- Insulin resistance is when cells of the body
don't respond properly to the hormone insulin.
Basically, someone who is insulin resistant
needs more insulin to have the same impact
than someone who is insulin sensitive.
And I've been a doctor since 2009 and a GP since 2015,
and despite the fact that insulin resistance
underlies many of our chronic health conditions
it's just not something that is talked about,
recognized or addressed until it's too late.
By the end of this video, you're going to know
the key signs that you're becoming insulin resistant,
so you can take action to stop it.
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Hi Carb Dodgers.
My name is Dr. Dan Maggs.
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Insulin resistance is synonymous with poor metabolic health.
Metabolic health relates to how the body
processes and uses energy from the food we eat.
Sadly, poor metabolic health
often leads to Type 2 diabetes,
cardiovascular disease, Alzheimer's disease,
and other inflammatory conditions.
It is a major problem throughout the world.
For example, it's thought that
only one in eight American adults
have good metabolic health.
Sadly, the signs of insulin resistance
are there for months or even years
before the diagnosis of one of these diseases,
often going unrecognized by many health professionals.
So, what if we could recognize
some of the indicators of insulin resistance,
identify what the problem is,
and therefore resolve them before we develop
these chronic states of really poor health?
So, let's get started.
The signs of insulin resistance,
they're not in any particular order.
It's a bit of pot-luck as to which signs
an individual will demonstrate,
so make sure you watch all the way till the end.
Number one is central obesity.
Excess fat stores are never healthy in the long term,
but fat stored around the middle,
what we call "central obesity",
is specifically associated with insulin resistance.
When your body will produce insulin
in response to raised blood glucose levels.
Any glucose that is not immediately needed for energy
has to be stored somewhere.
Most of that gets turned into fat.
The ability to store excess food as fat
is a survival process passed down from generations before
who had to endure long periods without food.
The ability to lay down fat stores in the good times
to call upon for energy during the harsh winter months
enabled humans to survive as a species.
However, for most people living in the western world,
there's never a time of food scarcity.
We're constantly laying down fat stores
for a winter that just never comes.
As we continually overload the body with excess foods,
in particular sugar and carbohydrates,
we exceed the capacity to store fat under our skin,
which differs from one person to the next.
We then start storing fat
in and around our central organs in our abdomens,
such as our liver and pancreas.
It becomes a vicious cycle of high insulin
causing fatty deposits in this area.
The more fat we have here, the more it becomes resistant
to the effects of insulin.
This in turn leads to higher insulin levels
and more fat storage.
And it's well documented
that fatty deposits in and around our organs,
so called "visceral fat",
causes damage over the long term.
There are clear links
with the development of Type 2 diabetes,
cardiovascular disease and high blood pressure.
So, from a practical point of view,
consider where do you store fat?
Is your waist circumference more than half your height?
If it is, this is a good indicator
that you're building visceral fat.
Unfortunately, many medical practitioners
only consider your Body Mass Index,
which is not a good assessment
of whether your fat stores are harmful or not.
Number two is elevated blood glucose.
Your blood glucose or blood sugar levels
should be closely maintained within a narrow range.
Here in the UK we use the range four to seven,
but I'm going to throw some other numbers up on the screen
in case you are familiar with a different numbering system.
When working well, your insulin production
works to keep these levels stable
regardless of what you've been eating,
by enabling glucose to be moved in and out of your blood,
coming out of storage when we haven't eaten
and into storage when we have.
If you've a check at your doctors,
like a routine blood test,
it's likely that you will have had your HbA1c,
or hemoglobin A1c levels checked.
This is a useful guide
to your average blood glucose levels
over approximately a 3 month period.
It's really useful for diagnosing diabetes.
However, long before you have a raised HbA1c,
your fasting blood glucose levels can be raised,
indicating insulin resistance in the liver.
Fasting levels are usually taken first thing in the morning
when you've had nothing to eat or drink, except water,
for a 12 hours period before the test.
This is a really easy to check yourself at home
with a blood glucose monitor.
These are available from most large pharmacies,
supermarkets and, of course, online.
The other thing you can check with a blood glucose monitor
is your blood glucose response to food.
Check before you eat and 2 hours after.
And irrespective of what you've eaten,
your blood glucose should be back
to a baseline of between for and seven
within that two hour period.
If it takes longer to come down,
then this can also be an indicator of insulin resistance.
Number three is cholesterol or lipids.
When you get a lipid panel
or your cholesterol checked at your doctors,
this measures more than simply your cholesterol.
In fact, it doesn't actually measure
your cholesterol levels at all.
That's a different topic for a different video.
Sadly, many doctors still just advise their patients
on the basis of their total cholesterol
or their LDL levels,
often referred to as bad cholesterol.
However, part of the diagnostic criteria
for metabolic syndrome, as set by various bodies
such as the World Health Organization
doesn't actually mention LDL.
Instead, they talk about HDL levels,
and our triglyceride levels,
because it's the ratio between
either triglycerides and the HDL,
or the ratio between HDL your total cholesterol levels
that indicates insulin resistance
and your risk for cardiovascular disease.
