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The Insulin Factor: Can’t Lose Weight? Can’t Concentrate? Can’t Resist Sugar? Could Syndrome X Be Your Problem?
Insulin Resistance results from the body’s protective mechanism to prevent high blood glucose. Insulin Resistance is an extremely common problem that can cause disease and limit life span. There are many things that raise blood glucose (e.g. refined carbohydrates, sugar stress) but just one that lowers it: insulin. Insulin Resistance is reversible if you make changes to your diet and lifestyle.
Summary of key points
They’re sweet, they’re comforting, they give you an instant feelgood high – small wonder that so many of us keep on turning to refined carbohydrates and sugar. We’re also surrounded by food products containing these instantly gratifying substances – fizzy drinks, chocolate bars, bagels, pasta, ice cream, sweets to suck, chew or swallow – and because the ‘fix’ we get from them is sweet and addictive, we are tempted time and time again.
We have been refining foods for centuries, as far back as the ancient Pharaohs who also observed the dangers of excess carbohydrates, but never as intensively since the middle of the 20th century. Too busy, too tired, too dissatisfied or too depressed, we are easily seduced by the promise of a quick sugar or carb high. So, you may not want to hear it but carbohydrates and sugars really are the bad guys, especially when it comes to Insulin Resistance and all of its knock-on effects. Understandably, it is a message that most people don’t want to hear. We are consuming more sugar in our diets today than ever before: in the UK the average person consumes 1201b of sugar a year, while in the USA the average person eats a staggering 1951b. This equates to people in the UK eating nothing except sugar every fifth day and in the US every fourth!
Captain Cleave on sugar
As early as the 1930s a Royal Naval doctor, Captain Thomas Latimer Cleave, identified the dangers of refined carbohydrates and sugar. He observed the correlation between rising incidences of heart and bowel disorders, obesity, diabetes, varicose veins, dental decay, haemorrhoids and related diseases with the under-consumption of dietary fibre and over-consumption of refined carbohydrates. Sailing around the world between different countries and communities, he observed that there was a close correlation between the degree to which a society’s diet was refined with cereals, rice and sugar plants, and the incidences of these diseases. For instance, tribal communities eating a traditional wholefood diet were free from these diseases, whereas tribal communities who had adopted a more refined diet were not. He continued to study the effects of refined foods on health, eventually publishing The Saccharine Disease in 1974.
The sugar-body fat connection
The single most significant cause of being overweight is eating too many refined carbohydrates, for example white bread, bagels, white pasta, white rice, biscuits, cakes, sweets, chocolate. It is virtually impossible to be obese on a natural food diet. It is very easy to overeat refined carbohydrates because they are a denser form of calories: an apple contains the same amount of calories as a single teaspoon of sugar. You could quite easily eat 10 teaspoons of sugar in a fizzy drink but you’d be hard pushed to eat 10 apples in one sitting! The best way to prevent being overweight is to avoid refined carbohydrates. The ultimate refined carbohydrate is white sugar.
The key difference between natural foods and refined sugars is that natural foods contain fibre, vitamins, minerals and other nutrients, whereas sugar and refined carbohydrates do not. This is why sugar and refined carbohydrates are often referred to as empty calories. What is more, sugar and refined carbohydrates also deplete nutrients in the body when they are metabolized. For example, every time you eat white sugar, you deplete your zinc and chromium levels as your body needs zinc and chromium in order to make insulin.
Although fat consumption and exercise play a part in weight control, they are not as important as you may think. It is quite possible to lose weight by reducing refined carbohydrates and not making any changes to your fat consumption and exercise routine. However, the Insulin Factor Plan does still recommend moderate exercise and emphasizes the need for good quality fats.
Sugar and diabetes
There is also a strong link between sugar and diabetes. This is because refined carbohydrates encourage the body to produce high levels of insulin, which ultimately exhausts the pancreas so it is unable to make enough insulin to control blood glucose, leading to diabetes.
