Insulin Resistance – Hormonal Obesity VIII

Insulin is a major driver of obesity.  But what drives insulin?  In some cases, certain foods drive the increase in insulin.  But there are clearly some time dependent factors about obesity that are unaccounted for.  What am I talking about?

Consider this.  There are people who have been overweight or obese for their entire lives.  For them, it is extremely difficult to lose weight on a permanent basis.  On the other hand, there are people who have only recently gained weight.  For them, it seems that it is much, much easier to lose the weight.  Why is that?

Most conventional theories of obesity do not allow for these effects.  Consider the Caloric Reduction as Primary (CRaP) theory, also known as calories in calories out.  According to this flawed theory, there should be no difference between those who have had obesity for 1 month versus those who have had it for 1 decade.  Having obesity for a long time should make no difference.  But anybody who has tried to lose weight or has known somebody trying to lose weight knows that duration of obesity plays a very large role.Carb Insulin Hypoth

Consider also the carbohydrate-insulin hypothesis.  According to this theory, there is also no allowance for duration of obesity.  It should make no difference.  As long as you reduce carbohydrates, you should lose weight.  But everybody who has struggled with their weight knows that it matters a lot whether you have been obese for months or for years.

Childhood obesity shows the same problem.  Those obese as children tend to be obese as adults.  Why?  Why is it so much harder for them to lose weight.  Children of obese adults tend to be obese.  Why?  Even as 6 month olds (breast fed so no junk food, don’t walk) there is an epidemic of obesity.  Why?

These are the time dependent effects of obesity.  If we can accept that insulin causes weight gain, then why do high insulin levels over long periods of time tend to make it difficult to lower the insulin levels so that we can lose weight.  Something is clearly missing here.  That missing something is insulin resistance.

What is insulin resistance?  Insulin is a hormone that is produced by the body.  In order for it to have its desired effect, it must bind to receptors in the body that signal what the next step is. Insulin Resistance 1

In this example, insulin is acting on the insulin receptor to bring glucose into the cell.  It acts very much like a lock and key.

Insulin is the key.  It fits snugly into the lock (the receptor).  Once the key and lock are together, the door opens and glucose is brought into the cell.

All hormones work in roughly the same fashion.  In this regard, there is nothing really special about the insulin and insulin receptor.

In the case of insulin resistance, the key (insulin) no longer fits very well into the door (insulin receptor).  Because there fit is poor, the door does not open fully and therefore less glucose comes in than normal.

What happens is that the cell now senses that there is too little glucose in the cell.  It is starved for glucose.  The cell needs more glucose.  In order to get more glucose the body produces extra keys (insulin).  The key and lock still do not fit very well, but because there are many more keys, the cell is able to get enough glucose.

This is the situation called insulin resistance.  Why do we care?  Because insulin resistance leads to very high insulin levels.  We care about the high insulin levels because insulin is a major driver of obesity.  As we become obese, we are driven by hormonal factors to eat more to get to our target weight.Hormonal Obesity theory step 2

Not only do high carbohydrate intake lead to high insulin levels, high insulin resistance also leads to high insulin levels.  As we shall soon see, it is this insulin resistance that leads to the time-dependent effects of obesity.

However, there is one important question unanswered.  What causes the insulin resistance in the first place?  Is the problem with the key (insulin) or the lock (insulin receptor).  It is quite easy to measure the insulin and it become clear very quickly that insulin is the same hormone whether it is from a non obese or an obese person.  There is no difference in amino acid sequence or any other measurable quality.

Therefore, we would have to conclude that the problem is not with the key (insulin).  The problem lies in the lock (receptor).  The insulin receptor does not respond quite the same way that it used to.  This is insulin resistance.  What causes insulin resistance?

To begin working it out, we can look at other biological systems.  We can find examples of biological resistance in many places and this may provide us a clue as to what causes insulin resistance.  While not all examples may apply specifically to the insulin/ insulin receptor problem, it may shed some insight into the problem and show us where to begin.Antibiotic resistance

For instance, there is a major problem in many parts of the world with antibiotic resistance.

