Dr Robert H Lustig Is A Professor Of Pediatrics In The
division of endocrinology, in the California University. He lives in San Francisco with his with his family. He is also a director of the weight assessment for the teen and child health program. He has basic clinical training on the development of hypothalamic, function and anatomy. He worked St. Jude childrens research hospital in Memphis. He has explored the roles of fructose as a mediator of chronic diseases and continued consumption of the calorie. He has mentored some pediatric endocrine fellows
Whats The Point Of Using Insulin If It Just Makes Me Gain Weight Doesnt Weight Gain Make Blood Sugar Harder To Control
Yes, insulin may restore you to a more natural weight based on your lifestyle habits. And weight gain does tend to cause insulin resistance, which makes blood sugars harder to control. But you may have to look at the initial weight gain as a temporary investment in a lifetime of better health.
Remember, insulin is a very strong hormone it can overcome insulin resistance and get blood sugar levels down to normal. And normal blood sugars are essential for making the kind of lifestyle changes that will ultimately help you to lose body fat and maintain a healthy weight.
Elevated blood glucose levels tend to make people tired and lethargic. It is not easy to exercise when you feel that way! Lowering blood glucose levels can restore your energy and give you the strength and attitude to maintain an active lifestyle.
High blood glucose can also make you feel hungry. Keeping your blood glucose near normal will allow you to better manage your food intake, particularly consumption of high-calorie sweets and other snacks.
In other words, gain a little today to lose a lot tomorrow.
How To Break The Cycle
In a way, weight gain is a sign that the insulin is working your body is utilizing sugar, fat and protein more effectively and able to store nutrients.
Typically, your appetite is increased when your blood sugars are higher. . When your body is utilizing nutrients better and is able to store them, food intake should be adjusted to maintain the same weight. Youll need to make further adjustments if youre attempting to lose weight. If food intake isnt adjusted, then you can expect to gain weight.
Also, insulin isnt necessarily the only factor.
When youre managing your diabetes, your body has a better chance to rehydrate, which can also cause mild weight gain. Of course, dehydration is a greater risk if you have diabetes .
Drugs you take for other conditions also sometimes cause you to gain weight.
So what are your options if weight gain and insulin are an issue? Try these three tips:
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Weight And Type 1 Diabetes
In diabetes, the body doesn’t use glucose properly. Glucose, a sugar, is the main source of energy for the body. Glucose levels are controlled by a hormone called insulin, which is made in the pancreas. In type 1 diabetes, the pancreas does not make enough insulin.
Undiagnosed or untreated type 1 diabetes can cause weight loss. Glucose builds up in the bloodstream if insulin isn’t available to move it into the body’s cells. When glucose levels become high, the kidneys work to get rid of unused sugar through urine . This causes weight loss due to dehydration and loss of calories from the sugar that wasn’t used as energy.
Kids who develop type 1 diabetes often lose weight even though they have a normal or increased appetite. Once kids are diagnosed and treated for type 1 diabetes, weight usually returns to normal.
Developing type 1 diabetes isn’t related to being overweight, but keeping a healthy weight is important. Too much fat tissue can make it hard for insulin to work properly, leading to both higher insulin needs and trouble controlling blood sugar.
Intensive Insulin Therapy And Weight Gain In Iddm
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Why Insulin Can Be A Problem
As weve noted, when your body is functioning normally, glucose and insulin are in lockstep. When blood glucose rises, just enough insulin is released to bring glucose back into the normal range.
But theres also a scenario where you can have too much insulin. This is generally thought to happen when your cells become resistant to insulin, a condition known as insulin resistance, a precursor to type 2 diabetes.
With insulin resistance, a greater amount of insulin is needed to get the same amount of glucose into your cells. And as the condition worsens over time, insulin levels can remain elevated even when you havent eaten anything.
We dont know exactly why insulin resistance happens. Its mainly thought to be caused by chronically-elevated levels of fatty acids in your bloodstream.5
What we do know is that people who are obeseparticularly those with higher amounts of visceral fat are more likely to be insulin resistant.
We also know losing excess body fat often resolves insulin resistance.
Now that you have the background, lets dive into the first question
Hyperinsulinaemia Versus Obesity: Intervention Trials
A more direct approach for assessing the role of fasting levels of insulin in weight gain includes interventions targeting insulin secretion. Insulin secretion can be partially inhibited with the potent ß-cell KATP channel opener diazoxide . In a randomised controlled trial, diazoxide in conjunction with a hypocaloric diet for 8 weeks led to greater weight loss in obese people than those in the control group treated by diet alone . In the diazoxide group, insulin levels decreased by 36% and ~55% without differences in blood glucose levels compared with the control. In a similar trial, diazoxide did not induce more weight loss than the hypocaloric diet alone in the control group . Unfortunately, the baseline fasting insulin levels in this study were significantly higher in the diazoxide group compared to the diet-alone group and the decrease in insulin secretion was not different between the diazoxide and control groups after 8 weeks of treatment. Taken together, body weight was reduced in all trials in which diazoxide achieved a lowering of basal and postchallenge blood glucose levels.