Sugar and heart disease
Not only does sugar increase your risk of diabetes, but it also increases your risk of heart disease. Interestingly, sugar will actually start affecting the health of your cardiovascular system long before you ever get diabetes. This is because high levels of insulin, normally caused by a diet high in refined carbohydrates, exist for many years before you develop diabetes, and excess insulin is one of the most powerful causes of furred arteries, high cholesterol and blood fats, (triglycerides) and high blood pressure (see chapter 1). Insulin is as responsible for elevated bad cholesterol and blood fats as dietary fat. As you know, there is a strong link between high cholesterol and blood fats, and heart attacks and strokes.
Sugar and tooth decay
Of course, it will come as no surprise that sugar is also the main culprit when it comes to tooth decay.
Digestive problems
Refined carbohydrates are also behind many digestive problems, because they feed unwanted bacteria in the gut. The refined carbohydrates line the wall of the gut and enable bacteria to thrive and survive rather than pass on through. These bacteria contribute to a range of conditions from excess flatulence, appendicitis, inflammation of the gallbladder and poor digestion of fats, abdominal bloating, offensive smelling stools, and even cystitis and interstitial cystitis.
The hostile bacteria cause inflammation in the gut provoking the immune system to produce molecules called cytokines. This is a normal self-defence mechanism. However, an excess of these immune defence molecules causes problems in the same way excess insulin causes problems. They can escape the gut and get into the bloodstream and disrupt the binding of insulin to its receptor cells. Research shows that these cytokines are a significant contributory factor to Insulin Resistance.
This is why the health of your digestive system is an important part of the Insulin Factor Plan.
But if you are completely appalled at the idea of not being able to eat sugar again, don’t panic! Firstly, it’s more a question of cutting down on foods that contain refined carbohydrates, and secondly it really isn’t as difficult as you think, particularly as there are supplements you can take to stop your cravings – most of my clients who are hooked on sugary things are surprised how easy it can be to give them up.
Summary of key points
In this chapter you can find out about your own risk of Insulin Resistance. The first thing you have to do is to work out your Body Mass Index (BMI) and then you can go on to further assess your risk of Insulin Resistance by answering a five-part questionnaire. We’ll also have a brief look at interpreting the results of a proper Insulin Resistance blood test, in case you want to do this, as it will give you a clearer indication of what degree of Insulin Resistance you have. We’ll also look in a little more detail at the major causes of Insulin Resistance in relation to your questionnaire results and which sections you should focus on in your Insulin Factor Plan.
Body Mass Index (BMI)
Although you do not have to be overweight to be insulin resistant, being overweight and having a high proportion of body fat are significant risk factors for Insulin Resistance and heart disease. For this reason, it is helpful to work out your Body Mass Index, or BMI. There are two groups of people for whom a BMI reading is not always helpful or accurate, namely:
Generally speaking, though, your BMI is a reliable indicator of your total body fat.
Work out your BMI by using the BMI table (see Resources). If you need help with assessing your BMI number, please talk to your doctor, who can work it out for you.
My BMI No.:
Date:
Interpreting your result
If your BMI puts you in the overweight or obese bracket, you need to start thinking about losing weight. People who are overweight have a greater chance of developing conditions that are caused at least in part by Insulin Resistance: high blood pressure, high blood fats and cholesterol, diabetes, heart disease, strokes and certain cancers. Even a small weight loss (just 10 per cent of your current weight) will help to lower your insulin and consequent risk of developing those diseases. You don’t and shouldn’t try to lose weight overnight, as crash dieting actually increases Insulin Resistance. Instead you should follow the Insulin Factor Plan as recommended in chapter 12 which will help you to lose weight steadily and permanently.
Underweight: less than 18.5 Normal weight: 18.5–24.9 Overweight: 25–29.9 Obese: more than 30Insulin Resistance questionnaire
Now that you have calculated your BMI, you are ready to complete the Insulin Resistance questionnaire. The questionnaire is not meant to be the definitive and most accurate method of assessing Insulin Resistance, although it certainly is a good guide.
