Tag Archives: insulin resistance

Low Vitamin D Linked to Obesity and High Triglycerides


Understanding of the various ways vitamin D effects the body is growing rapidly. Originally this vitamin was thought to only effect calcium in the blood and bone but recent research shows it possesses important influences on the immune system and cancer development. A study just published in Journal of Endocrinology and Metabolism June 2012 now shows that this same vitamin can possibly influence metabolism. A common disorder of metabolism known as Syndrome X or the Metabolic Syndrome is characterized by high triglycerides and low good cholesterol (HDL), abdominal obesity, along with elevated blood pressure and blood sugar. The researchers discovered those with vitamin D levels between 16 and 20 were 75% more likely to develop the Metabolic Syndrome within 5 years than those with vitamin D levels above 34 (levels below 30 are considered low).

Whether low vitamin D is the cause of the Metabolic Syndrome is unclear. Vitamin D prevents fat cells from reproducing, helps the natural process of triglyceride breakdown and helps regulate blood sugar by making insulin work more efficiently. Without enough vitamin D the fat cells could multiply faster, triglyceride levels accumulate and blood sugar rise as is seen in Metabolic Syndrome.

As I have explained in previous posts at metabolism.com, vitamin D is also related to development of hardening of the arteries (atherosclerosis) and obesity in Type 2 Diabetes which could be considered a more advanced form of Metabolic Syndrome.

Doctors’ efforts to monitor vitamin D levels are being hindered by new regulations by Medicare and private insurance carriers to deny payment for vitamin D screening. Lately, a number of my patients’ vitamin D tests were denied by insurance carriers with patients being charged over $200 per test because it was not “indicated”.

Recommendations for vitamin D supplementation are debated. When skin is exposed to sunlight it manufactures vitamin D so there is thought that people who get sun exposure should not need vitamin D supplement but that is not borne out in reality. Previously the recommended daily allowance (RDA) was 400 units per day an amount which has been increased slightly for the elderly. Some experts recommend 1000 unit daily or more. In my practice I generally recommend starting at 1000 units and then rechecking 25 hydroxy vitamin D levels a few months later. Some individuals require 4000 unit or more daily to achieve vitamin D levels over 30. When purchasing vitamin D the D3 form appears to be converted in the body more rapidly than the D2 variety. High priced brands of vitamin D, in my opinion, are a waste of money.

Gary Pepper, M.D.
Editor-in-Chief, Metabolism.com

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Polycystic Ovarian Syndrome Is Common in Adolescent Girls


Polycystic Ovarian Syndrome (PCOS) sounds like a rare disorder but it is surprisingly common. This is a disorder with onset in early adolescence effecting up to 10% of young women. Characteristic signs and symptoms include increasing facial and body hair, hair loss from the scalp, muscular or heavy build, acne, thickening and darkening of the skin known as acanthosis nigricans, blood sugar problems including type 2 diabetes, high cholesterol and irregular menstrual cycles and infertility. In older women with PCOS coronary artery disease is more common. In severe cases deepening of the voice and enlargement of the clitoris (clitoromegaly) can be seen. Before the underlying hormone disorders were clarified, the main method of diagnosing this disorder was by finding multiple cysts on the ovary. We now understand that the main problem is not the ovarian cysts but metabolic disorders including insulin resistance and elevated male hormone levels (testosterone) in the blood.

Another misconception about PCOS is that it only occurs in overweight women. Obesity is common in PCOS but thin women are also capable of developing PCOS. The underlying hormone problems are complex but are thought to be at least in part due to high insulin levels in the blood resulting from insulin resistance. With insulin resistance the body requires high levels of insulin due to insensitivity of the tissues to insulin’s presence.
What treatments are available for PCOS? There are very few, if any, drugs specifically approved for the treatment of PCOS. This is probably because of the low profit potential for treating this disorder. Drug companies cannot afford to invest millions of dollars in research because almost all of the existing standard therapies are generic drugs. Some of the most useful medications for treating PCOS are drugs used to treat type 2 diabetes because of their effect to reduce insulin resistance. These drugs are metformin and Actos. Metformin is the most popular oral medication for diabetes treatment in the U.S. Actos has been available for about 10 years but due to recent negative publicity about an unproven risk of bladder cancer, its popularity is declining. Neither drug is approved by the FDA for treatment of PCOS but multiple studies confirm the clinical and hormonal benefits of using these medications in this disorder. In 2011 research was published in the Journal of Clinical Endocrinology and Metabolism suggesting that the generic cholesterol lowering drug, simvastatin may also show benefits similar to metformin for the treatment of PCOS.