In T2DM, treatment with exogenous insulin increases systemic insulin levels and this may support fat tissue growth . The heterogeneous nature of T2DM means it is difficult to draw conclusions about the role of insulin or hyperinsulinaemia in a healthy metabolic state. Therefore, insulin therapy in type 1 or type 2 diabetes is not discussed here.
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People Used To Call Pasta Diet Food
But over the last two decades, carb-phobia has sky-rocketed.
And now? Pasta is more commonly known as fattening.
So when folks want to lose weight, theyre often told to eliminate the rigatoni, rotini, and raviolialong with rice, potatoes, bread, and even fruit.
The reason: Carbs, of course and the hormone insulin.
Its all based on a controversial hypothesis known as the carbohydrate-insulin model of obesity.
From 30,000 feet, it looks like this:
- You eat carbohydrates.
- Your body releases insulin.
- Then, according to the model, insulin 1) keeps your body from burning fat for energy, and 2) drives fat and sugar from your bloodstream into your fat cells.
- All this makes your body think its starving, causing it to slow your metabolism and increase your hunger.
Its a beautifully simplistic explanation as to why we have a still-growing global obesity problem.
And many advocates of the carbohydrate-insulin model claim it leads to a beautifully simplistic solution: Adopt a low-carb diet.
With this approach, they say, youll create a hormonal environment that gives you a metabolic advantage, allowing you to effortlessly lose fat while eating as much as you want.
No more worrying about calories or portions.
Fructose Consumption And Insulin Resistance
The classic relation between insulin resistance, increased fasting plasma insulin concentrations, and glucose intolerance has been hypothesized to be mediated by changes in ambient nonesterified fatty acid concentrations . Elevated nonesterified fatty acid concentrations are one of the metabolic consequences of a chronic positive energy balance and increased body adiposity . If, as discussed above, fructose consumption leads to increased body weight as a result of decreased insulin secretion and reduced leptin production, an increase in circulating nonesterified fatty acids might follow. The exposure to increased concentrations of nonesterified fatty acids may reduce insulin sensitivity by increasing the intramyocellular lipid content . Increased portal delivery of nonesterified fatty acids, particularly from visceral adipose tissue, could also lead to impaired carbohydrate metabolism, because elevated portal nonesterified fatty acid concentrations increase hepatic glucose production . In addition, over time, increased nonesterified fatty acid concentrations may have a deleterious effect on cell function .
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What Matters Most For Fat Loss
No matter if you eschew carbs or eat lots of them, theres one thing for sure: You cant separate a calorie from its food source.
Soda contains sugar. So does an apple. Both foods are mostly carbs.
But you cant eat that apple without also getting some fiber, which slows the absorption of the sugar into your bloodstream. Plus, its a solid food thats dense with other healthful nutrients.
Whats more, an apple isnt highly-palatable or highly-rewarding, so it doesnt stimulate your brain towards overconsumption like soda does.
All those factors affect fullness and food consumption.
Consider: A large Coke from McDonalds provides 80 grams of sugar and 290 Calories. Its relatively easy to consume in one sitting along with a cheeseburger and fries, too.
But youd have to eat four small apples to consume an equal amount of sugar and calories from that soda. Know anyone that typically does that in one sitting? Or regularly wants to, even though they may thoroughly enjoy apples?
Same number of calories. Same amount of sugar. But a very different experience nutrition-wise.
How might this play out across your entire diet?
Dr. Hall conducted a study to gain insight.51
He admitted 20 adults to the NIHs metabolic ward and randomized them to a diet of ultra-processed foods or minimally-processed foods. They were allowed to consume as much or as little as desired. After two weeks, they switched and did the alternative diet for two weeks.
So ultimately
What Happens In The Case Of Insulin Resistance:
– A large amount of sugar enters the blood stream
– Our body responds by signaling our pancreas to release a larger amount of insulin.
– Insulin travels to our cells to tell them to open and take in sugar.
– Instead of opening and taking in the sugar, our cells ignore or resist the insulin.
– Our pancreas reacts by producing more insulin to attempt to get our cells to respond.
– If our cells are not taking in the sugar, then it remains in our blood stream leading to higher blood sugars.
– Eventually our pancreas cannot keep up and blood sugar levels continue to rise putting us at risk for prediabetes and eventually diabetes.
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Why Insulin Is Important
In my opinion, why insulin is so important can be best explained through the example of metabolic syndrome a term used to unify severe health risks of the present.
The risk criteria for metabolic syndrome are:
- High blood glucose
- Low HDL
- High triglycerides
- Central obesity
All these factors significantly contribute to modern metabolic diseases, such as :
- Type 2 diabetes
- Alzheimers disease
- Parkinsons disease
Indeed, metabolic syndromes risk factors all share a common root cause hyperinsulinemia or persistently high insulin levels . And often, they are accelerated through insulin resistance.
Hence, insulin and insulin resistance is at the heart of mortality in Western society.
