Breaking insulin resistance

April 24, 2004

I have been following the discussion about insulin resistance with great

interest. Most of the information that was put forward was already quite

familiar for me, but I got new insigts about it. I would like thank the

authors for that.

What remained unanswered is

a) how to help seriously insulin resistant and carbohydate addict person

to remain on low-carbs diet or low-glycemic index diet and not to fall

on eating frenzy and crazy munchies every now and then and to have to

start all over again?

b) how quickly the state can be corrected with ayurvedic regimen? what

herbs should be used to work excess insulin and balance bodily

functions?

c) what kind of sport regimen would help 1) athletic typse and 2) layman

who never does sports?

Often people who suffer this condition have also edema, eczema, skin

rash, allergies, bloating, yeast infection, joint problems or various

related problems. But what keeps them from getting back to normal is the

addicition to carbs and binge-eating.

For instance one vegetarian person that I know tries to follow ayurvedic

anti-ama regimen with kitcharee, but falls every now and then to eat

some bread which according to his words leads to uncotrollable frenzy

for more carbs: some more bread (until all is finished), 3 platefuls of

morning cereals, some fruit, and anything else that can be found from

the kitchen goes as well. He will eat until completely full. Having his

water enema and eczema to re-occure the following day.

Of course this keeps his insulin resistance from healing and he is

getting more and more frustrated about it.

--

Ossi Viljakainen | ossi.viljakainen

April 25, 2004

Dear Ossi Viljakainen,

There is something called Behaviour Modification.

It is not easy.

We get to be whatever we have become, beacuse of whatever it is that appeals to

us, and bodies end up becoming the end products of our desire or gluttony.

Neuro-Linguistic programming , believes that everybody has all the answers.

If they need an answer to a question, they ask for it, or look it up. But, they

seek the answers.

For example---smoking and the effects of it.

Once the knowledge has been obtained, what keeps people from not giving up

smoking is their internal psychologic make up. Some people give up after a

disaster--like a heart attack. Some give up for 3 days and go back to it. Some

give up for good. Some just cannot.

Neuro-linguistics, is a way of asking the patient a few questions and letting

him derive his own conclusions. Your patient needs such help.

Medications or Herbs are all clutches that we hang on to, and become our

crutches that we depend on. Its only the internal make up of the people that

ultimately makes us win these batles.

On a different topic, what sports should people engage in , when they do not do

any sports?? Walking is a very good exercise. Especially, if it entails long

distances and going uphill and down hill.

ayurveda wrote:

I have been following the discussion about insulin resistance with great

interest. Most of the information that was put forward was already quite

familiar for me, but I got new insigts about it. I would like thank the

authors for that.

What remained unanswered is

a) how to help seriously insulin resistant and carbohydate addict person

to remain on low-carbs diet or low-glycemic index diet and not to fall

on eating frenzy and crazy munchies every now and then and to have to

start all over again?

b) how quickly the state can be corrected with ayurvedic regimen? what

herbs should be used to work excess insulin and balance bodily

functions?

c) what kind of sport regimen would help 1) athletic typse and 2) layman

who never does sports?

Often people who suffer this condition have also edema, eczema, skin

rash, allergies, bloating, yeast infection, joint problems or various

related problems. But what keeps them from getting back to normal is the

addicition to carbs and binge-eating.

For instance one vegetarian person that I know tries to follow ayurvedic

anti-ama regimen with kitcharee, but falls every now and then to eat

some bread which according to his words leads to uncotrollable frenzy

for more carbs: some more bread (until all is finished), 3 platefuls of

morning cereals, some fruit, and anything else that can be found from

the kitchen goes as well. He will eat until completely full. Having his

water enema and eczema to re-occure the following day.

Of course this keeps his insulin resistance from healing and he is

getting more and more frustrated about it.

--

Ossi Viljakainen | ossi.viljakainen

Durgesh Mankikar, MD

April 27, 2004

The carb craving comes from the Insulin Resistance itself and can not

be relieved until the Insulin function becomes more normal.

For meateaters breaking this syndrome - is fairly easy and takes

about two weeks if one follows a protocal such as South Beach Diet.

For vegetarians kitchree by itself is not suffecient - one can

compensate by taking fat and proteins with all carbs - never eat

carbohydrates alone (meaning without proteins or fats). Since

maintaining steady blood sugar levels is the key to breaking Insulin

resistance - then it is clear that eating small meals several times a

day is a very effective technique.

For those who can afford it having a glucose meter can help as it can

work as a biofeedback instrument - informing us as to what is

actually happening with blood sugar. Take the test several times a

day - if the blood sugar is falling below 80 - immediatly eat

something which includes proteins and fats and small amounts of carbs

from slower digesting carbs. If the blood sugar is climbing above 100

then immediatly eat some protein and fat. Almonds - ghee - cheese -

natural coconut oil - is helpful. One fellow in Kerala urges all of

his patients to take a tablespoon of ghee or coconut oil when the

symptoms begin.

What one is trying to achieve is steadyness of blood sugar - this

should not be difficult for most.

Remember all rapidly digesting carbs are forbidden. Some people think

that one are two cups of tea a day can not possibly hurt. This is

wrong never take sugar or honey when Insulin resistant. Also all

stimulants are also forbidden with or without sugar. No coffee, tea,

cigarettes, betal, pan, etc.