In the late 1980’s, I along with Dr. Lester Gabrilove at Mt. Sinai Hospital in New York, published our research showing that an anti-fungal medication, ketoconazole, could reverse the hormonal, physical and metabolic problems associated with PCOS. Due to the potential toxicity of ketoconazole this therapy never gained wide spread acceptance. The manufacturer refused to fund additional studies to determine how to more effectively use this drug, due to the low profit potential and liability concerns.

This information is strictly for educational puroses. Due to high risk of toxicity of medical therapy in young women who can potentially become fertile under treatment for PCOS, no drug should be taken without the close supervision of a physician. The reader agrees to the Terms of Service of this website, metabolism.com

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Will Insomnia Lead to Diabetes?


During the past decade researchers have discovered that lack of adequate sleep can cause metabolic defects similar to those of diabetes. Blood sugar tends to be higher and insulin resistance more pronounced in people who don’t get adequate sleep. To create these abnormalities in blood sugar metabolism for studies, researchers typically deprived subjects of sleep to an extreme degree for several days. Recent research however, showed that less drastic sleep deprivation can create the same diabetes-like problems in metabolism.

In a study just published in the June edition of the Journal of Clinical Endocrinology and Metabolism (95:2963-2968, 2010), researchers in the Netherlands allowed normal subjects to sleep for only 4 hours for a single night. They found that after one night of sleep deprivation the body was not able to respond nearly as well to insulin as after a normal night of sleep.

Can this type of sleep deprivation eventually lead to permanent blood sugar problems? A group of researchers from Columbia University found that people who habitually sleep less than 5 hours per night are twice as likely to develop diabetic levels of blood sugar compared to those who sleep more.

What is the connection between sleep deprivation and diabetes? The thought is that lack of sleep fosters an inflammatory environment in the body. Whether this is because during sleep the body removes inflammatory cells and toxins or whether sleeplessness increases the production of inflammatory agents is not known. Inflammation, in turn, creates the basic metabolic defect in type 2 diabetes known as insulin resistance. Since insulin is the hormone that regulates blood sugar, if the body is resistant to insulin than high blood sugar (diabetes) can develop.

Conclusion? Work and worry less, sleep better and longer, and reduce your risk of getting diabetes. (Did I hear you say he must be dreaming?)

This article is for educational purposes only and is not meant as medical advice or treatment.

Gary Pepper, M.D.
Editor-in-Chief, Metabolism.com

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Great Ways to Deal With Carbs in Your Diet


Carb craving seems to be a major hurdle for people with metabolic disorders like diabetes and thyroid disease. Is this just a problem all people face or is there something more specific about metabolic disorders that draws people in the direction of carbs? It is clear that when “insulin resistance” is part of the medical picture that sudden drops in blood sugar that result from this, are most rapidly corrected by consuming sugars and carbs. This may explain part of the attraction.

In her recent book, Eat Your Way to Happiness, expert and author Elizabeth Somer offers readers excellent advice for dealing with cravings and carbs in general.

We thank Elizabeth and her publisher for permission to post this excerpt again:

10 Steps for a Carb Makeover
by Elizabeth Somer, M.A., R.D.,
Author of Eat Your Way to Happiness

If you are a carb craver, you need to treat yourself with a little kindness. It’s not your fault you can’t keep your fingers out of the cookie jar or the bag of chips. You can’t “will away” those cravings. They are hardwired in your head.

So work with your carb cravings. Make sure each meal contains at least one whole grain. Plan a quality-carb snack at your most craving-prone time of the day (typically midafternoon or late evening). To maximize your mood and minimize your weight, you need to take this quality-carb message seriously. That means tackling the issue with a 10-step plan.

Step #1. Purge the kitchen of all white flour. Open the cupboards and toss the junk. Throw out the obvious: the white rice, the instant mashed potatoes, any cracker or cookie made with anything but 100% whole grain (you are pretty much down to Triscuits and 100% Whole Wheat Fig Newtons), all potato chips, Pop-Tarts, boxes of bread crumbs, Pasta Roni, Hamburger Helper, cans of Chef Boyardi Ravioli, Costco muffins and such. Search the freezer for French fries, hash browns, breakfast foods made from processed grains or other high-calorie/low-quality items like Marie Callender’s frozen pasta entrees or pot pies.

