Hello everyone! Welcome back to another Friday blog. Today I wanted to take a deep dive into Insulin Resistance - What exactly is it and why should we be paying very close attention to this? Let's delve in.

Insulin resistance (IR) means there is "an impaired biologic response to insulin stimulation of target tissues," primarily involving liver, muscle and adipose (fat) tissues. This means that insulin is not effectively able to get glucose - fuel - out of the bloodstream and into the cell to burn for energy - consequently, blood glucose and insulin levels rise. This is a fundamental problem with metabolism and mitochondrial function. As mitochondrial function declines and glucose is not efficiently processed into usable energy, the cell naturally begins to resist more fuel from coming in. In this situation, we have plenty of "potential energy" but are not able to convert it to "usable energy." This potential energy can get shunted to "stored energy" - or fat, such as triglycerides. IR puts us at increased risk for CHD (coronary heart disease), CVD (cardiovascular disease), NAFLD (non-alcoholic fatty liver disease), CKD (chronic kidney disease), digestive problems, stroke, cancer, Alzheimer's, PVD (peripheral vascular disease) T2D (type 2 diabetes), HTN (hypertension), obesity, high uric acid, and hyperlipidemia (high triglycerides). IR negatively affects our hormones, sleep quality, energy level, immune function, lymphatic drainage, our hunger, and ability to maintain a healthy weight. 

Your body wants to maintain roughly 1 teaspoon of sugar in the blood at all times, which is a baseline blood sugar of about 70-80. When blood sugar is elevated above this, the beta cells in the pancreas are stimulated to produce insulin to bring the blood glucose back to baseline (70-80). If insulin is blocked - due to cells not being able to process glucose efficiently - more insulin is required to force glucose into the cell. As blood sugar levels rise, the pancreas works harder to pump out even more insulin to get glucose out of the blood and into the cell - insulin levels RISE...and stay high just in case there's another big sugar load.

Why is the pancreas working so hard to get blood glucose down? Sugar is very damaging to tissues. Sugar is sticky and sticks to whatever it comes in contact with, such as our proteins - rendering them dysfunctional or completely non-functional - this is glycation. Think of that crunchy outer layer on Crème Brûlée - that is glycation. Glycation of your retina, for example, results in cataracts. Glycation of your hemoglobin results in hypoxia (low oxygen). This is reflected in a hemoglobin A1C test - a 3-month average percent of hemoglobin with sugar molecules attached - rendering them unable to deliver oxygen. Understand that if a high percentage of your hemoglobin is glycated and unable to deliver oxygen, ALL other tissues are being impacted at the same level. Damage is being done to your arteries, your hemoglobin can't deliver oxygen to the most distant parts of the body, and you begin to experience neuropathy in your feet and hands as you become diabetic. You want your HbA1C to be < 5.0. Think of what can happen to your brain that uses roughly 25% of the body's total oxygen and energy...

There is a range or spectrum in severity of IR - the more cells that are dysfunctional - can't process glucose for energy - the more severe the IR. Over 10-15 years as this process continues to progress, all organs and tissues are impacted - resulting in T2D (type 2 diabetes). "The metabolic consequences of insulin resistance can result in hyperglycemia, hypertension, dyslipidemia, hyperuricemia, elevated inflammatory markers, endothelial dysfunction, and a prothrombotic state." This means we end up with high blood sugar, high blood pressure, imbalance of cholesterol and triglycerides, high uric acid, high CRP, vascular problems and increased blood clotting - which increases the risk of heart attacks and strokes. Did you know that 93.2% of the US population is metabolically unwell? "U.S. cardiometabolic health has been poor and worsening, with only 6.8% of adults having optimal cardiometabolic health, and disparities by age, sex, education, and race/ethnicity." Currently in the US, 50% of adults and 30% of teens are either prediabetic or diabetic, 75% of adults are overweight or obese, 40% have a fatty liver, sperm count is declining, meanwhile infertility, autoimmune, mental illness and cancer are all significantly rising. This is shocking - we spend the MOST money on healthcare - spending $12,555 PER PERSON - more than double the average for other wealthy countries - and yet we have the most chronic disease and shortest lifespan. Obviously, we are not doing things correctly or reversing these trends.

Okay, so how do we know if we are metabolically unwell? Most of us don't have a clue what level of IR we have and how much it impacts our health. This is totally being missed because physicians are not taught to look at this. A simple fasting insulin test will give you incredibly valuable information about your metabolic function. MDs generally decline to order fasting insulin because they have no clue how to read the test and insurance may not pay. However, you can do this on your own for about $25 through an independent lab. It's worth it! Why would this be so important?

Let's say you get your typical bloodwork done and they test fasting glucose, but not fasting insulin. In this scenario you see that your fasting glucose is 95. Your MD will tell you everything is fine since your glucose is <100. However, this doesn't tell you the level of insulin it takes to bring the glucose down to 95. [Ideal fasting insulin should be between 1-3, according to Boston Heart]. When >3, you have an increased risk for all the chronic diseases we previously mentioned. Your fasting insulin may be 20 (which is in the "normal" range), while your friend's may be 3 - therefore VERY different metabolic function. Let's continue along this scenario and calculate your level of IR with HOMA-IR (homeostasis model of insulin resistance)

HOMA-IR: fasting glucose x fasting insulin/401.85 = level of IR (insulin sensitive = <1.0, moderate IR = 1.9, severe IR = 2.9).

Let's calculate your IR: 95 x 20 /401.85 = 4.7 This is SEVERE IR. Damage is being done to your arteries and organs, meanwhile you have NO idea because your MD only looked at your fasting glucose. You may be puzzled as to why out of the blue you begin to experience one or more chronic diseases like fatty liver, elevated blood pressure or stubborn weight around the belly that won't go away.