Whilst you may have already made up your mind that you have Insulin Resistance, the following questions should give you clarification. Importantly, most ‘yes’ answers – other than those in the family history section – can be addressed successfully with the Insulin Factor Plan. Even if you only have a low risk of Insulin Resistance, the questionnaire will show you which aspects of your diet and lifestyle you need to keep an eye on. It is also useful for you to return to and see what progress you have made.
The Insulin Resistance questionnaire is made up of five parts:
1 Family and Health History
2 Signs and Symptoms
3 Dietary Factors
4 Lifestyle and Exercise
5 Lab Test Results (not essential, but explanations are given so you can understand your results).
Part one – family and health history
Scoring this part of the questionnaire
This is simple. You need to answer ‘yes’ or ‘no’ to each question, with the exception of the age question. Each ‘yes’ answer is awarded a single point. In the age question, you score more the older you are, with a maximum of 3 and a minimum of 0.
Do you have now or have you ever had in the past:
1 A family history of diabetes (type II), heart disease or stroke?
2 A family history of obesity or high cholesterol?
3 Type II diabetes (non-insulin dependent, adult-onset)?
4 High blood pressure (Hypertension)?
5 High blood sugar (Hyperglycemia)?
6 Low blood sugar (Hypoglycemia)?
7 Polycystic Ovary Syndrome (PCOS)?
8 Gout or arthritis?
9 Kidney stones?
10 A BMI of 30 or over?
11 Take the birth control pill (now, or for more than a year in the past)?
12 Exercise less than one hour a week?
13 Are you of South Asian, African, Polynesian, or Mexican origin?
14 Crash dieted to lose weight quickly?
15 What is your age? (60+ = 3, 50–59 = 2, 30–49 = 1, under 30 = 0)
Score out of 17 (women) =
Score out of 16 (men) =
Part two – signs and symptoms
Scoring this part of the questionnaire
Again, ‘yes’ answers score one point, but please note that if your BMI is equal to or over 33 then you score one point four times for the weight-related questions.
Do you have now or have you ever had in the past:
1 Is your BMI 33 or more?
2 Is your BMI 30 or more?
3 Is your BMI 27 or more?
4 Is your BMI 24 or more?
5 Difficulty losing weight despite exercise and/or a calorie-controlled diet?
6 An addiction to carbohydrates/sweets?
7 Inexplicable fatigue, tiredness, lack of energy?
8 Headaches, nausea or fatigue that is alleviated by eating?
9 A feeling of always being thirsty?
10 Need to eat every 3 hours or less?
11 Irritable after 4 hours without food?
12 Sleepy or fuzzy headed particularly after carbohydrate meals?
13 Suffer from afternoon fatigue?
14 Indigestion after meals?
15 Acne?
16 Physically unfit?
17 Hirsutism (excess facial hair or on the thighs)? (Women only)
18 Dry, flaky skin?
19 An earlobe crease in each ear?
20 Postural hypotension (your blood pressure drops when you stand up)?
21 Arcus senilis in your eyes? (This is a marking in the coloured part of the eye, the iris, where there is a white circle within the circumference, usually at the top of the iris under the eyelid (11 to 1 o’clock), but sometimes in the lower part too (4–8 o’clock), and sometimes around the whole iris)
Score out of 21 (women) =
Score out of 20 (men) =
Part three – Diet
Scoring this part of the questionnaire
Each ‘yes’ answer scores one point. Please note that if you smoke more than 15 cigarettes a day, then you score one point three times for the smoking-related questions. The same principle applies to the alcohol, water intake and vegetable intake questions.
