Presentation on theme: "Metabolic Syndrome & Insulin Resistance"— Presentation transcript:
1Metabolic Syndrome & Insulin Resistance By Elizabeth Large, NDGordonMedical associates3471 Regional ParkwaySanta Rosa, CA 95403
2Metabolic SyndromeMetabolic syndrome is called a syndrome rather than a disease because it refers to a group of risk factors that occur together and increase the risk for coronary artery disease, peripheral artery disease, type 2 diabetes and stroke.It is believed to effect approximately 25% of the population.
4Metabolic Syndrome Criteria 3 + of the followingCentral or abdominal obesity (waist): Men - Greater than 40 inches and Women - Greater than 35 inches,Triglycerides greater than or equal to 150Blood HDL - Men - Less than 40 Women - Less than 50Blood pressure greater than or equal to 130/85Fasting glucose greater than or equal to 100
6GeneticsThe Thrifty Gene proposed by geneticist James Neel in Historically advantageous in times of famine, but then became detrimental in the modern world.Thrifty genes are genes which enable individuals to efficiently collect and process food to deposit fat during periods of food abundance.Those carrying the thrifty gene survived when food was scarce.
7Thrifty GeneResearch shows that those with this gene have a slowed metabolic rate. The mitochondria produce 70% less ATP than controls.Ethnic Groups commonly effected were stressed populations:African Americans (50%), Pima Indians (nearly 100%), Polynesians, Mexican Americans (50%)Genetic theories are unproven at this point
8Insulin and GlucoseWhen food is eaten, carbohydrates are broken down to the end product of glucose.This stimulates the release of Insulin which the body needs to absorb glucose into fat, heart, liver and muscle cells which act as a sponge.Overtime, the cells began to ignore the insulin messenger. When that signal is ignored, the body’s insulin producers— beta cells—have to work harder and harder, overproducing insulin to get the job done causing insulin resistance.
9Insulin promotes fat storage Excess glucose can also be converted to fatty acids, which are the immediate precursors of fats (triglycerides)In addition to facilitating the transport of fatty acids into cells that need them as fuel, insulin promotes their conversion to fat for storage in adipocytes (fat cells). if we overeat and don’t exercise enough, the supply of fat will exceed the demand for energy. That can lead to obesity, the main cause of insulin resistance, which can lead to diabetes.
10Insulin in Excess Signals the body to store fat causing obesity InflammationOxidative stressIncreases vagal nerve gastric acid productionAlters sex hormone production (PCOS, low testosterone in men, high in women, increased estrogen in men) Virulization of women and feminization in menFatty liver disease
11Obesity/Inflammation Connection Obesity is a state of chronic low-grade inflammation that is initiated by changes in the adipose tissue.Research suggest that as fat cells increase in size, the composition of their lipid membrane composition changes in a manner that may make these cells more prone to triggering inflammation.
12Inflammation/IRIncreased plasma levels of pro-inflammatory markers including cytokines and C-reactive protein (CRP) in obese individuals Many of the inflammatory markers found in plasma of obese individuals appear to originate from adiposeIn chronic inflammation, chemicals released such as TNF and IL6 directly interfere with insulin signaling pathways making cells more insulin resistant.
13Vicious Cycle of Obesity "Now we know that fat cells are little hotbeds of inflammation. Therefore excess belly fat is a great source of inflammation.Therefore being obese can cause insulin resistance and insulin resistance can cause obesity.
14Cardiovascular Effects Insulin resistance significantly increases the risk of ischemic stroke in nondiabetic adults, independent of traditional vascular risk factors or metabolic syndrome , “October 2010 issue of Archives of Neurology”Individuals in the top quarter of insulin resistance had a 45 percent greater risk of any type of vascular event.
15Cardiovascular Effects Insulin stimulates the sympathetic nervous system, increasing nor-epinephrine release contributing to high blood pressureInsulin increases triglycerides and cholesterol. Eat eggs not sugar!
16Cardiovascular Effects Insulin damages the endothelium or cells lining our blood vessels. Endothelin dysfunction reduces nitric oxide production needed for healthy blood vessels. It also reduces blood flow by causing vascular smooth muscle contraction and the growth of vascular smooth muscle cells. As a result, the blood vessels are thicker with a smaller lumen; blood flow is slower and there is increased risk of clotting inside the vessels (thrombosis) and stroke.
17StrokeInsulin resistance significantly increases the risk of ischemic stroke in non-diabetic adults.October 2010 issue of Archives of Neurology
18Hormonal activationAromatization -Testosterone is chemically converted to estrogen.In people with excess fat and especially abdominal fat with higher aromatase so greater conversion of testosterone to estrogen.Insulin increases LH blocking testosterone production.Testosterone: lower in men and higher in women.
19Hormonal Activation – PCOS Polycystic Ovarian SyndromeProduction of multiple small cysts beneath the ovarian capsule. These insulin-damaged ovaries act like testicles; they make excessive androgens, from DHEA to testosteroneIncreased Luteinizing hormone.Anovulation
20PCOSA woman’s body converts these androgens to estrogens as and levels of both testosterone and estrogens can significantly exceed that of progesteroneSymptoms: excess facial hair, lack of ovulation, heavy periods, painful periods, irregular or absent periods, acne or oily skin, depression or mood swings
21Fatty LiverFatty liver, also known as fatty liver disease (FLD), is a reversible condition where fat accumulates in liver cellsDespite the strong association between insulin resistance and dyslipidemia/fatty liver, the precise mechanism linking these conditions is unclear.Signs: Decreased (HDL) cholesterol and increased (VLDL) and possible elevated liver enzymes. Dx: Ultrasound or a non-contrast CT scan of the abdomen
22Cortisol/AdrenalineThose with Metabolic syndrome has been shown to have higher cortisol levels.High sugar causes cortisol to spike.A New York Times article on a study showing when children eat sugar, their adrenaline levels rise far higher than those of adults – up to 15x higher than baseline.
