The Collateral Damage of Insulin Resistance
Insulin resistance (also called hyperinsulinemia) is a physiological condition associated with diabetes and heart disease, as well as gout, erectile dysfunction, and fatty liver disease. The hallmarks of insulin resistance — from a clinical assessment perspective — are elevated triglycerides, reduced HDL, increased LDL-cholesterol, increased blood pressure, and abdominal obesity. Because of what has become known as the “common soil” hypothesis, insulin resistance is now recognized to link to many chronic diseases related to Type 2 diabetes, which as a group constitute the largest cost to the health care system.
By now, we are all well aware of the pandemic increase in the incidence of Type 2 diabetes globally. There has been a considerable increase over the past decade in the number of Type 2 diabetics in the United States, but this pales in comparison to the explosion in the numbers of diabetics in India and China. Why? The genes of the people in the United States, India, and China haven’t changed in the past decade. The emerging culprits are our lifestyle, diet, and environment, all of which are changing in synchrony.
As you travel the world, have you noticed that you see the same commercial stores in various airports? No matter where you live, have you noticed how cultural diversity in food has started to converge on the same processed food options? Throughout the world’s urban populations, similar pollutants are being found in the air and water. Common soil. Sometimes the answers to complex questions are right under our noses, but we fail to recognize them. This is what is known as a cultural scotoma, or “blind spot.”
What trends related to insulin resistance have not been recognized on a global level yet but are emerging? Recently I had a conversation with the prominent research ophthalmologist, Shalesh Kaushal, M.D., Ph.D. He indicated that retinopathy has traditionally been viewed as a condition of older age, but it is now increasingly seen in people of younger age. Dr. Kaushal pointed out that his research and that of others has found that specific dietary principles found in a diet high in unrefined grains, legumes, and fruits and vegetables has the ability to affect physiological processes associated with the cause of retinopathy.
The observation that retinopathy is increasing significantly was confirmed in a study published in the Journal of the American Medical Association in 2010 titled “The Prevalence of Diabetic Retinopathy in the United States, 2005-2008.” Retinopathy is the most common cause of blindness in the United States, and — as stated above — is increasing exponentially in India and China as well. Is there any connection between the rising prevalence of Type 2 diabetes and retinopathy? The answer is a resounding “yes!” The collateral damage from the condition of insulin resistance is not only Type 2 diabetes, but also retinopathy, cardiovascular disease, and even adult acne.
Where does this lead us? It leads to a potential solution, which is a lifestyle and diet that will improve insulin sensitivity. This is where personalized lifestyle medicine plays an important therapeutic role. It is not just what medications to prescribe for each of these conditions, but rather what the appropriate lifestyle and diet are for the person to treat their underlying insulin resistance.
There are now numerous published medical studies indicating that a low glycemic index diet has a positive effect on not only improving insulin resistance, but managing type 2 diabetes, retinopathy, cardiovascular disease, and acne vulgaris. This is not a strange diet, but rather one that limits sugars, refined flour products, and excess saturated and chemically-modified fats, while increasing beans, whole grains, fruits and vegetables, and lean meats and fish. Two recent studies, one in the New England Journal of Medicine and the other in the American Journal of Clinical Nutrition have gained consideration attention in that they provide medical support for the value of the low glycemic load, Mediterranean-type diet in the prevention and management of conditions associated with insulin resistance. The study in the New England Journal of Medicine in the Feb. 25, 2013 edition titled “Primary Prevention of Cardiovascular Disease with a Mediterranean Diet” described the outcome of people at high risk to cardiovascular disease who complied with a Mediterranean-style diet supplemented with virgin olive oil or nuts had a reduced incidence of major cardiovascular events, which are known to be associated with insulin resistance. The study published in the American Journal of Clinical Nutrition in the March 2013 issue was titled “Systematic Review and Meta-Analysis of Different Dietary Approaches to the Management of Type 2 Diabetes,” and concluded that low glycemic load Mediterranean-style diets are effective in improving markers of insulin resistance and cardiovascular risk in people with Type 2 diabetes, and this approach should be considered in developing an overall strategy for diabetes management.
Taken as a whole, the picture is very clear that our lifestyles and environments are contributing not only to the exponential increase in Type 2 diabetes globally, but that the underlying issue of insulin resistance associated with Type 2 diabetes and its collateral damage in terms of increased incidence of cardiovascular disease and retinopathy, along with many other companion health problems that plague our world health care systems. The good news is that there is a solution to these problems through the effective implementation of a personalized lifestyle health care program that incorporates a low glycemic load diet plan.
This article was originally published in the Huffington Post on March 19, 2013.