Do you now or have you ever in the past:
1 Eat refined carbohydrates (e.g. white bread, white rice, sugar)?
2 Eat hidden sugars in foods or drinks?
3 Regularly eat large meals?
4 Smoke more than 15 cigarettes a day?
5 Smoke more than 8 cigarettes a day?
6 Smoke cigarettes every day or more than 10 a week?
7 Drink caffeinated drinks (with or without sugar) (e.g. coffee or cola drinks)?
8 Drink more than four cups of tea a day (with or without sugar)?
9 Drink more than 2 units/glasses of alcohol a day?
10 Drink more than 4 units/glasses of alcohol a day?
11 Eat fried food more than once a week?
12 Eat barbecued food more than once a month?
13 Eat processed foods regularly, including microwave or oven meals?
14 Eat protein foods (e.g. fish, white meats, eggs, meats) less than 3 times a week?
15 Are you a vegan (no meat or dairy products)?
16 Drink more than two glasses of fruit or vegetable juice a day?
17 Seldom eat oily fish, nuts and seeds? (see chapter 6)
18 Eat less than one portion of fresh vegetables a day?
19 Eat less than two portions of fresh vegetables a day?
20 Eat two meals a day or less?
21 Eat just one meal a day?
22 Drink less than three glasses of water a day?
23 Drink less than five glasses of water a day?
24 Drink less than eight glasses of water a day?
Score out of 24 =
Part four – lifestyle and exercise
Scoring this part of the questionnaire
Each ‘yes’ answer scores one point, except where indicated with regard to frequency of exercise. Exercise in this context means anything in which you are physically moving for at least 20 minutes at a time, be it aerobic, stretching or resistance work.
Are you now or have you ever in the past:
1 Regularly stressed or anxious?
2 A poor sleeper?
3 Always chasing appointments or deadlines?
4 Unable to relax without feeling guilty?
5 A person who has a persistent need for achievement?
6 Easily angered?
7 A sedentary person (e.g. office worker)?
8 A person who does anaerobic (e.g. weights only) and no aerobic exercise?
9 A person who exercises 3–4 times a week (score 1)?
10 A person who exercises 1–2 times a week (score 2)?
11 A person who exercises less than once a week (score 3)?
12 A very competitive person?
13 Irritable and impatient?
Score out of 16 =
Part five – Blood test results
Scoring this part of the questionnaire
Read through this section and answer any questions for which you have blood test results. Skip this section if you have not had a blood test done.
Do you currently have any of the following?
1 High fasting insulin
2 High fasting triglycerides
3 High triglycerides after a meal
4 Decreased HDL (good) cholesterol
5 Elevated LDL (bad) cholesterol
6 Elevated total cholesterol
7 Elevated systolic blood pressure (your first figure is over 139)
8 Elevated diastolic blood pressure (your second figure is over 89)
9 Elevated fibrinogen
10 Elevated PAI-1 (plasminogen activator inhibitor-1)
11 High uric acid (or gout)
12 Low Serum or Salivary DHEA (DHEA may have an inverse relationship with Cortisol and insulin)
13 Elevated testosterone in women (acute hyperinsulinemia increases testosterone blood levels and suppresses SHBG synthesis) (women only)
14 Low levels of sex hormone binding globulin (SHBG) (women only)
15 Decreased testosterone (serum or saliva test) (men only)
Score out of 14 (women) =
Score out of 13 (men) =
If you have answered ‘yes’ to any of the questions above, other than insulin itself, you should consider a fasting glucose and insulin test to rule out Insulin Resistance and diabetes. Also, make sure you discuss ‘positive’ results with your doctor. (See Resources for laboratory information.)
Your scores
Section five of the questionnaire determines whether you have Insulin Resistance or not, and to what degree. However, the sections one to four of the questionnaire help to quantify your risk and will show you which aspects of the Insulin Factor Plan you need to follow. The higher your score in the first four sections, the more advisable it is to have an Insulin Resistance test.
Use the chart below to note your scores and total them up.
Total scores
1 Family and Health History /17(F) /16 (M) 2 Signs and Symptoms /21 (F) /20 (M) 3 Diet /24 4 Lifestyle and Exercise /16 5 Blood Test Results /14(F) /13 (M) _______ Total /92 (F) /89 (M)Interpreting the questionnaire
