…The precursor to diabetes and other chronic diseases!
Diabetes is a huge health problem worldwide, with numbers affected expected to grow rapidly in the coming years. Given that it’s expensive to control (average cost in North America is $10,700CDN or $7,811USD yearly per person) and is a risk factor for other diseases like heart disease and obesity, it will increasingly contribute rising health costs and health risk in the future. Currently, according to the International Diabetes Federation 2024 statistics, 589 million adults worldwide are living with diabetes and this number is predicted to rise by 45% to 853 million by 2050. Already treatment of diabetes consumes approximately 12% of the global health budget.
In North America, 1 in 7 adults have diabetes, and 1 in 3 are not diagnosed. We have one of the highest prevalence in the world at 15.1% of the population. One in 4 live births are affected by hyperglycemia (high blood sugar), a potentially significant effect on the next generation.
Why is this happening?
Diabetes develops when our insulin stops working properly. This can happen relatively quickly, as in Type 1 (“early onset’, autoimmune) diabetes where the immune system attacks and destroys the insulin producing cells in the pancreas, or more slowly over years, as in Type 2 (“adult onset”, lifestyle related) diabetes where the body becomes resistant to the action of insulin (“insulin resistance”) requiring increased production of insulin to control blood sugar levels. Type 2 diabetes is only diagnosed once our insulin production can no longer keep blood sugar within the normal range and sugar levels become higher than normal even when fasting. The advancement of insulin resistance to diabetes generally takes several years.
What surprises me is that doctors don’t look for increases in fasting insulin, the test that would tell us that we are becoming insulin resistant and are on the path to developing diabetes. When I first read about this, I asked my doctor for this relatively inexpensive blood test (compared to the cost of treating diabetes!). I was told that there was “no protocol” for testing blood insulin levels. It seems that doctors are discouraged from doing additional testing, even if it could predict the development of a very expensive disease.
This just doesn’t make sense to me on multiple levels: increased blood insulin causes inflammation, and this is now believed to be the root cause of many diseases like heart disease, obesity, fatty liver disease, Alzheimers and other dementias, hormone imbalances, and cancer), as well as diabetes. If we can predict and reverse this years before it develops, why aren’t we doing it?
So, what causes insulin resistance?
Like all hormones, insulin is released in one part of the body (the pancrease produces insulin) and works in another part of the body by attaching to a receptor. Just like staring at a bright light fatigues the light receptors in the retina of the eye causing you to see dark spots for a short time when you look away, lots of insulin in the blood can cause the insulin receptors to become resistant to the action of insulin. Insulin production is triggered by sugar in the blood and even the anticipation of eating something sweet.
One thing I notice when travelling in Europe, is how much less sweet the diet is — even the “sweets” are usually less sweet tasting. We have an amazingly sugar-sweetened diet in North America. Even foods that are not normally sweet have sugar added to them during processing. At the same time, fiber is being removed or ground up enough to make it ineffective. Fiber slows the absorption of carbohydrates from sugar and starches (starch is turned to sugar when digested), so eating fiber along with your carbs reduces the spike of blood sugar that demands higher insulin production. These are the reasons why whole foods are healthier than juices and processed foods. I was surprised when I read years ago that pulp-free fruit juices are as unhealthy as soda pop — they both contain sugar without any fiber and will raise blood sugar and insulin.
Your taste and perception of what is satisfying is influenced by your diet. A high sugar diet can result in cravings for sugar and perception that less-sweetened foods are bland. But your taste will adjust quite quickly to a lower sugar intake, I guess you could say more sensitivity to the taste of sugar, and you’ll start to prefer less sweet foods and find sweet treats you formerly enjoyed to be far too sweet for your taste!
What to do about all this…
First we need to reduce the amount of carbohydrates we are eating and replace some of them with fiber and protein. Realize that starches (flour, potatoes, etc) are broken down into sugars when digested. Remember that fiber slows the absorption of sugars, reducing the damage. Note that the “keto” diet generally counts “net carbohydrates”, a number that is calculated by subtracting grams of fiber in the food from the total grams of carbohydrate, taking into account the effect of fiber in foods.