If the vata disease (sympathetic reactivity) is severe then vata

reducing medicines will be necessary. Also maybe oil Basti and oil

treatments are helpful. Daily oil massage helps many to calm the

nerveous system somewhat. And of course in all reactive diseases

digestion must be supported and gas reduced. Gas is an important

component in reactivity. Keep the bowels cleared without disturbing

the intestines unnecessarily. If the bowels are made loose with

laxatives this will cause more gas and intestinal disturbance and

will of course make the symptoms worse. One old vaidya recommends 1/2

cup castor oil vasti at night before bed to help to steady the sleep

pattern and encourage a gentle morning motion. A good nights sleep is

the best thing we can do for a highly reactive nervous system.

ayurveda, Ossi Viljakainen

<ossi.viljakainen@i...> wrote:

> I have been following the discussion about insulin resistance with

great

> interest. Most of the information that was put forward was already

quite

> familiar for me, but I got new insigts about it. I would like thank

the

> authors for that.

April 28, 2004

I am sorry, but I don't understand what being insulin resistant means??? Does

the body still secrete insulin? If not wouldn't that make you a diabetic at

best? What are the symptom's? Thank you!

Bonnie

-

vinod3x3

ayurveda

Tuesday, April 27, 2004 2:51 PM

<ayurveda> Re: Breaking insulin resistance

The carb craving comes from the Insulin Resistance itself and can not

be relieved until the Insulin function becomes more normal.

April 28, 2004

Many call insulin resistance as 'prediabetic'. Actually this disease

is much larger than diabetes and covers many modern health conditions.

Most modern people who have eaten large quantaties of sugar and

rapidly digesting carbs from white flour etc. probably have some form

of this disorder.

The mechanisms are controversial but I think they can easily be

understood by thinking of the basic problem of eating more

carbohydrates than the body needs. One mechanism the body has for

dealing with these excess carbs is to convert them to fat and deposit

them in the general fat reserve areas of the body. Still the problem

of the excess insulin that has been secreted in an attempt to deal

with these sugars is left. The excess insulin itself begins to act as

a stressor to the cells because the cells do not need this sugar and

therefore do not need the insulin. The cells have a secondary

protective mechanism for dealing with this excess hormone - the

insulin receptor sites become blocked so as to resist further insulin

demands. This blocking of the insulin receptor sites is what is

generally refered to as Insulin resistance or Syndrome X. Many sugar

problems hypo and hyper are related to this disorder.

Insulin resistance is curable to some extent in most people and of

those who have reestablished proper sugar metabolism they find many

of the debilatating symptoms associated with improper sugar

metabolism simply disapear. Many have recovered after many years of

suffering. The techniques are not difficult but not everyone can do

it as they must discipline themselves severly for a short time.

Example someone mentioned powerful carbohydrate cravings which are

not easy to deal with. Such people usually need professional help.

Syndrome X is cured by diet and exercise alone in moderate cases.

Below is a long article by Dr. Michael Lam that gives an overview of

Syndrome X. I have left out his supplement recommendations as I do

not think his ideas would appeal to many in this forum.

Syndrome X

(also known as Insulin Resistance, Metabolic Syndrome, Glucose

Intolerance, Pre-diabetes, and Cardiovascular Dysmetabolic Syndrome

Contents

Introduction

How do you develop Syndrome X

SYNDROME X as explained by Dr Reaven

Pathology of Syndrome X

Manifestation of Syndrome X

Laboratory Values

Syndrome X in a Nutshell

Cardiac Syndrome X

Causes of Syndrome X

Syndrome X and Type 2 Diabetes

Syndrome X and Coronary Heart Disease

Syndrome X and Aging

Conventional Treatment of Syndrome X

Natural Treatment of Syndrome X

Conclusion

Introduction

Those who are in the sub-clinical phase (age 35-45) and clinical

phase of aging (age 45 and above) have a one in three chance of

getting this syndrome and not knowing it. Perhaps the following signs

are more recognizable: feeling sluggish, physically and mentally,

especially after a meal but at many other times as well. Gaining a

pound here and a pound there-and having increasing difficulty in

losing them. Having blood pressure creep up year and after year. And

finding that the blood cholesterol, triglycerides, and blood sugar

levels are doing the same. These are all accepted signs of aging.

They are also all signs of Syndrome X.

Syndrome X can explain why you feel lousy today -- such as being

tired and fuzzy-minded. It can explain why you have high

triglycerides, high cholesterol or high blood pressure, why you are

feeling lousy after meals, and why you are seeing your health spin

out of control without knowing why. It can also explain why you are

aging faster than your peers. More importantly, Syndrome X sets the

stage for catastrophic health problems, such as heart disease,

diabetes, Alzheimer's, cancer, and other age-related diseases.

It is estimated that this syndrome afflicts over 60 million Americans

and one in four adults over age 35. Hypercholesterolemia, cigarette

smoking, hypertension, and obesity are the main culprits for the

development of artherosclerotic coronary artery disease (CAD).

However, these account only for half of the cases of CAD. The other

pathologic processes underlying atherosclerosis remains unknown.

Syndrome X may be the cause of up to fifty percent of all heart

attacks. It is an epidemic of massive proportions.

How do you develop Syndrome X?

