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BLOOD SUGAR REGULATION

When most people hear the word insulin they directly associate it with diabetes. Diabetics have an inability to produce insulin and need to take insulin via injections or in pill form to help them balance their blood sugar. But what most people do not recognize is adult-onset diabetes is a final stage breakdown process due to decades of poor life-style choices.

Prior to the onset of diabetes, our bodies give us many warning signs we are heading in the wrong direction. Unfortunately we ignore many of these warning symptoms because they are not translatable into a disease. By the time we are given a “label” to define what is wrong with us, it is often after much damage is done. And the same underlying, physiological imbalances that lead to adult-onset diabetes are heavily implicated in many of today’s “modern illnesses”.

Diabetes and many of the “western industrial diseases” are at an all time high. Cancer and cardiovascular disease are the number one and two killers. Diabetes effects 5% of the population and is growing at more than 6% per year. Depression is now considered so commonplace, pharmaceutical sales total in the billions. Obesity is frighteningly too common. One in three adults is now considered obese while 25% of children are categorized the same. The research linking obesity to these ailments and more is so overwhelming the collective mainstream media has even picked it up as newsworthy. Not a week goes by without some publication making it a main feature. The nightly news has ongoing segments on foods and America’s eating habits (whether they are accurate or not is not the point of this article). Could our nutritional and lifestyle behaviors be part of the problem? If so, is there any common denominator involved?

Insulin and Glucose

When we are hungry, it is an indication we need to eat. Biochemically, what transpires is the sugar (glucose) level in our bloodstream has dipped too low. If we do not eat, our energy begins to ebb, we may become cranky, experience some fatigue, or lose our ability to focus on the tasks at hand. Some people may become intolerable. Their mood changes dramatically. Certain individuals need to take a nap (some may even pass out) while still others feel jittery or shaky. Blood sugar regulation is so critical to our health and welfare that it became the basis for a legal defense in the murder case of Mayor Mosconi and his aide Harvey Milk in the late 1970’s. It came to be known as the “Twinkie Defense” (see Food and Mood”).

What is this mechanism that has such influence over our daily lives and behaviors?

As our glucose levels drop, it sends off the signal of hunger. When we eat in response, the foods are broken down into their basic components: proteins, fats and carbohydrates (sugars). To facilitate the utilization of sugar, the pancreas produces and releases insulin. The insulin hooks up with the sugar molecule and delivers it to the vast majority of the cells in the body (some cells don’t require insulin to receive glucose). When it arrives at the cell, there is a special designated place on the membrane of the cell that receives the insulin. This is called a receptor site. When the insulin hooks up with the receptor site, similar to a boat puling into dock, it releases the glucose molecule to enter into the cell. The glucose is then incorporated into the mitochondria (this is an organelle of the cell), and is utilized to make ATP. ATP is the compound the cells use for energy. Without ATP, the cells fatigue and eventually die.

When alterations in the insulin response mechanism occur, the body’s ability to carry out its metabolic processes is diminished. Over time, a wide variety of symptoms and dysfunctions develop. As the mechanism becomes more skewed, the degree and intensity of ones symptoms increases, their overall sense of well-being decreases and the possibility of major illness elevates dramatically.

Changes in Insulin Response

Insulin is released in response to the quantity and rate which sugar enters the body. When we eat a meal or snack containing a balance of protein, carbohydrates, and fat, the insulin response occurs with minimal duress. The amount of insulin released into the bloodstream is commensurate with the glucose being absorbed. The release of insulin in response to the rate of glucose absorption is known as the glycemic response.

When we eat refined foods i.e. pastas, breads, cookies, desserts, juices, soda, alcohol, white rice, the rate at which sugar enters the blood is accelerated. This is because the fiber has been removed in the manufacturing process. The fiber in grains, fruits and vegetables maintains the proper rate of sugar entry. Without the fiber, the hastened sugar release stimulates an overproduction of insulin to compensate. If this happens occasionally, the body is able to adjust through other mechanisms and return to balance without any further problems.

However, if refined carbohydrates are a major part of one’s regular diet, the result is a constant over-stimulation of insulin production. The ability of the body to regulate insulin production and the cells capacity (due to other mechanisms involved with insulin dysregulation-see cortisol) to receive it becomes compromised. The cell gets less glucose. Its ability to manufacture ATP is hindered. The body senses this fatigue as low blood sugar and in response we eat. The more we eat, the more insulin is produced. If the food eaten continues to be refined, an overproduction of insulin remains. This vicious cycle will continue until enough glucose manages its way into the cell for ATP production. Unfortunately, by the time the cell receives its necessary amount, an inordinate quantity of sugar has now been consumed and remains in the blood. This excess sugar is converted into fat. Obesity may follow (This does not mean thin people do not have this problem. Being overweight is only one sign of hyperinsulin.).