You want to aim for a higher HDL level
and a lower triglyceride level
in order to have lower risk.
So, why do so many doctors focus on LDL
and don't address low HDL or raised triglycerides?
The answer is statins, the drugs for lowering cholesterol.
Statins only work to reduce LDL,
rather than, actually,
the underlying cause of heart disease.
Despite their best efforts, pharmaceutical companies
have never been able to produce a drug that raises HDL.
So, the well-researched and well-documented
criteria for cardiovascular disease risk
that were developed off massive studies,
such as in the Framington Heart Study,
just pretty much get ignored.
So, next time you get your lipids checked,
ask for your HDL and triglyceride levels
so that you can get a true picture of your risk.
Number four is fatty liver disease.
Fatty liver can be caused by excessive alcohol consumption,
however there is a huge growing problem around the world
of Non-Alcoholic Fatty Liver Disease.
It is thought that a staggering
25% of the adult population of the world
has Non-Alcoholic Fatty Liver Disease.
It can be picked up by an ultrasound scan of the abdomen,
but central obesity, like we talked about earlier,
is a strong indicator,
with 80-90% of obese adults having fatty liver disease.
It can also be indicated
by abnormal liver function blood tests,
however normal liver function tests
don't mean that you don't have fatty liver disease.
This fatty infiltration of the tissues of the liver
can often be ignored by medics as not being a serious issue,
because it's almost expected if a person is overweight.
I have to hold my hands up and admit that,
back when I was in training,
I can recall seeing a patient
who'd been diagnosed with fatty liver disease
on an ultrasound scan.
Because at that time I didn't really understand
the link between nutrition and fatty liver disease
I simply assumed that the patient was drinking
far more alcohol than he was admitting too.
The problem is that a fatty liver is an unhappy liver.
Fatty liver causes insulin resistance
and therefore Type 2 diabetes and cardiovascular disease.
It is also a leading cause of liver cancer
and cirrhosis of the liver.
Like many signs of insulin resistance,
the problems lie undetected for possibly years
before a diagnosis.
In the words of Professor Roy Taylor,
"Before diagnosis of Type 2 diabetes,
there is a long silent scream from the liver".
Number five is blood pressure.
Hypertension, or high blood pressure is a huge issue,
both as part of disease processes
such as cardiovascular disease and kidney problems,
but also as a stand alone disorder.
It's usually labeled as "essential hypertension",
where the word essential basically means
we don't really understand the cause,
or it's put down to aging.
Now, aging of course does have
an effect on blood vessels and heart function
which can lead to raised blood pressure.
However, I, like a growing number of doctors,
really do believe that hypertension
is a clear sign of insulin resistance for many.
There are several reasons for this,
but in a nutshell,
the kidneys regulate the amount of fluid within our bodies.
Too much fluid and the blood pressure will go up.
Elevated insulin levels cause the kidneys
to retain fluid within the body.
When we address the elevated insulin levels,
by going on a low card diet or fasting,
the kidneys stop retaining that fluid
and blood pressure goes down,
often within a matter of days.
And I've seen many people reduce,
or completely get of the blood pressure medication
they thought they would have to take
for the rest of their lives.
Now, the definition of hypertension
varies from country to country, but generally,
and I think higher than 140/90 is considered high.
So, if you haven't done so recently,
perhaps get a check on your blood pressure,
know your blood pressure level
and then you can take action.
Now, these first 5 symptoms of insulin resistance
are all markers of poor metabolic health.
If you have three or more of them
then you officially have Metabolic Syndrome,
and unfortunately, your risk is much greater
for the diseases associated with this,
such as Type 2 diabetes, cardiovascular disease et cetera.
The next two are perhaps even well less well known
for their association with insulin resistance,
but are nevertheless potential indicators.
Number six is skin conditions.
We've talked about the effects
of insulin on blood glucose, and on the kidneys,
but insulin can also be considered
a growth stimulating hormone.
It's no wonder that it's effects will be seen
across our biggest organ, our skin.
It can be easy for us doctors
to see skin problems as an isolated issue.
However, we need to see many skin conditions
as a reflection of what's happening internally.
I certainly wasn't aware
until I started my weight loss journey
that insulin resistance has links
with so many skin conditions,
and I've had loads of messages from clients
whose skin conditions have just cleared up.
And before I take you through the following skin conditions,
I'm not saying that these are all caused
by insulin resistance,
or that everybody who has these skin conditions
has insulin resistance.
What I'm saying is that we, as doctors,
when we encounter these conditions
should start to think about
what is going on beneath the skin
that may help us pick up insulin resistance earlier.
Skin tags.
These are often seen as small fleshy growths
in the creases of skin around the neck or the armpit,
stimulated by an overgrowth of skin
due to the effects of excess insulin.
Acanthosis nigricans.
Seen as thickened, velvety patches of skin,
again, seen around the neck and armpits most commonly.