Syndrome X develops slowly over time, often over a course of 20 years

or more. It is the end result from years (often decades) of taking in

a modern day diet high in refined carbohydrates such as breads,

starches and sweets. These foods, once taken, trigger a rapid

increase in blood sugar levels, and the body responds by raising

levels of insulin secretion that in turn helps to move the sugar out

of the blood stream into the cells. Insulin is a hormone secreted by

the pancreas. It helps the body utilize glucose (blood sugar) by

binding with receptors on cells like a key would fit into a lock.

Once the key - insulin - has unlocked the door of the cell, the

glucose passes from the blood into the cell. Inside the cell, glucose

is either used for energy or stored for future use in the form of

glycogen in liver or muscle cells.

The more carbohydrates you eat, the more your pancreas releases

insulin to lower the excessive blood sugar. This is especially so

with simple or refined carbohydrates that are converted into sugar

quickly (the high-glycemic index foods like white bread and white

flour) once inside your body. While insulin levels rise and fall with

each meal and is part of the normal metabolic process, chronic

carbohydrate overload causes chronic insulin overload. The cells of

the body, be it the muscles or the fat tissues, recognize that

excessive sugar is toxic. They try to shut down the influx of sugar

into the cells and therefore go through a down-regulation process to

resist the command of insulin. This state is called insulin

resistance. The pancreas, in response to the insulin resistance and

resulting lowered transport of glucose out of the blood stream to the

cell, puts out even more insulin in order to avoid too high a blood

sugar level. This compensatory increase in insulin output continues

until the pancreas fails to keep up. Some people produce two, three

or four times the normal amount of insulin. Yet, because the cells

have lost their sensitivity to insulin, they require even more of it

to maintain normal glucose levels. In advanced stages of insulin

resistance, when the pancreas becomes exhausted and can no longer

maintain the insulin production, insulin production drops, resulting

in adult onset diabetes mellitus (also called type 2 diabetes).

Insulin resistance plus compensatory hyperinsulinemia is nature's way

of preventing the evolution into type 2 diabetes. It is often

referred to as a pre-diabetic state.

As long as there is insulin resistance, the blood sugar and blood

insulin levels are both high. Over time, high blood sugar and high

insulin cause a myriad of destructive damages to almost every tissue

they touch. It is important to recognize while insulin resistance or

high blood sugar is each bad for health on its own, it takes both

insulin resistance and compensatory hyperinsulinemia, to result in

the various manifestations. These manifestations represent the

resultant damage and surfaces as a compilation of symptoms

representative of multi-system dysfunction. This includes the

cardiovascular system, muscular system, kidney system, reproductive

system, and lipid metabolic system, just to name a few. These

symptoms, when grouped collectively in a setting of insulin

resistance, is called Syndrome X. It can go undetected for up to 40

years, and a family history of type 2 diabetes, CHD, or hypertension

increases the risk for Syndrome X.

SYNDROME X as explained by Dr Reaven

Syndrome X was first discovered by Stanford University Professor and

researcher Gerald Reaven, MD. In 1988, he first presented the results

of twenty years of study that showed that the effect of an array of

changes around a little known medical condition called insulin

resistance to increased heart disease.

In his book Syndrome X, Dr Reaven describes the condition as follows:

This deadly heart ailment begins in the bloodstream, shortly after we

eat. That's not a startling idea, for we know that eating fatty or

cholesterol-laden foods can be bad for our hearts. However, the

Syndrome X culprit isn't red meat or butter, it's carbohydrates. Yet

these carbohydrates are reluctant, inadvertent offenders.

Before entering the body proper, our food is broken down into various

constituent parts in the intestine. One of these is glucose (blood

sugar) from carbohydrates. Upon entering our cells, some of the

glucose is put right to work providing the energy that cells need to

perform their various tasks. The rest is stored in certain cells for

later use. But the glucose doesn't simply flow into the storage

cells. Instead, it must be guided in by insulin, a protein secreted

by the pancreas.

Insulin acts like a shepherd, herding its precious flock into the

cellular "corrals". Unfortunately, in many of us, glucose behaves

like a group of errant sheep, stubbornly refusing to go where the

shepherd directs. When that happens, the pancreas pumps out more and

more insulin. That's the biochemical equivalent of sending out more

and more "shepherds" to get the "sheep" into the "corrals". Imagine

hundreds of shepherds chasing thousands of sheep across a pristine

field covered with thick, beautiful green grass. Those hundreds of

feet and thousands of hoofs will quickly tear up the field, ripping

out or flattening down clumps of grass. Soon, the field that once

looked so green and lush will be trampled and scarred, brown and

dirty.

Something similar happens inside your body when glucose refuses to

move into the storage cells at insulin's command. The interior

linings of your arteries, like the grassy field, are "ripped"

and "trampled" as the body attempts to overcome this problem.

Eventually, the insulin "shepherds" corral the glucose, and order is

restored in the body. But all is not well, for the "field" (the

lining of your coronary arteries) is damaged, and there's other

damage, as well. This damage sets the stage for heart disease.

Pathology of Syndrome X

The fundamental defect in patients with Syndrome X is insulin

resistance in both adipose and muscle tissue. The net result is

hyperinsulinemia. The term hyperinsulinemia refers to higher-than-

normal levels of insulin in the blood.

