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What Came First: The Excess Insulin or Adipose?

For most, the fist step in losing weight is lowering insulin levels. The crucial first step in effective weight management is to accept, internalize, and admit that body weight is not as simple as “calories in, calories out.” One of the reasons that this is true is because of hormones. (It’s always comes down to the hormones, right?!) Insulin is the main anabolic (causes growth) hormone in the body. There is a big debate out there in the world of Obesity Medicine physicians: When it comes to obesity, metabolic syndrome and Type 2 Diabetes, which comes first: the excess insulin or the excess fat? While the answer may be nebulous, understanding insulin is crucial to understanding energy regulation, and, therefore, energy regulation. So, let’s study up!


Normal Role of Insulin


Insulin is secreted by the pancreas in response to blood sugar. It’s job is to tell the cells of muscle, fat and liver to absorb this blood sugar from the blood into the cells in order to keep the blood sugar at a normal level and to provide energy to the cells. That glucose is then either used up as energy or stored in the form of fat. At the same time, insulin prevents blood sugar from being created from burning fat in order to lower the blood sugar level. The more sugar there is in the blood, the more insulin is secreted by the pancreas. At a certain point, however, two thing happen that tip the balance.


Insulin Resistance


Insulin is supposed to only be secreted periodically throughout the day, and then have its levels go down. It is supposed to go up after meals for a time, and then go down and be low. If it is too high for too long, then insulin resistance happens. I compare this to when someone might be nagging you all of the time. What do you do? You tune them out. What does that person do? They may start to yell louder and louder and more and more. This may lead you to tune them out more and more, and so the cycle worsens. This is what happens when the blood sugar is too high and for too long to insulin levels. When this happens, a person ends up with high levels of insulin for too much of the time. Remember what insulin does? It causes food to be stored as fat and it prevents fat from being burned. This is why I say that the first step in losing weight is to control the insulin level.




First Step in Weight Loss - Normalize Insulin


Because insulin is an anabolic hormone that inhibits the process of turning fat into fuel (which is what is needed to eliminate the fat), the first step in reducing excess fat tissue is to address any persistently elevated insulin levels. When a person’s weight management program does not do this, there is typically frustrating results and hunger. When it does do this, the program is highly tolerable, effective, and improves metabolic health, and not just weight. Why doesn’t everyone do this? Well, it is not as easy or as simple or as “one size fits all” as it sounds. The best analogies I can use are “Teaching someone to fish instead of giving them lunch,” or, “One step backward and two steps forward.” It is an investment in long term health, not a quick fix. It is not as simple as the “Keto Diet” or “Intermittent Fasting” for everyone, although there are some important pearls to incorporate into a program potentially from those. The design of the program includes the macronutrient composition, the calorie amount, the nutrient timing, the exercise frequency, intensity, and type, medication changes, and periodic cycling of programs. In the end, the “prescription “ usually appears simple, elegant, and easy to incorporate. It is arriving at the plan that can be complex, taking into account many variables, but not the plan itself. That is what I try to provide each person.


Determining Insulin Resistance


One way to estimate your level of insulin resistance is to go back to the blog, “What’s In a Lipid Panel” and look at the triglyceride / HDL ratio. If you have a HA1c level, anything >5.6 is consistent with some level of insulin resistance. If you carry your body weight mostly in the upper body, like the “apple shape”, you are more likely to have insulin resistance. If you are over the age of 40, you likely have some degree of insulin resistance.


So, what came first, the excess insulin or fat? I don’t know, but I know which one has to go first: the excess insulin.


Trivia question: Answer in an email. Correct answers will be put in a drawing for a free box of bars: When you lose a pound of fat, where does the fat "go?"



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