Definitely toss your carb triggers, junk foods that you are powerless to resist. Remember, if you have to drive to the store to get ice cream, you will be much less likely to binge.

Then read labels on the rest. If wheat flour or enriched flour is in the top three ingredients on a label, you are holding a poor-quality carb. Toss it.

Okay, okay, if this cold-turkey approach is a bit over the top, then keep two or three junk carbs and toss the rest. But beware: these items may be “trigger” foods that tempt you to indulge. Also, keep in mind that this is not so much about “giving up” as it is giving to” your health, your mood, and your belly and thighs.

Step #2. Restock the kitchen with the 100% whole grains you like, such as 100% whole-wheat bread, old-fashioned oatmeal, Kashi Autumn Wheat Cereal or GoLean Cereal, Zoom hot cereal or instant brown rice. Experiment with new grains, like barley, millet, amaranth, whole-wheat couscous or bulgur.

If you can’t imagine your spouse or kids loving whole-wheat pasta or whole-wheat tortillas, then choose the next best thing. For example, try Aunt Jemima frozen Pancakes with Whole Grains, or tortillas or pastas made from blends of whole wheat and refined wheat, such as Ronzoni or Barilla whole-wheat blend pastas.

Step #3. Switch to quality carbs in recipes. For example, if a recipe calls for

white rice: use instant brown or wild rice, bulgur, millet or other whole grains

flour: use at least half whole-wheat flour

bread (such as French toast): use whole-grain bread

potatoes: use sweet potatoes, yams, squash and/or corn

Step #4. Plan snacks and bring grains with you. When packing your lunch and snacks for the day, make sandwiches with 100% whole-grain bread, use low-fat cheeses such as Cabot Vermont 50% Reduced Fat Cheese, and include other grains like 100% whole-grain crackers or air-popped popcorn.

Step #5. Create nonfood rewards. Praise yourself with a manicure, flowers, a game of golf on Saturday or a Netflix movie. Follow the “if . . . then” rule: if you steer clear of the junk, then you get the back rub, hour of alone time or bubble bath.

Step #6. Take time. Often we grab food before we even know whether we really want it. That knee-jerk reaction gets us into trouble. Take a 10-minute pause before diving into any snack, from popcorn to leftover doughnuts.

Step #7. Identify the craving. Is it for something crunchy or chewy? Cold, sweet or creamy? Once you have pinpointed exactly what you want, then find a low-calorie food that satisfies that craving. Luckily, the better you eat, the more your cravings for fatty or overly sweet carbs will dwindle.

Step #8. Eat breakfast. As discussed in Chapter 2, eat a nutritious breakfast and you are much more likely to resist junk-food temptations throughout the day.

Step #9. Keep hunger at bay. Eat small meals and snacks evenly distributed throughout the day. This helps keep serotonin levels (and other nerve chemicals like NPY) in the normal range.

Step #10. Out of sight, out of mind. Put another way, seeing is craving. Watch out for temptations at the mall, restaurants and friends’ houses. It is easy to overdo carbs when most of the ones offered to you are the low-quality ones. For example, studies at the University of Illinois found that people ate 45% more calories when there was a bread basket placed on the table in restaurants than when the waiter came by and offered them a slice from a basket. Ask that the tortilla chips be removed when dining at a Mexican restaurant and you will save yourself 300 unnecessary calories. Avoid the coffee shop with the display of muffins, scones and croissants.

The above is an excerpt from the book Eat Your Way to Happiness by Elizabeth Somer, M.A., R.D.. The above excerpt is a digitally scanned reproduction of text from print. Although this excerpt has been proofread, occasional errors may appear due to the scanning process. Please refer to the finished book for accuracy.

Copyright © 2009 Elizabeth Somer, M.A., R.D., author of Eat Your Way to Happiness

Author Bio
Elizabeth Somer, M.A., R.D., author of Eat Your Way to Happiness, is a registered dietitian and author of several books, including 10 Habits That Mess Up a Woman’s Diet, Food & Mood and Age-Proof Your Body. She is a member of the editorial advisory board of Shape magazine and editor in chief of Nutrition Alert, a newsletter that summarizes the current research from more than 6,000 journals. She appears frequently on NBC’s Today and other national television shows.

For more information please visit www.EatYourWayToHappiness.com.

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