Each cell reacts to insulin differently. Some organs are highly

sensitive to high insulin, while others are less so. Insulin

resistance per se therefore does not cause damage, but it is the

reaction of various tissues to chronic high insulin that is the main

problem. An example is the kidney. The ability of insulin to

stimulate sodium re-absorption by the kidney could be very normal but

at the same time the muscles in that individual could be quite

resistant to insulin action. The kidney is therefore an "innocent

bystander" of the increased insulin secretion in this person due to

the muscle insulin resistance.

Excessive insulin causes damage to the whole body, including:

¡P Endothelium. The inner lining or endothelium of the arterial walls

comes under attack by excess insulin. The risk of arterial blood

clots, which can cause heart attacks or strokes, is increased. The

pathophysiology is very complicated. It is clear, however, that the

damages include reduced nitrous oxide activities (which could lead to

hypertension), increased platelet and monocyte adhesion, increased

pro-coagulant activity, impaired fibrinoloytic activity, and impaired

degradation of glycosylated fibrin. The net result: increased blood

pressure, increased formation of atherosclerotic plaques, increased

thrombus formation, angina, and heart attack. The risk of

cardiovascular disease is increased significantly when the

endothelium is damaged.

¡P Pancreas. Type 2 diabetes develops when the pancreas

ultimately "burns itself out" from the excessive demand for insulin

production which it cannot keep up in an insulin resistance state.

Only 20% of people with excessive insulin due to insulin resistance

develop diabetes. The rest continue to produce enough insulin to meet

the demand.

¡P Ovaries. The ovary, being exposed to consistently higher levels of

insulin, increases its testosterone secretion accordingly, the ovary

being

insulin sensitive. It is a major factor in the development of

polycystic ovary syndrome.

¡P Cancer. Some research indicates it might also increase the risk of

prostate, colon and breast cancer.

¡P Premature Aging. Syndrome X also generates high levels of cell-

damaging free radicals and causes premature aging. Some researchers

believe it can also increase the risk of Alzheimer's disease.

¡P Kidneys. Excessive insulin leads to sodium retention. Fluids follow

sodium, resulting in excessive fluid in the body and ultimately

hypertension, a condition that is present in 50% of those with

Syndrome X

Manifestation of Syndrome X

The manifestations of Syndrome X can be broken down into eight major

categories:

1. Glucose intolerance: Not all individuals with Syndrome X have

diabetes by definition. However, their blood glucose concentration is

usually higher than those individuals who do not have Syndrome X.

Many people who are insulin resistant produce large enough quantities

of insulin to maintain near normal blood glucose levels. In Syndrome

X, VLDL, chylomicrons and their metabolic remnants (chylomicron and

VLDL remnants) are removed more slowly from the plasma by virtue of

their increased concentrations, resulting in increased postprandial

lipemia. Unfortunately, the increased VLDL also reduces the ability

to remove postprandial newly absorbed chylomicrons. More often than

not, they have impaired glucose tolerance (IGT). A glucose tolerance

test, during which insulin and blood glucose are measured, can help

determine if someone is insulin resistant.

2. Dyslipidemia: The characteristic findings are high plasma

triglycerides and low HDL cholesterol. This combination is a hallmark

of Syndrome X. The pathway is quite interesting. With high blood

insulin level, the liver produces more triglyceride rich VLDL, a

carrier of fat. The amount of triglycerides therefore increases.

Cholesterol ester transfer protein (CETP) transfers cholesterol from

HDL to VLDL, exchanging it for triglycerides. Therefore, the HDL

("good") cholesterol falls.

In addition, there is a shift in the LDL particle diameter to smaller

and denser LDL cholesterol fractions, which is the most potent and

damaging kind. The dense LDL cholesterol will attack the endothelium,

causing inflammatory responses that will lead to a cascade of events

that ultimately results in fatty streak and plaque formation

characteristic of atherosclerosis.

3. Uric acid metabolism: There is a decrease in the ability of the

kidney to excrete uric acid, so renal uric acid clearance is

decreased and the blood uric acid concentration is increased.

4. Kidney manifestation: It appears that half the patients with

hypertension are insulin resistant. This is due to fluid retention

caused by high insulin level.

5. Hemodynamic manifestations: There is evidence that the sympathetic

nervous system activity is increased in insulin resistant

individuals. Systolic pressure is often greater than 140 mmHg, and

diastolic pressure higher than 90 mmHg. This further contributes to

hypertension.

6. Fibrynolytic changes: There is an increase in Plasminogen

activator inhibitor 1 (PAI-1). When PAI-1 is high, dissolution of

blood clot is reduced, and fibrinogen and thrombus formation

increases. The increase in fibrinogen tends to increase coagulation.

This plays a role in the development of coronary heart disease.

7. Obesity. Obesity is a common feature. The body mass index (BMI) is

often greater than 25 kg/sq.m. Until recently, insulin resistance was

thought to cause obesity only in adults, because it is considered an

age-related condition. This is clearly wrong. A 1998 evaluation of

more than 2,000 Finnish men led to the finding that insulin

resistance is associated with obesity beginning in early childhood

and middle age. The researchers also noted that each five percent

weight increase at age 20, over the average for that age, was

associated with a nearly 200 percent greater risk of full-blown

Syndrome X by middle age.

High insulin itself does not cause obesity. On the contrary, obesity

leads to increased insulin resistance. We are all born with a certain

degree of insulin resistance or sensitivity. As one gains weight, the

body becomes more insulin resistant. Studies have shown that tissue

sensitivity to insulin is decreased by about 30-40% in people who are

35% over their ideal body weight.