Also, the body needs food on a regular basis to maintain its vitality. When we abstain from eating for more than a few hours, the body has an ingenious mechanism in place to offset low blood sugar and releases cortisol.

Cortisol and blood sugar

Manufactured by the adrenal glands, cortisol will stimulate the release of sugar reserves (glycogen) in the liver. Glycogen will be converted to glucose and taken up by the body. Again, if this is an occasional oversight, the body does not suffer any consequences.

Yet, as with eating refined carbohydrates, if one has the habit of skipping meals and snacks throughout the day, this biochemical adaptation is ongoing. The same is true for individuals that eat their only main meal at night, or believe powdered drinks and protein bars (even though most protein bars may accurately claim little sugar, the sweet taste can still trigger an inappropriate insulin response) are a healthy substitute for food. They are woefully mistaken and are depriving their body of the necessary supply of glucose (as well as other nutrients). Increased levels of cortisol continue to be stimulated in either situation to maintain adequate glucose balances. If these eating habits are maintained, glycogen stores will be depleted and cortisol will seek out other resources to maintain glucose levels. In turn, cortisol attacks the body’s muscle tissue for its supply.

Cortisol breaks down muscle tissue and converts the amino acids from the tissue into glucose by a process called gluconeogenesis. This function is part of our survival mechanism. It allows the body to maintain proper glucose levels in times of continuous high stress or food scarcity. Though most of us do not worry about food scarcity, by eating erratically, our bodies operate under conditions as if it existed. This is closely simulated by individuals (predominantly women) concerned with their weight. The avoidance of food and the use of cigarettes, coffee and food substitutes to maintain a thin appearance greatly exacerbates this response. Though they may reach their asthetic goal, it has its cost. This is why they may appear to be so thin and still have cellulite. The body has been stripped of muscle tissue but the fat remains.

Cortisol’s relationship with insulin is thus critical. And if cortisol remains elevated for an extended period of time, it alters the makeup of the cell membranes of the body and interferes with receptor site activity. This makes it more difficult for the insulin to properly align with its receptor site. When the cell membrane can no longer respond to insulin effectively, it is known as insulin resistance. Insulin resistance leads to hyperinsulinemia (increased insulin levels). There are other causes for insulin resistance, including genetic factors, but they are beyond the scope of this article.

Insulin Resistance (IR)

It is conservatively estimated that 25-35 percent of the population in westernized cultures has IR to some degree. Research indicates IR is a contributing factor in diabetes, obesity (and obesity in turn contributes to insulin resistance), sleep apnea, hormone metabolism problems, cardiovascular disease and certain forms of cancer.

Complicating this issue is that increased cortisol production occurs in response to other forms of stress: mechanical, chemical, emotional and thermal (see article on stress for more details). Cortisol’s main function is to act as a body modulator, always attempting to maintain homeostasis. And to maintain this balance its priority is to make certain the glucose levels remains normal, even at the sacrifice of numerous bodily functions.

This expands the possible influences on receptor site sensitivity and IR. Anything that promotes long term cortisol production may also promote IR. The influences and importance of many of our lifestyle choices now become evident i.e. late night hours, poor sleep habits, financial and relationship worries, air and water quality and lack of aerobic exercise. All these and more have a powerful impact of the cortisol-insulin relationship. Pro-active changes in all these areas will be of benefit. However dietary habits remain the most influential factor with blood sugar regulation and IR.

One final note: All hydrogenated, partially hydrogenated, vegetable, man-made oils and trans-fats (these can also occur from frying or even applying high heat to healthy oils i.e. sesame oil) must be eliminated from your diet. First, these fats will imbed themselves into the cell membranes, removing healthy fats critical to cell membrane function. As a result, since the fatty acid composition of the cell membrane is critical to its functional capacity, all functions involved with the cell membrane will be altered. One immediate outcome is receptor site activity for insulin and all hormones, steroids etc. are changed. This contributes to IR. Second, these processed fats will lead to the production of inflammatory chemicals (Pg2) at the cell level (so does both increased insulin and increased cortisol). This chemical alters insulin receptor site activity Furthermore, since these changes are a stress to the body, cortisol will be produced in response and kick off its own feedback cycles and adaptations, perpetuating IR.