As you use more and more antibiotics, there tends to be a natural selection for antibiotic resistance organisms to survive and reproduce.

Therefore, with the continued use of antibiotics, there tends to develop antibiotic resistance.  By understanding this concept, we can see that the key weapon to prevent the development of antibiotic resistance is to reduce the use of antibiotics.  That is, antibiotics cause antibiotic resistance.

In parts of the world where there is limited antibiotic use, there is very little antibiotic resistance.  In parts of the world where antibiotics are used liberally, there is much antibiotic resistance.

What about viruses?  What causes us to be resistant to viruses like diptheria and polio for instance?  Before vaccines were widely available, it was well known to getting a virus causes you to become resistant to further infection by the virus.

In fact, vaccines are based entirely on this premise.  By giving dead or weakened virus, we could build up a persons immunity without actually causing the full disease.  That is, viruses cause viral resistance.  And antibiotics cause antibiotic resistance.

These examples, of course, do not apply directly to insulin resistance.  However, it starts to give us a clue that resistance can actually be brought on by the very agent itself.  Could insulin cause insulin resistance?

Continue to Hormonal Obesity IX here

Begin here with Calories I

To see the entire lecture – the Aetiology of Obesity 2/6 – The New Science of Diabesity click here.


8 Responses

  1. […] This is our current advice.  And this dietary pattern is associated with much higher levels of obesity.   To be continued… Click here for Hormonal Obesity VIII […]

  2. I’m getting more and more confused because another researcher, Stephan Guyenet, says the opposite.

    What do you say to his post here?

    • I don’t agree with his arguments. First, he tends to extrapolate rat studies to humans. Second, if insulin causes weight gain, then giving insulin (to humans) should cause weight gain. Guess what? It always does. There’s nothing more to it. If insulin causes weight gain, reducing insulin should cause weight loss. Guess what? It does. You can review the Hormonal Obesity series from the beginning to follow my argument.

  3. […] As people become obese, the insulin resistance develops over time. This is also in evidence as pre diabetes or impaired fasting glucose develops. From the accompanying figure, you can see that as you measure normal, lean people to obese to T2D, the insulin resistance progressively goes up. The reason for this progression we have covered previously in our posts on insulin resistance. […]

  4. Thank you Dr. Fung for taking a courageous stance regarding the truth about DM and insulin. My question is, once my body (cells) become resistant to insulin/glucose – by what mechanism do those cells have the ability to repair so that they are capable of accepting glucose again? I ask because I recently purchased a BG monitor and my testing is showing intractable IR regardless of activity levels. I have switched to a ketogenic diet and eating a dinner meal only – but my blood sugar does not seem to want to drop below 100. It’s been two weeks – I’ve lost 7 lbs (5’4″ -189) – but my fasting levels range between 101 and 107. I am taking 2Tbsn ACV prior to bedtime, chromium, magnesium, D3, ALA, biotin, B complex, Omeg3a). Should I expect it to take longer for those levels to drop? Are there any different supplements and/or medications that would assist without causing me more problems in the long term? [Some more background: I have been following a generally low carb diet for 3 yrs and lost 75kbs and plateaued for the last year where I experimented in adding complex carbs etc… All leading to falling off the wagon entirely this past spring.]

  5. […] פוסט זה מוגש כשירות לציבור. הזכויות על התוכן שייכות לכותב של הפוסט המקורי. את הפוסט המקורי ניתן למצוא בכתובת הזאת. […]

  6. Looking for truth (Kristen)

    Dr Fung, thank you for your contributions here. I would really like to reconcile why this explanation differs from your more recent one on insulin resistance. Did your theory change because of the ability to now see the receptors? If so, does it follow then that overcrowding the cell with glucose leads to poor energy by some other mechanism? The new explanation also makes it seem like IR does in fact function differently than other types of resistances we develop. I hope you can help revocile these difference!!!! Thank you.

    Dr. Jason Fung: There is no difference between theories. It’s all the same.

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