Let's calculate your friend's IR: 95 x 3/401.85 = .71 - they do NOT have IR. How would you ever know without actually testing fasting insulin? Your doctor is NOT catching this - in fact he/she is completely unaware and not doing anything about this until you become diabetic. Once you become diabetic, severe damage has been done to your arteries and all your organs. Your pancreas may be failing and unable to keep pumping out the level of insulin required to lower that blood sugar, so fasting glucose gradually goes up. Once it reaches 126, you are considered diabetic. Your pancreas fatigues and begins to fail in producing the high level of insulin - due to damaged beta cells. When your pancreas can no longer make insulin, you become type 1 diabetic and require insulin injections, which continues to cause damage throughout the body.

Elevated fasting insulin may be the reason you can't lose weight or may experience hormonal issues like PCOS. Insulin is a growth hormone that, when elevated, stimulates thickening of the arterial smooth muscle and damages the large blood vessels causing heart disease, Alzheimer's and cancer. Meanwhile, elevated blood glucose is damaging the smaller micro-vessels causing neuropathy, nephropathy, retinopathy and organ damage - due to glycation of our tissues. This is not a good situation. Fuel is getting stored, not used for immediate energy - we stay hungry because our cells are not getting their needs met and a viscous cycle ensues.

Okay, we know to ask for fasting glucose and fasting insulin on our bloodwork - or go get it on our own - but there are other things we can look at to give us a snapshot of our metabolic health. I'm going to give you the "ideal" range according to the literature - this is not the same as the "normal" range. I don't want to be "normal" since 93.2% of normal is sick. Here is the OPTIMAL range I shoot for - As always, this is meant to inform the public and does not constitute medical advice, so please discuss this with your physician.

• Fasting Insulin = 1-3 
• Fasting glucose = 70-85
• HbA1C = <5.0
• Triglycerides = 40-60 (above 60 vascular damage begins to occur)
• HDL = 90-105
• Total cholesterol = 220-260 (your body can't make new cell membranes, make hormones or repair. The brain needs a lot of cholesterol, and we need cholesterol to help prevent cancer.)
• waist circumference = men <40, women < 35
• Blood Pressure = <120/80
• HOMA-IR = [(f)Glucose x (f)Insulin/401.85] = <1.0
• Triglyceride/HDL = <1.0

So, how can we reverse IR and get into the optimal metabolic ranges so we can feel confident our health is moving in the right direction? Get right to the source of the problem - mitochondrial function. We need our mitochondria to make our energy efficiently, and we need a large mitochondrial team to make optimal energy to power the brain and body. Let's look at some strategies to make this happen and literally correct our poor metabolism.

• Time-restricted eating - stop eating every few hours - narrow the window for food consumption- this allows you to stay in clean-up mode longer reducing inflammation and allowing our mitochondria to be healthier. Having 2 meals for example without snacking helps reduce the number of glucose and insulin spikes throughout the day. Most people in the US are eating 11 times over the course of 15 hours. Our mitochondria never get a break!
• Reduce the glucose/carbohydrate load - gives your mitochondria a break from burning glucose which produces lots of ROS (reactive oxygen species) and driving inflammation and switch to burning fat - a much cleaner fuel.
• Remove highly processed foods - they are void of nutrients and high in sugar, fructose and empty calories. They are full of chemicals our body doesn't recognize and drive inflammation and cravings that damage mitochondria
• Exercise - increases oxygen used to burn our fuel, results in decreased inflammation as it activates endogenous antioxidant systems.
• Move - 10 min after meal exercise such as walking, cleaning or dancing -  your muscles soak up the glucose like sponges decreasing the need for insulin and can blunt the spike in glucose by 30%.
• Cold exposure - signals mitochondrial biogenesis - literally tells our mitochondria to increase their numbers to produce more heat
• Eat real food - vegetables, low-glycemic fruits, plenty of quality protein (~1g/lb ideal body weight) with lots of EVOO, fiber and polyphenols.
• Sleep - getting into deep sleep to allow the glymphatic system to wash the brain of debris and clearing inflammation to enhance mitochondrial function.
• Get Sunlight - quality full-spectrum light - get outdoors more - try to get sun exposure in the am to help reset the circadian clock as well as synthesize vitamin D and activate sulfur in the skin for detoxification. Aim for an hour of natural sunlight exposure to get the full spectrum.
• Avoid blue light after dark - (computers, phones, tv, electronics) they have the same light frequency as midday and fool your body clock. It also penetrates deep causing damage that results in wrinkles. 
• Get red light in the evening - stimulates melatonin production and is great for winding down before bed. You can use a fire, candles, or red/amber bulbs. Melatonin is one of the 2 antioxidants mitochondria use to protect themselves from damage, as they produce a lot of ROS (reactive oxygen species) when making ATP.
• HP-EVOO - (high polyphenol extra virgin olive oil) polyphenols in EVOO signal mitochondria to uncouple from the membrane, make more mitochondria and increase mitochondrial efficiency. Polyphenols are also powerful anti-inflammatory molecules that protect the mitochondria from damage. Taking a shot of HP-EVOO first thing in the am literally tells your body no glucose is needed and to burn fat. Oleic acid in EVOO penetrates the blood brain barrier to enhance cell membrane function among other things, while the powerful polyphenols feed the microbiome, mitochondria, restore membrane function, heal the intestinal and arterial lining, turn on protective genes and turn off cancer genes. It is a powerful tool in reversing metabolic dysfunction and insulin resistance.