The Impact of IR

We described there is an optimum balance between the glucose and insulin effected by the foods we eat and the eating habits we establish. As we shift from healthy foods and eating at regular intervals, the glucose-insulin ratio becomes skewed. The following sequence describes basic phases of the glucose-insulin adaptation.

Reactive hypoglycemia: This describes the stage when insulin levels are higher than glucose levels. This transpires from long periods without food or the hyper-response of insulin due to consumption of refined foods. Either way, the body perceives itself to be in a state of low blood sugar and acts to this stress accordingly and releases cortisol.

The resulting increased insulin and cortisol levels have innumerable ramifications. Increased insulin will elevate estrogen levels, thus exacerbating any current female hormonal issues or directly influence the onset of such problems i.e. PMS, PMDD, fibroids, infertility, etc. It will also increase testosterone levels in women. This is directly implicated in polycystic ovary syndrome (PCOS) and also makes weight loss extremely difficult.

On the other side of the aisle, IR will increase estrogen production in men. Recent research shows that approximately 75% prostate disorders are estrogen based. IR may also lower the level of testosterone, decreasing vitality, muscle tone, sex drive and make weight loss more difficult. Regardless of sex, the resulting increased estrogen levels are now directly linked to cancers, including breast, bone, colon, and brain.

One final note on increased estrogen levels: it decreases thyroid hormone levels in the blood, suppressing ones metabolic rate. This decreased function is compounded by the ongoing, increased cortisol production. High levels of cortisol interfere with the proper conversion of thyroid hormone (T4) into its active form (T3). The combination of IR and increased cotisol is responsible for many of the incorrectly diagnosed hypothyroid cases in this country. Quite often, apparent thyroid dysfunctions resume to normal after correcting cortisol and IR problems, without medicinal intervention.

IR lead to obesity and its complications. This includes myocardial infarction (decreased thyroid plays a role here), premature death and again, increased estrogen production.

Fat tissue is a second site for estrogen production. This is one of the main reasons why it is more common for young girls to start menarche earlier in life. The consumption of junk foods has become a main staple in their diet and they have become overweight at an early age (remember, 25% of today’s kids are deemed obese). This accelerates the onset of IR. This also explains the increasing incidence of female-related dysfunctions in younger girls. This increases the likelihood of developing female-related hormonal dysfunctions i.e. polycystic ovary syndrome. Further research needs to be done to verify if this puts them at greater risk to develop estrogen-related forms of cancer.

Hyperinsulinemia will decrease the production of glutathione. This is an antioxidant the body produces and is probably the most valuable nutrient involved with detoxification. Depletion of this nutrient increases the body’s level of toxicity, causes an increased level of free radicals and decreases the body’s ability to defend against them (see the articles on antioxidants and detoxification).

Inflammation is increased with IR. The decreased production of glutathione is a main contributor. Another primary influence previously mentioned is the production of Pg2 that occurs at the cell membrane. As IR occurs, the balance of fatty acids in the cell membrane is altered. The production of this pro-inflammatory cell chemical (which is critical for the immune system to function) is increased. Simultaneously, the production of its counterparts Pg1 and Pg3, the cells anti-inflammatory chemical, is lowered. This imbalance precipitates most inflammatory conditions, including arthritis, asthma, allergies and cancer metastasis.

The ingestion of refined carbohydrates that creates IR is responsible for a majority of the depression we encounter. It decreases ATP production thus leading to lethargy and fatigue. It alters cell membrane function so the brain chemicals known as neurotransmitters are less efficient (see food and mood). It decreases thyroid function slowing down ones metabolic rate and energy. The subsequent release of cortisol interferes with sleep patterns. It is during sleep when our physical and emotional body heals.

Yet, many physicians see fit to prescribe anti-depressants all too easily. Quite often, more than one medication is given, either to counteract side effects or to enhance the limited capability of the original medication. The distribution has become so wide spread, children under the age of three are now on these medications. And as Peter Breggin has disclosed in his writings, this pervasiveness has become so lucrative, one of the major companies actually toyed with the idea of creating a flavored antidepressant just for kids.

Many of the new antidepressants attempt to maintain higher levels of the brain chemical serotonin. If the explosion in prescriptions being filled is reflective of a genuine problem in the population, then decreased serotonin appears to be epidemic. Is it possible that imbalances in the glucose-insulin response mechanism are involved? The answer is yes.