Second, choose whole foods rather than processed ones. Food processing removes fiber and adds sugars, fats and all kinds of chemicals that we can’t even pronounce, let along understand what they do in the body. These chemicals are included to preserve the shelf life of the product or make it look nice, not to improve our health!
Third, get outdoors and exercise. Exercise has been described as the “silver bullet” for avoiding and controlling diabetes, as it lowers blood sugar (using it up for energy) along with the many other health benefits it gives us. Being outside is a great stress reducer, and stress hormones increase blood sugar — the stress response physically prepares us for “fight or flight”… to fight off a perceived danger or run away from it!
Fourth, if you have access to your blood lipid tests, you can do a calculation that can indirectly tell you if you may have become insulin resistant using an online Triglyceride to HDL calculator. You will need your blood triglyceride and your HDL-cholesterol measurements (included in a full lipid panel). I’ll post links to one of these calculators in the References below. Fill in your cholesterol numbers in the boxes in the center of the page, being sure to correct the units to mmol/L if you live outside the US. Scroll down on the right to find an explanation of the results, again being careful to read the explanation for mmol/L if your test was done outside the US.
Why worry??
Researchers are telling us that more than 50% of us in North America have some level of insulin resistance. Some have stated they believe that number may be more like 85% of the population in parts of North America. These people are all at high risk of developing diabetes and the diseases associated with raised insulin blood levels. While we will often read that obesity causes heart disease, diabetes, cancer, liver disease, etc., researchers are now telling us it’s more accurate to say that all of these diseases have a common cause… and that cause is high levels of insulin due to insulin resistance. The damage caused by elevated insulin starts long before diabetes is diagnosed, and the prevention of these diseases needs to start much sooner, not waiting for blood sugar to increase and for Hemoglobin A1c test to show that it’s staying elevated enough to see extra sugar attached to the hemoglobin in our red blood cells.
Type 2 diabetes was once called “adult onset” diabetes as it was only seen in adults. Now, this type of diabetes is increasing in teenagers and even at younger ages. Our processed, high sugar diet and sedentary lifestyles are catching up with our children too. Insulin resistance is starting earlier in life.
Often doctors don’t bother warning us when signs of fatty liver are detected now as “almost all of [their] patients have it”. Perhaps it would be the same with insulin resistance, even if they did test for it, if over half of us have it. But, for me, if I knew that I was at high risk of developing diabetes and that the process had already begun, that would be motivation enough to change my lifestyle. Heck, we have made major changes since my hubby had his first heart attack in 2004. When it’s that important, most of us will gradually make the needed changes.
Call me the “keto queen” if you want… the keto diet, along with more walking and avoiding processed foods, seems to be the best way I’ve learned to reduce our risk of developing insulin resistance. At my husband’s last cardiologist appointment, the doctor said his major arteries were clear and to keep on doing what we’ve been doing. Hopefully we’re continuing to gradually reduce his risk of another episode.
Post note: On further thought, I’ve decided to create a separate list of people who are interested in seeing more of my art side, rather than subject those who are more interested in health news and controversies to the art world (although I couldn’t resist adding a fun sketch of my hubby, done after a visit to the Picasso Museum!) So, if you’d like to be added to my Art Priority List where I’ll reveal my creations first and share the stories behind the art, send me a message at jeannie.beaudin@gmail.com and I’ll add you to the list!
References:
Triglyceride to HDL calculator — units are set for mg/dL (US units). Be sure to reset for Canadian Standard International Units (mmol/L) if you are outside the US: https://www.omnicalculator.com/health/cholesterol-ratio
International Diabetes Federation statistics: Https://diabetesatlas.com
Dr. Ben Bikman, PhD, Metabolism researcher, author of “Insulin-IQ” podcast, and “Why We Get Sick” – the link between metabolism and chronic disease: https://benbikman.com
Jeannie Beaudin, Artist and Author 