I will be back on my usual schedule. Meanwhile, if I am offered cake at a birthday party I always eat a piece or two, knowing that the next day I probably will not eat until dinner at 7pm.

    To me the whole program is liberating: You are almost certainly not going to gain weight, regardless of what you eat, on one meal per day. Assuming you have some sense about the whole thing. Now, from what I have read here, if someone is 100 lbs over weight, and insulin resistant, that is something entirely different. One could probably, and should probably, fast for days at a time, if not longer. But even once the 100 lbs is gone, the intermittent fasting program has to be in place..

    • Hi Richard. You should probably read, not only, Dr Joseph Kraft but Dr Michael Mosley. Mosley referred to himself as TOFI (thin outside fat inside). Don’t be so fast to cast aspersions on those 100lbs overweight. In my case, I had JUST become diagnosed as diabetic, now my A1C is normal and has been for about a year. Insulin resistance starts LONG before a diagnosis of T2D. This is the whole point of Dr Kraft’s research. People develop insulin resistance a decade or so before a clinical diag of T2D. You may well be diabetic, in other words, just not have been told yet. If you were to read Dr Roy Taylor everyone has their BMI threshold, above which insulin resistance and, ultimately, T2D; below which the body returns to full normal function. T2D requires insulin resistance, not the other way around.

    • My point was, per Dr Taylor, I may well have simply lost 30lbs and had normal liver/pancreas function return. Yes, I’d still have been obese, just not diabetic. Now I am neither.

      • Just not diabetic OR insulin resistant. Use the url and watch Dr Taylor’s “Reversing the Irreversible”. In very short order, in all his clinical trials, people returned to near normal insulin response within a week and better than baseline control group within 8 weeks.

  11. Does fasting cause constipation? If so, what’s the best advice?

    When I began to fast I noticed this effect. I assume as insulin drops, water is lost, so there’s a need to drink more water to replace it. This does seem to be a side effect of fasting for some and I would appreciate readers’ thoughts. I’ve tried drinking more but it doesn’t seem to be a complete solution. Maybe our system adapts in time?

  12. Try having your coffee with butter.

  13. Do you think Low Carb Diet and intermittent fasting will help thyroid function to the point you would not need meds?

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