Know Your Treatment Options
Stay in contact with your doctor to discuss your treatment options if you are noticing weight gain. There are many different medications that can help with managing diabetes, so discuss any concerns you have with your doctor to make sure you are on the best medications for your needs.
When making changes to your diet and activity level, it’s important to continue to measure your blood sugar levels to stay within your goal range and to see how these are affecting your blood sugar.
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Insulin And Body Set Weight
Hormones are chemical messengers regulating almost everything. For example, they regulate hunger, satiety, thirst, body temperature, and body weight.
The region of the brain responsible for the regulation of those essential processes is called the hypothalamus.
With this in mind, a defining ability of the human body is the adaption to change called homeostasis.
Therefore the hypothalamus is tightly regulating body temperature around a stable level. Thats usually about 36°C or 98°F.
Similarly, the same principle of homeostasis applies to body weight. Hence, it isnt high caloric intake or lack of exercise that causes weight gain.
However, the food industry is trying to tell us so because the calorie approach justifies low-quality food.
Instead, a hormonal imbalance is setting body weight to an unhealthy level. Given that, the hypothalamus commands the body to increase fat mass using available calories.
As a result, the body is short of energy and craves for increased caloric intake.
Consequently, the hypothalamus increases the hunger hormone ghrelin and decreases the satiety hormones peptide YY, cholecystokinin, and leptin.
Restrictingcalories to counteract the bodys effort to increase fat mass doesnt work outlong-term. In that case, the basal metabolism is down-regulated to satisfy thehigher priority goal of gaining body fat.
For thisreason, overeating and lack of physical activity are symptoms of obesity ratherthan its causes.
What Did The Data Show
Energy expenditure was 26 Calories higher per day in the high-carb diets versus the low-carb diets.
This conclusion, however, has been criticized by David Ludwig, MD, PhD, a leading proponent of the carbohydrate-insulin model.
Thats because only four of 32 of the studies had durations of at least 2.5 weeks, and according to Dr. Ludwig, it takes two to three weeks for the body to adapt to a low-carb diet, also known as being fat-adapted.14,30,31,32,33
Currently, theres no validated method for objectively measuring if someone is fat-adapted. So while it may indeed take longer than two weeks, no one knows if thats true or can say how they know when it occurs.
To support their assertion, however, proponents of the carbohydrate-insulin model often cite the results of a 20-week study from Dr. Ludwigs group, conducted after Dr. Halls 2017 meta-analysis.34
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The Importance Of A Healthy Weight
When kids with diabetes reach and maintain a healthy weight, they feel better and have more energy. Their diabetes symptoms decrease and their blood sugar levels are better controlled. They also may be less likely to develop complications from diabetes, like heart disease.
Doctors use body mass index to determine if a person’s weight is healthy. If your doctor recommends that your child lose weight to control diabetes, a weight management plan can hel. Even if your child’s BMI is in the healthy range, the doctor can help you come up with a healthy meal and exercise plan.
How Does Elevated Insulin Contribute To Weight Gain
When there is a lot of excess insulin and blood sugar in our blood stream, it signals our body to put that excess sugar in storage. We can store some sugar in our liver and muscles, however, when these are full our body start to store the extra sugar as fat. This of course starts to cause weight gain.
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Hyperinsulinaemia Versus Obesity: Genetic Studies
The role of insulin in adipose tissue growth was also tested by selectively disrupting the insulin receptor gene in fat cells of white and brown adipose tissue. Such mice grew normally and their glucose tolerance was not different from control littermates. Basal glucose uptake into adipocytes was unchanged, but insulin-stimulated glucose uptake reduced by ~90%. Mice with such selective insulin resistance of adipose tissue had low fat mass and were protected from age-related obesity . In summary, four different approaches to lowering insulin secretion had the same consequence: prevention or remission of obesity .
Fig. 1
Prevention/remission of obesity by targeting insulin or insulin action. In people who are obese, lowering insulin secretion by treatment with the ß-cell KATP channel opener diazoxide, or the long-acting somatostatin analogue octreotide, caused significant weight loss compared with the control group
More important is the observation that stimulating glucose uptake by insulin requires much higher hormone concentrations than is needed to inhibit lipolysis, even in the same individual. In five clamp studies, the mean insulin concentrations required to have a 50% effect on the stimulation of peripheral glucose uptake were ~720, 480, 348, 360 and 360 pmol/l . Half maximal stimulation of glucose uptake required an insulin concentration that was about six times higher compared with that required for 50% inhibition of lipolysis .
How To Balance Ghrelin Levels
If you have a sneaking suspicion your ghrelin levels are in need of some TLC, here are a couple of ways to balance them:
- Eat adequate amounts of protein. Protein helps you feel full and should be consumed with every meal. Studies show how eating protein promotes healthy ghrelin levels.
- Avoid sugar as much as possible. As you can see by now, consuming too much sugar disrupts hormonal balance, making weight loss seem an impossible feat. Be sure to read labels. If an item contains high-fructose corn syrup, dont buy it. A 2013 study published in Nutritional Diabetes shows how high-fructose corn syrup is one of the primary culprits of imbalance when it comes to hormones and weight gain.
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