The consumption of carbohydrates increases insulin. Insulin is necessary to take the amino acid tryptophan across the blood brain barrier and into the brain. Here it is converted into serotonin (side note: serotonin is the precursor to melatonin. If melatonin helps you sleep, the odds are you have an elevated cortisol problem that needs to be addressed.) Unfortunately, the resulting influences from the inundation of carbohydrates desensitize the serotonin receptor sites in the brain. As a result, the connection between serotonin and its receptor site is not made properly. The body perceives this as decreased serotonin, a feeling of depression sets in and the desire for refined foods increases. This ongoing depression and eating cycle will perpetuate the depression and again be a major factor in obesity and all its complications.

Compensated Dysglycemia

This reflects an imbalance in the insulin-glucose ratio similar to reactive hypoglycemia. The difference is in respect to the actual levels in the blood. Reactive hypoglycemia has a blood level below optimal and the insulin is above. With compensated dysglycemia, the glucose levels may be normal but with an even higher insulin level or both may rise above the optimal level with the relative insulin levels increased even more so. This is not accompanied by any different problems other than what was previously described, but does increase one’s risk to develop them.

Metabolic Syndrome X

This is a pre-diabetic state. A larger percent of the population is now classified in this category and the numbers continue to grow. In this stage the insulin levels are extremely high, both in relation to the increased glucose and the optimal levels. It is during this phase where IR has even greater effects and leads to hypertension, sleep apnea, cerebral vascular accidents and myocardial infarct.

Eventually, due to pancreatic fatigue, insulin production wanes. It slowly diminishes until it levels off with the glucose, yet both remain above the optimal levels. As this continues, insulin will dip below the glucose level and then the optimal level. In either scenario the person is classified as diabetic.

Diabetes

The pancreas is no longer able to maintain insulin production. Glucose levels rise. Insulin drops below the optimal level and the blood glucose soars. For those who do not get this under control, the side effects can become a nightmare for the individual and their family. The number one problem is blindness. Amputation occurs in over 50% of the diabetics. Neuropathies affect a greater number of those afflicted, approximately 60-70%. Kidney failure involves about 40% of diabetics. Many suffer with more than one of these maladies.

The aforementioned stages does not occur as clean cut as they are presented. There is tremendous overlap and not everyone develops the same symptoms. They have been presented in a manner to elucidate as clearly as possible the developing problems that accompany blood sugar dysregulation. Though the vast majority contends with some form of sugar regulation problem, their genetic make-up, daily life stressors and environmental influences play a role.

Symptoms and Tests

Symptoms give us helpful clues as to what is ailing us. They give us a starting point and lead us to uncover the problem. The following is a list of symptoms of IR:

Fatigue
Hunger or sleepiness after eating
Difficulty losing weight
Migrating aches and pains
Sugar cravings

Clinical signs involves with IR:

Increased cholesterol, triglycerides and decreased HDL
Increased abdominal fat
Hip:waist ratio-greater than .95 in males: greater than .80 in females ( this is not always accurate for estrogen-dominant women)
Increased blood pressure
Increased uric acid
Elevated fasting glucose
Elevated fasting insulin
Increased Hb1AC and/ or fructosamine

To find out the influence of cortisol or the impact this phenenomena has on thyroid and reproductive function, salivary hormone tests are extremely accurate and reliable. The information afforded helps facilitate a more accurate diagnosis and follow up therapies.

There are some basic guidelines to follow to address IR and increased cortisol.

Do not skip any meals, especially breakfast.
Breakfast should contain high quality protein.
Eat every 2-3 hours whether you are hungry or not
Avoid all refined carbohydrates, hydrogenated, man-made oils and trans-fats.
Stay away from sweet drinks and juices.
Snacks should combine low glycemic fruits with nuts, seeds and their butters.
Meals should consist of predominantly vegetables, greens, whole grains and lean,
quality meats.

It is necessary to support your dietary changes with a supplement program. Since each individual has specific needs to re-balance their chemistry, any outlined recommendations may be wrong for you. The following herbs and nutrients are used with IR. Before taking any, please consult with your practitioner.

Gymnema sylvetre, fenugreek, bitter melon
Chromium, zinc, magnesium, vanadium
Alpha lipoic acid
Biotin, niacin, niacinamide, inositol, Vitamin E
Carnithine

When dealing with IR, proper steps must be taken to regulate cortisol levels. For more specifics on that, please reads the article on stress.