Another example of skin overgrowth
stimulated by excessive insulin production
Hidradenitis suppurativa,
thankfully commonly shortened to HS.
This is a painful, long-term skin condition
that causes abscesses and scarring on the skin.
Usually occurs around hair follicles
in areas of sweat glands such as groin,
armpits, buttocks, under the breasts.
We have a protein in the body called mTor
which is a regulator of cellular growth.
This is stimulated by food intake.
Over stimulation,
typically by the western diet and also puberty,
is linked with excessive insulin release
which can lead to these painful cysts.
The same is also true with acne vulgaris,
which is typically seen in adolescents,
but not always.
A symptom of hormonal changes,
possibly aggravated by our western diet
causing overgrowth and inflammation in the skin.
Psoriasis is an autoimmune condition,
and the reddened, scaly patches of skin
are driven by a systemic inflammatory response.
The inflammation is also associated
with the cytokine release
as part of our immune system being triggered.
It is known that we can have
excessive cytokine release from fat cells.
Cytokines are part of our immune response,
which is vital at times of infection.
However, like many things, too much can be a bad thing.
Thrush.
Thrush is a fungal skin infection
that can occur in the mouth,
warm skin crease areas such as the groin and breast,
and also the genitals.
Candida is the name of the fungus
and usually our immune system can deal with it.
However it will thrive
when there is an ample supply of glucose,
particularly if our immune system is compromised.
We know that insulin resistance
can lead to raised blood glucose levels,
and this excess of glucose will be found
in sweat, saliva and our urine,
so feed the infection in these areas.
Poor skin healing.
If you've had a traumatic skin wound,
and I don't necessarily mean a major one,
that has been really slow to heal,
this can be a sign of insulin resistance.
If you remember that chronic inflammation
occurs as a result of persistently raised insulin
and also from the cytokines released from fat cells.
Well, whilst inflammation
is a necessary part of wound healing,
it doesn't settle down
then new skin cells are unable to form.
And additionally, too much glucose
can cause bacterial growth
and feed infection and further delay healing,
or worse lead to a more widespread infection.
Number seven is poor reproductive health.
Polycystic Ovarian Syndrome, or PCOS,
is the most common form of female infertility.
And much like the kidneys are sensitive to insulin,
so are the ovaries.
Too much exposure to insulin
prevents the conversion of testosterone to estrogen,
which is a normal process,
so there is not enough estrogen
to signal the release of an egg on a monthly basis.
So, the partially matured eggs get retained in the ovaries,
which appear as cysts.
Without the release of an egg,
there will be no chance of pregnancy.
The higher levels of testosterone
cause the male signs of PCOS,
coarser facial and body hair,
and male pattern baldness.
And PCOS is now commonly treated
with metformin, which is a diabetic drug,
because, yeah, you guessed it,
it helps to improve insulin sensitivity.
And yet, most medics don't associate the symptoms
and treatment with insulin resistance.
I've yet to meet a woman with PCOS
who had been advised about the link
between her diet, insulin resistance and her condition.
Have you suffered from PCOS?
Did you know it was related to insulin resistance?
Gestational diabetes.
Pregnancy is a state of natural insulin resistance.
It allows the woman to lay down some fat stores
to ensure she has adequate energy supplies
to nurture the growing baby.
This should then return to normal after pregnancy.
Gestational diabetes happen
when that natural insulin resistance becomes deranged
and blood glucose levels become too high.
This is usually associated
with pre-pregnancy obesity,
or a family history of diabetes.
Women are then at a higher risk of diabetes later in life
and should be screened annually to check for diabetes.
And it's not just women that can be affected.
Men can be affected too.
High body fat levels in men
can cause low testosterone levels.
This is because fat tissue
contains an enzyme called aromatase.
This enzyme converts testosterone into estrogen.
The more fat tissue, the more aromatase
and the more estrogen you have,
which means less testosterone.
Low testosterone can affect sperm production
and is a cause of infertility in men.
This can also affect a man's energy levels,
sex drive and muscle strength.
And of course, erectile dysfunction.
As well as low testosterone levels,
which can affect erectile function,
insulin resistance can also affect
the dilation of blood vessels.
For the same reason as hypertension,
the reduced dilation of blood vessels
can cause erectile problems.
So, the possibility of insulin resistance
should be explored in patients
who present with this condition.
So, we have had a look at the many
and varied signs of insulin resistance.
What it really tells us
is that too much insulin and insulin resistance
causes widespread problems
that present as different external signs.
Individuals may exhibit one or many of these signs.
If you recognize any of these in yourself,
then now is the chance to take action
and improve your health before you develop
any of the more sinister consequences
of poor metabolic health.
And that is the focus of this entire channel.
So, if that is of interest to you
and you're not subscribed already,
then I'd love it if you would subscribe to this channel
so that you get a notification
whenever I release a new video.
And that's it for today's video.
Let me know what your key takeaway message is
down in the comments,
and give it a thumbs up if you've enjoyed it.
And hopefully, I will see you in the next one.