Why obesity makes us more insulin resistant is not totally clear. It

may be related to the fact that people who are obese because of their

increased levels of body fat release more fatty acids from their fat

depots, which in turn can inhibit insulin action.

8. Antioxidant Depletion. Low levels of antioxidant vitamins and DHEA

(dehydroepiandrosterone) and high cortisol levels are commonly found

in people with Syndrome X. It is likely to due to the increased free

radical activity, and concurrent reduction in the endogenous

antioxidant level as the body tries to neutralize the free radical

activities. It has been shown, for example, that atherosclerotic

plaques not only contain cholesterol but also oxidized ascorbate

(vitamin C). The body deposits the antioxidant ascorbate there in an

attempt to overcome the free radical damage.

Laboratory Values

Fortunately, no complicated tests are needed to diagnose Syndrome X.

Very simple measurements and good interpretive skills and careful

attention in history taking are needed to have an accurate indication

of insulin resistance. It comes down to the clinician's knowledge of

metabolism and endocrinology. Abnormal test results include elevated

blood pressure, triglycerides, uric acid and glucose levels

accompanied by a low HDL count. If these results are all normal, the

chances of being insulin resistant are very low. Let us take a closer

look.

¡P Fasting triglyceride level above 1.9 mmol/L (170 mg/dl) is a very

good marker of the increase in postprandial lipemia, the appearance

of small dense LDL, and the increase in PAI-1 levels. A high fasting

triglyceride is a key marker for Syndrome X (or insulin resistance)

¡P HDL cholesterol level that is less than 1.0 mmol/L (38 mg/dl) is

also a good indicator of insulin resistance.

¡P Fifty percent of individuals with hypertension have insulin

resistance. Systolic pressure is often greater than 140 mmHg and

diastolic pressure greater than 90 mm/Hg without medication.

¡P Fasting glucose above 5.5 mmol/L (100 mg/dl) indicates that a

person is at risk of insulin resistance. The higher the glucose

within the normal glucose range, the greater the insulin resistance.

A two hour glucose concentration post glucose load of greater than

7.8 and less than 11.1mmol/L (140 and 198 mg/dl respectively) may not

merit the diagnosis of type 2 diabetes, but would suggest insulin

resistance.

¡P Triglyceride to HDL cholesterol ratio of more than 2 is a warning

sign. If the ratio is over 4, it is a good indicator of insulin

resistance.

Interesting, fasting insulin level may not be the best indicator. The

measurements are hard to do, and the values are going to differ from

lab to lab. One can have a high insulin level and not have syndrome X.

It should also be noted that a high LDL in itself is not a key marker

for Syndrome X.

LDL in most laboratories is derived from calculations. The formula is:

LDL = total cholesterol - HDL cholesterol - (triglyceride / 5).

It should be noted if the triglyceride level is above 300 mg/dl, the

LDL calculation would not be accurate because of correlation

problems. In this case, the actual measured LDL level should be

obtained. While a high LDL is a good indicator of cardiovascular

risk, a low HDL cholesterol level is even more significant, as well

as a low (<4.5) total cholesterol/hdl cholesterol ratio. Furthermore,

advanced cardiovascular indicators such as lipoprotein (a),

homocysteine, and C reactive protein (an indicator of endothelial

inflammatory response) should be part of the routine workup in anyone

suspected of Syndrome X.

Syndrome X in a Nutshell

The underlying cause of Syndrome X is insulin resistance - a diet-

caused hormonal logjam that interferes with your body's ability to

efficiently burn the sugar you eat. The more sugar you eat, the

higher the risk for syndrome X. Syndrome X occurs when the high

insulin level damages our bodies' internal systems, producing a crop

of symptoms. Specifically, this group of health problems includes

insulin resistance (the inability to properly deal with dietary

carbohydrates and sugars), abnormal blood fats (such as elevated

cholesterol and triglycerides), being overweight, and high blood

pressure.

Characteristics of syndrome X include:

¡P Insulin resistance

¡P Abnormalities of blood clotting

¡P Low HDL and high LDL cholesterol levels

¡P High triglyceride levels

¡P Central obesity (excessive fat tissue in the abdominal region)

¡P Impaired glucose tolerance

¡P High blood pressure

¡P Low levels of antioxidant vitamins and DHEA, with high anti-

inflammatory and anti-stress hormone cortisol

If you have 3 or more of the above, you should consider yourself

either having or at high risk of Syndrome X.

Cardiac Syndrome X

The term "cardiac Syndrome X" refers to a heart condition where chest

pain and electrocardiographic changes that suggest ischemic heart

disease, are present, but without angiographic findings of coronary

disease. Some research has shown that people with cardiac Syndrome X

also have lipid abnormalities. This suggests that Syndrome X and

cardiac Syndrome X may be one and the same.

Causes of Syndrome X

No one knows for sure what causes syndrome X. Some scientists think

that a defect in specific genes may cause insulin resistance and

intensive research is underway. What we do know so far is:

¡P Insulin resistance is aggravated by obesity and physical

inactivity; both of which are increasing in the U.S.

¡P The more sugar you take in, the higher the chances of you

developing Syndrome X.

The fact that many obese people have high insulin levels but do not

develop diabetes or syndrome X is interesting. Many obese people have

high insulin sensitivity and do not have insulin resistance at all.

