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What is insulin resistance and why do 80% of Americans have it?

Most people have insulin resistance in this country and don’t even know it. It’s the driving force behind SO many of the chronic diseases that are plaguing this country. Heart disease, diabetes, fatty liver disease, dementia and Alzheimer’s, high blood pressure, poly-cystic ovarian disease and so many other are largely cause by insulin resistance.

So, what is insulin resistance and how do you know you have it? Most of the time, doctors are focused on fasting glucose and so insulin resistance is totally overlooked. Insulin resistance shows up LONG before it starts to affect your glucose and even your HbA1c. Insulin resistance is when your body can’t use the hormone insulin effectively anymore. Insulin is responsible for getting blood glucose (sugar) out of our bloodstream and into our cells where it can be broken down. All cells in the body have insulin receptors and these receptors can become damaged and “resistant” to insulin when your blood sugar is too high and stays to high. The main thing insulin resistance does to damage our cells is called “glycation”. Glycation literally "stiffens" our cells and makes them less flexible. Stiff joints, stiff muscles, stiff arteries, stiff brain, stiff skin are all the result of insulin resistance. Also, all that extra sugar is converted to fat and we start to accumulate that visceral (organ) fat around our bellies and in our livers.

So how do you know you have insulin resistance? Although a blood test is the most accurate way to know if you have insulin resistance, there is something that you can do at home to know whether you may have insulin resistance. It’s called your "waist to height ratio". It measures how much visceral fat you have. Take your waist in inches measured at the widest part of your waist (not where you wear your pants) and divide it by your height in inches. Anything over 0.53 is an indicator that you may be insulin resistance. You should never have a waist measurement that is more than double your height measurement. Another test is to measure your Triglyceride to HDL ratio. Take your last lab panel and divide your HDL number INTO your triglyceride number. A ratio of <2 is considered good while a ratio of >3 indicates that you may have insulin resistance. By the way, this ratio is a significant predictor of a future cardiovascular event (stroke or heart attack). Lastly, and probably most accurate is called the HOMA-IR test. This stands for the homeostatic model assessment of insulin resistance. You need to know your fasting glucose as well as your fasting insulin (a lab test not normally performed unless you ask for it). You calculate your HOMA-IR by taking your fasting glucose and multiplying it by your fasting insulin, then, you divide that number by 405. See the equation below for HOMA-IR. A number of < 1 is good while a number > 2 shows that you have some insulin resistance and a number > 3 show that you have significant insulin resistance.

Lastly, remember that insulin resistance is REVERSIBLE. Eating lower glycemic index foods such as laying off the sugary carbs (bread, pasta, cereal, bagels, soda, beer, etc.), increasing your exercise and intermittent fasting can all significantly improve your insulin sensitivity. The disease of insulin resistance is actually “pre-mature aging”. If you see someone, including yourself, who is aging biologically faster than chronologically, think insulin resistance.

Best in Health,

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