Why only one in eight Americans are metabolically healthy
By Christopher J. Stadtherr, MD
Insulin resistance is now the most prevalent medical condition in the world, and yet many people are unaware of it. In health care, we are accustomed to talking about a myriad of diseases as if they are all separate entities, e.g. hypertension, type 2 diabetes, coronary artery disease, obesity, etc. Aside from rare exceptions, though, these diseases are all due to one underlying condition—insulin resistance.
Insulin - A vital hormone The hormone insulin tells the cells of your body what to do with energy. As glucose levels rise, your body compensates by releasing more insulin, which signals your body to either use glucose as a fuel or to store it as energy. A limited amount of glucose gets stored as glycogen in muscle tissue or liver, and the excess glucose gets turned into fat. Insulin is not always problematic. In fact, it's vital to our physiology. Individuals who cannot produce insulin, as in type 1 diabetes mellitus, are unable to process or store glucose. Prior to the discovery of insulin, type 1 diabetes was fatal within weeks to months.
In contrast, type 2 diabetes is characterized by high insulin levels that contribute to our bodies becoming insulin resistant.
What is insulin resistance? Insulin resistance is a condition in which your body becomes less sensitive to insulin, and thus you must make more of it. Over time, this situation results in increased insulin levels. This process is driven by lifestyle factors (diet and activity), stress, and inflammation.
The syndrome of insulin resistance is more commonly called the Metabolic Syndrome, which is defined by the presence of three of the following five criteria: • Abdominal obesity • Elevated blood pressure • Elevated fasting blood glucose • Elevated triglycerides in the blood • Low level of HDL cholesterol in the blood
These findings are directly attributable to the higher levels of insulin and are responsible for the increased risk of numerous chronic health conditions. In fact, studies suggest that insulin resistance is the most important determinant of ill health.
For most people, the first sign of insulin resistance may be the accumulation of abdominal fat, while the other markers are more subtle and may go undetected for a long time.
Metabolic Syndrome is common It is estimated that 88 percent of Americans have at least one component of the Metabolic Syndrome, according to a study in 2019. In addition, 35 percent of Americans meet the criteria (at least three components) for Metabolic Syndrome—19.5 percent among those aged 20 to 39 and increasing to 48.6 percent of those aged 60 and older. Unfortunately, most affected individuals are not aware of the presence of Metabolic Syndrome, even though their high insulin levels may be detectable many years before they’re diagnosed with diabetes or a related condition.
The following diagnoses are consequences of persistently high levels of insulin: • Obesity • Type 2 Diabetes • Hypertension • Cardiovascular disease • Stroke • Polycystic Ovary Syndrome (PCOS) • Erectile Dysfunction • Fatty Liver • Cancers—especially breast, prostate, and colon • Dementia
These common diseases of modern civilization are all just symptoms of the same underlying condition—insulin resistance, which is perhaps the greatest threat to our health in the modern world. With that knowledge in hand, what can we do to prevent these complications?
What to do It is important to first identify any potential manifestations of insulin resistance, with a proper physical examination and laboratory evaluation. While it may not be possible to eliminate some of the contributing factors such as stress or inflammation, it is possible to reverse insulin resistance by certain lifestyle modifications.
When it comes to nutrition, it is important to reduce the intake of processed foods, particularly those that contain sugar, refined grains, and seed oils.
Exercise can also improve insulin resistance by recruiting muscles to burn excess glucose. Any amount of physical activity can be beneficial, including resistance training, aerobic activity, and even walking.