There is evidence of a widespread variability in insulin mediated

glucose disposal by muscle in non-diabetic individuals. In a study

conducted by Dr.Reaven on 500 individuals, there is an apparent ten-

fold difference between the most insulin sensitive and the most

insulin resistant non-diabetic individual.

Syndrome X and Type 2 Diabetes

There are over 60 million people in the United States alone that have

Syndrome X. There are an additional 24 million people that have

glucose intolerance, a pre-diabetic state. In addition, there are

over 16 million people who have adult onset diabetes mellitus (Type 2

diabetes) and only half of these individuals even realize they have

diabetes. It has been estimated that diabetics have had their disease

for over 8 to 10 years before the physician even makes the diagnosis.

This may account for the fact that over 60% of the patients already

have major cardiovascular disease at the time of diagnosis of

diabetes.

Science has not yet determined why some people with insulin

resistance eventually develop diabetes and others do not. Type 2

diabetes develops in a relatively small number of individuals who are

insulin resistant. Most individuals who are insulin resistant

continue to secrete large amounts of insulin and do not get type 2

diabetes. We do know that insulin resistance is the body's natural

defense against chronic high sugar load. It is the body's defense

against the evolution to diabetes. In other words, type 2 diabetes is

often the advanced stage of insulin resistance.

The point to remember is that while most insulin resistant patients

do not get diabetes, they are still at risk for coronary heart

disease.

Ideal fasting blood sugar level

The easiest way to measure the status of sugar in your body is

through a simple fasting blood sugar laboratory test. A fasting serum

glucose level of more than 125 mg/dL is the current threshold for

identifying patients with diabetes. This was based on the incidence

of diabetic retinopathy. Now physicians are increasingly focused on

the diabetes-related risk of coronary heart disease. In a cross-

sectional study of 2,440 people, researcher Dr. Dennis Sprecher

reported that people with a fasting serum glucose level of 100-125

mg/dL had an adjusted, 2.8-fold higher risk of having a coronary

heart disease event than people with a fasting glucose level of less

than 79 mg/dL. This finding suggests that patients with high levels

of serum glucose in the nondiabetic range (100-125 mg/dl) also face a

substantial risk of having coronary heart disease. In fact, the

Cleveland Clinic Foundation now uses a fasting serum glucose of 90

mg/dL or higher as a biomarker of coronary heart disease risk. Ideal

fasting blood sugar should be no higher than 90mg/dl, regardless of

age.

Syndrome X and Coronary Heart Disease

Individuals with Syndrome X have an increased risk of heart disease

according to the American Heart Association (AHA). The relationship

is not Syndrome X leading to CHD or one factor being responsible for

the increased risk, but rather that, taken as a cluster, there is

increased prevalence of CHD in people with insulin resistance and the

various manifestations. Those afflicted with syndrome X is akin to

have been injured by a shotgun blast, with multiple bullet wounds.

While none of the multiple bullet wounds may by itself lead to death,

the collative damage caused by the multiple bullet wounds raises the

chances of death significantly. In real-life terms, we are talking

about increasing risks of cardiovascular disease, cancer, stroke, and

pre-mature aging.

Only one study has shown that in people followed prospectively,

insulin resistance increases the risk of CVD. There are multiple

studies showing that insulin level, as a predictor or surrogate

measure of insulin resistance, predicts CHD. We also know that a low

HDL is a powerful predictor of CHD. There is more and more evidence

that small dense LDL particles and increased remnant lipoprotein

concentrations due to the increased postprandial lipemia are linked

to CHD.

Syndrome X and Aging

Vladimir M. Dilman, M.D., co-author of The Neuroendocrine Theory of

Aging, refers to insulin resistance as an "age-related pathology." In

fact, it is one of the few consistent indicators of longevity.

Centenarians have a lower blood sugar and blood insulin level

relative to their age.

In the mid-1970s, biologist Anthony Cerami discovered that

chronically high blood glucose levels are the main trigger in a

chemical process that produces advanced glycosylation end products

(AGES), which are implicated in normal and advanced aging and age-

enhanced diseases. AGEs form at accelerated rates whenever blood-

sugar levels are high as with as with age.

AGEs damage to the body is extensive. Referred to as a carmelization

or browning reaction, cross-linking by AGEs involve a chemical

reaction between sugar and protein molecules. No one part is spared.

Serious damage to cell membranes and collagen fibers is near

universal. This cross-linking leads to the stiffening of connective

tissue and hardening of arteries, leading to pre-mature aging and

hypertension. As cross-links increasingly reduce the flexibility and

permeability of tissues and cells, cellular communications and repair

processes also begin to break down. A compensatory inflammatory

response may be launched by the body, especially in the endothelium.

This leads to a cascade of damaging events resulting in fatty streaks

and atherosclerosis. Eventually, the tissues of the body become

irreversibly transformed, and the inevitable result is aging, disease

and finally death.

It is well known that bathing your cells in high sugar (as in

diabetics) causes premature aging. This is because this sugar-driven

damage acquires breakneck speed, raising their levels of AGE-infused

collagen to those of elderly people. Diabetics suffer a very high

incidence of nerve, artery and kidney damage because high blood sugar

levels in their bodies markedly accelerate the chemical reactions

that form advanced glycation products. The endothelium of diabetic

patients also secretes unwanted growth factors that leads to blood

vessel hypertrophy and reduced lumen size. This reduces the blood

flow, exacerbating the already compromised insulin delivery and

further increases the chances of insulin resistance. The reduced

blood flow leads to reduced oxygen delivery to needy tissues,

resulting in increased peripheral neuropathy commonly seen in

diabetes.