23Another vicious cycle..Cortisol effects worsen insulin resistance and its consequences include weight gain, especially with increased abdominal fat; elevated blood pressure; higher blood sugar; insomnia and reduced activation of thyroid hormone.Insulin resistance increases cortisol production, which in turn worsens insulin resistance.
24InflammationChronic inflammation and its cytokine messengers, especially TNFa and IL-6 increase energy demands in an already-challenged system; they worsen insulin resistance, and add to sympathetic nervous system activation.The effect of insulin on oxidative load: depletes our glutathione, vitamin C, vitamin E and other antioxidants
25IR and Type 2 DiabetesDiabetes mellitus type 2 – or adult-onset diabetes a metabolic disorder characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency.
26IR and Type 2 diabetesPre-diabetes :Elevated insulin and borderline glucose levels precede onset of type 2 diabetes.In time elevated insulin will stress the beta cells, which wear out over time. When most are diagnosed with type 2 diabetes, they have already lost some of their ability to make insulin.
28TestingGlucose/Insulin Tolerance Test: Insulin resistance - insulin levels rise above 200Lipids (Cholesterol, HDL, LDL, TRIG) VAPFasting glucose and hA1cCRP - independent biomarker for the development of CVD which emphasizes the connection between inflammation, obesity, and CVD.Homocysteine, Free and Total Testosterone, Estrogen, Liver Enzyems.
29Food as MedicineDietary Goals – Reduce obesity and improve insulin sensitivity.“Hunter Gatherer”Diet. It reflects what our Paleolithic ancestors (i.e., before agriculture) evolved eating over a million years and, as such, has the highest potential of supporting healing and preventing disease.Examples: The Zone, Paleo Diet, Diet Cure, Schwarzbein Principle, South Beach Diet, Candida Diet.
30Food as MedicineAvoid: White Foods with a low glycemic index and fast foods. Complex carbohydrates in moderation.Non-Starch Vegetables –should be the majority of carbohydrates.Protein - Beans, Legumes, Fish, Free Range Animal Protein. Grass fed beef. Protein at each meal preferred.Healthy fats – avocado, organic butter, olive oil, coconut. Avoid hydrogenated oils and fried foods. Nuts in moderation.
31Food as MedicineFruit – moderate consumption. Only in season. · Small amounts of fruit are OK but eat it with protein meals and not alone. Berries are best. No dried fruit.Reduction or elimination of sweeteners (including artificial and stevia)Dairy - whole milk is best. But the best is no milk, as it raises the blood sugar.
32Lifestyle ChangesExercise may be the single most important factor for reversing insulin resistance. Exercise improves insulin sensitivity, lowers fasting glucose, lowers fat mass, and improves fat metabolism.Sleep - Sleep deficiency significantly worsens insulin resistance, with a nearly 40% decrease in glucose tolerance
33SupplementsR-Lipoic Acid: Taking 600 mg orally daily improves insulin- sensitivity in diabetics; stimulates glucose uptake by GLUT- 4 receptorsCarnosine: Antioxidant. Helps prevent damage caused by too much sugar in the body, “glycosylation,”Antioxidants in general to protective from oxidative stress of high insulin.Cinnamon:decreases blood glucose and improves insulin sensitivity – 1-6 G for 4 months.
34Supplements Berberine - 1500 mg per day improves insulin sensitivity Fiber - slows down release of glucose into the blood. Guar gum, glucomannan, oat fiber.Vanadium – Research slows activates GLUT 4 transporters.Chromium improves glucose metabolism mcg per day
35Berberine Study“Compared with metformin, berberine exhibited an identical effect in the regulation of glucose metabolism, such as HbA1c, FBG [fasting blood glucose], PBG [blood sugar after eating], fasting insulin and postprandial insulin [insulin level after eating]. In the regulation of lipid metabolism, berberine activity is better than metformin. By week 13, triglycerides and total cholesterol in the berberine group had decreased and were significantly lower than in the metformin group (P<0.05).”
36Drug TherapyMetformin: commonly used for type 2 diabetes and to treat young women with infertility due to PCOSImproves insulin sensitivity, with “increased peripheral uptake and utilization”Decreases intestinal absorption of glucose. The reduced absorption of glucose from the gut means less sugar gets into the blood stream to stimulate pancreatic insulin release.Patients with larger body-mass index (BMI) respond better to metformin treatment than do the more slender
37MetforminReduced the amount of insulin released in response to drinking sugar (46% less)Reduced blood levels of LH (67% lower),Reduced free testosterone (44% less)SHBG (which rose nearly three times higher than the untreated baseline.)Reduces Total-cholesterol, LDL-cholesterol and TG
38TestsVAP panel (an expanded lipid profile), CRP, hA1c, 2-4 hour Glucose and Insulin Tolerance Test, homocysteine, LH, Free and total testosterone, Estrogen, Liver enzymes and fasting glucose.Adiponectin: A hormone e secreted by fat cells. Improves insulin sensitivity, reduces insulin resistance and may protect pancreatic b cells. High levels are associated with normal insulin sensitivity. Low levels correlate with metabolic syndrom and diabetes.
39The road to healthRemember metabolic syndrome is an outcome of our sedentary, fast-food oriented modern lifestyle. With commitment to healthy eating, daily exercise and your doctors support, metabolic syndrome can be reversed.Thank you
40Contact Dr. Large Elizabeth Large N.D. Gordon Medical associates 3471 Regional ParkwaySanta Rosa, CA 95403