Conventional Treatment of Syndrome X

Physicians have been concentrating on treating the symptoms exhibited

by Syndrome X such as hypertension and dyslipidemia rather than

concentrating on the underlying problem, which is insulin resistance.

Since over 50% of the prescriptions filled in the United States are

for hypertension, elevated cholesterol levels, heart disease, and

diabetes, you can get a glimpse of the economic importance of this

problem.

Syndrome X is usually totally reversible without drugs. The key is to

slow down carbohydrate absorption while increasing insulin

sensitivity. This can be done by lowering your carbohydrate intake

(the low-carb diet), together with a nutritional supplementation

program designed to slow carbohydrate absorption, increase insulin

sensitivity, and normalize blood sugar levels.

However, human nature (and human metabolism) being what it is, the

majority of patients with syndrome X cannot accomplish these goals.

In these cases, each metabolic disorder associated with syndrome X

needs to be treated individually, and aggressively on a short-term

treatment with drugs is seldom but may be needed.

Treating the lipid abnormalities. The lipid abnormalities seen with

syndrome X (low HDL, high LDL, and high triglycerides) respond nicely

to weight loss and exercise. Treatment should be aimed primarily at

reducing LDL and triglyceride levels, and raising HDL levels.

Successful drug treatment usually requires treatment with a statin or

one of the fibrate drugs, or a combination of a statin with either

niacin or a fibrate. It should also be noted that the use of statin

drugs is not without its problems.

Treating the clotting disorder. Patients with syndrome X have several

disorders of coagulation that make it easier to form blood clots

within blood vessels. These blood clots are often a precipitating

factor in developing heart attacks. Patients with metabolic syndrome

X should generally be placed on daily aspirin therapy to help prevent

such clotting events.

Treating the hypertension. High blood pressure is present in more

than half the people with metabolic syndrome X, and in the setting of

insulin resistance, high blood pressure is especially important as a

risk factor. Recent studies have suggested that successfully treating

hypertension in patients with diabetes can reduce the risk of death

and heart disease substantially. Low dose diuretics should be used

according to Dr.Reaven. No more than 12.5 mg of hydrochlorathiazide

should be prescribed. People with Syndrome X should not be prescribed

the anti-hypertensive dosages of thiazides that have been recommended

in the past. Difficult cases should be controlled with ACE

inhibitors. ACE inhibitors increase levels of nitrous oxide (a potent

endothelium generated vasodilator), resulting in vasodilatation and

blood pressure reduction. ACE inhibitors also have been shown to

improve endothelial function, and so have HMG-CoA reductase

inhibitors (such as lovastatin and pravastatin), and to a lesser

degree, calcium channel blockers (such as verapamil and nifedipine).

Treating High Blood Sugar. High blood sugar must be normalized.

Traditionally there are four points of intervention to reduce blood

sugar:

¡P Pancreas. Two major classes of drugs are the sulonylureas and the

meglitinides. Sulfonylureas have been used for more than 4 decades.

Their primary goal is to increase the level of endogenous insulin by

stimulating the pancreatic secretion. These agents have no direct

effect on insulin resistance. They may decrease the resistance

slightly by reducing plasma glucose level. The meglitinide class, of

which repaglinide is approved in the U.S., also stimulates insulin

release from the pancreas. Clearly, these should be avoided among

those with Syndrome X who already have a high insulin level. Further

insulin will only worsen the problem.

¡P Intestines. Alpha-glucosidase inhibitors are currently represented

by acabose. The primary mechanism of action of these agents is to

inhibit specific enzymes that break down carbohydrates in the small

intestine. Absorption of carbohydrates is delayed, resulting in a

reduction of postprandial hyperglycemia. No specific action on

insulin resistance has been reported.

¡P Liver. The biguanides, of which metformin is the agent used in the

U.S., mainly decrease hepatic glucose production, They also increase

peripheral insulin sensitivity, leading to reduced plasma glucose

level. They also have also some effect in reducing intestinal glucose

absorption. Clearly this is a better drug to use than the previous

two.

¡P Muscle. This class of oral agents is known as the

thiazolidinediones, of which troglitazone is approved for use in the

U.S. It reduces insulin resistance by increasing the uptake of

glucose by peripheral tissues such as skeletal tissue. It is

therefore uniquely designed to attack insulin resistance.

Natural Treatment of Syndrome X

While there are no drug treatments that can directly reverse the

insulin resistance that causes syndrome X; there is, in fact, a way

to reverse the insulin resistance - and that is through diet,

exercise, and nutritional supplementation.

1. Diet

Clearly, the following goals should be met in any diet for Syndrome X

sufferers:

a. Reduction of carbohydrates. With less carbohydrates around, there

will be less insulin needed.

b. Reduction of LDL cholesterol which can lead to heart disease

c. Reduction of blood glucose level

d. Increase in insulin sensitivity

The question is: If you reduce carbohydrate, and reduce fat, then how

are you going to get enough calories? If one food group is reduced,

the calories must be supplied by another food group. The mandate is

clear - reduce carbohydrates, especially simple refined

carbohydrates. How you make up the calories is less clear. There are

only two options available: carbohydrates can be replaced with

proteins or with fats. Clearly saturated fats should be restricted to

reduce the risk of cardiovascular disease and to lower LDL

cholesterol level. Therefore, part of the carbohydrate should be

replaced with "good" fat. Replacing carbohydrates with proteins

ignores the fact that protein, once in the intestinal tract, converts

to amino acid. Amino acids increase insulin secretion. It is unclear,

however, whether proteins are as potent as carbohydrates in

stimulating insulin secretion.

Dr Reaven's Syndrome X diet derives 45 percent of calories from

carbohydrates, 15 percent from proteins and a hefty 40 percent from

fats. In contrast, American Heart Association recommends keeping fat

intake to no more than 30 percent of your total calories and boosting

the carbohydrates to at least 55 percent.

What makes Dr Reaven's diet different from the latest run of lower

carbohydrate diets is that his eating plan is low in protein. This is

very different from Dr Atkins' diet that is high in protein.

A diet high in protein is suitable for those with normal insulin

sensitivity, but inappropriate for those with syndrome X. It is

important to note that there are good fats and there are bad fats.

The fats recommended by Dr.Reaven are mostly heart-friendly

unsaturated fats from plant and vegetable sources such as olive oil

and nuts, not from artery-clogging saturated fats present in steaks.

Dr Reaven suggests replacing saturated fats with and mono- and poly -

unsaturated fats will equally benefit LDL cholesterol lowering as

compared to replacing saturated fats with carbohydrates. This is

confirmed in multiple studies. Mono- and poly-unsaturated fats do not

raise insulin levels, so you get the benefit of both LDL cholesterol

and Syndrome X control. Unsaturated fats are found in foods such as

vegetable oils (olive oil in particular is high in mono-unsaturated

fats) nuts, and avocados, whereas saturated fats are abundant in

fatty cuts of meat and whole milk dairy products.

It has been postulated that use of low glycemic-index carbohydrates

will avoid worsening the manifestations of Syndrome X due to its slow

glucose release and absorption rate. There is little doubt that low

glycemic-index carbohydrates such as fruits and vegetables are

superior when compared to high glycemic-index carbohydrates such as

white flour and white bread. Dr Reaven studied this by increasing the

fiber intake to the level recommended by the ADA for diabetics, and

it had almost no effect. In a recent paper, substantial increases in

the fiber level (exceeding the ADA recommendation) resulted in

improved metabolic characteristics, as compared to a high

carbohydrate/low fat diet. No comparison was made between the very

high fiber diet vs. a diet low in carbohydrates and high in

unsaturated fats.

The simplest and most effective approach is to replace the

carbohydrates with poly- and mono-unsaturated fats and restrict

saturated fat intake, to achieve both lower LDL cholesterol and

improve Syndrome X.

3. Exercise.

Epidemiological studies have shown that modest exercise improves

mortality. However, unequivocal metabolic benefits from exercise will

not be achieved from a casual walk a couple of nights a week.

Significant, regular, chronic exercise is required to see

improvements in insulin action, triglycerides, and HDL cholesterol.

Exercise is as powerful a tool as weight loss.

4. Weight Management.

Every attempt should be made to reduce total body weight to within

20% of the "ideal" body weight calculated for age and height.

Syndrome X will improve significantly. There is little question about

its effectiveness.

5. Other lifestyle Factors:

a. Alcohol. In population-based studies, moderate drinkers are found

to have lower insulin levels as compared to non-drinkers. Our small-

scale studies have shown moderate drinkers to be more insulin

sensitive. There have been no intervention studies to show that

initiating alcohol consumption in individuals who are insulin

resistant with low HDL is beneficial. So it is not reasonable to

suggest that non-drinkers should start to drink 1-2 drinks per day.

On the other hand, we do not have the evidence to recommend

abstaining from alcohol.

b. Smoking. Smoking is unequivocally bad, including the association

with high triglycerides, low HDL cholesterol and insulin resistance.

Conclusion

Two of the key players that modulate our health is glucose (also

known as blood sugar) and the hormone insulin. Because of the high

carbohydrate foods we, as a whole population, now eat, our bodies'

levels of glucose and insulin have gone out of control. Such high

carbohydrate foods probably include cereals, muffins, breads and

rolls, pastas, cookies, donuts, and soft drinks.

Quite simply, we are overdosing on glucose and insulin -- and both

substances in high doses accelerate the aging of our bodies and

encourage the development of disease. Insulin resistance is the

body's way to resist excessive sugar and carbohydrate levels. 60

million Americans have this syndrome. When insulin resistance is

accompanied by compensatory hyperinsulinemia, the systemic damage

from the hyperinsulinemia is collective known as Syndrome X.

Fortunately, Syndrome X can be reversed with dietary, lifestyle, and

nutritional supplements. Dr Reaven, the father of Syndrome X,

advocate a diet high in unsaturated fat (45%), low in protein (15%),

and moderate in carbohydrate (40%). Exercise, weight management, and

optimum nutritional supplements such as chromium polynicotinate,

vitamin C, proline, lysine, and other antioxidants help to normalize

sugar and increase insulin sensitivity.

Sign In

Breaking insulin resistance

Recommended Posts

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Join the conversation

Support the Ashram

Join Groups

Top Downloads