"I am not eating more or exercising less, so why am I gaining weight around my waistline?" I get this question from my friends and family.
As we already know, there is more to the above equation than just food calories in, exercise burning those calories, and having weight go up. Not all calories are good for us and can cause inflammation and illness over time. Stress, nutrition, sleep quality and quantity, and illness all play a role in disrupting our glucose and insulin balance. It is important to ask yourself what of the above is contributing, and I usually ask about blood test results and if recording a week of food and exercise can be done to give more information. There usually is something else going on because our bodies are always working towards balance. With rising insulin, the body still works to maintain some balance in that state of elevated insulin. It can show up as being hungry all the time, irritable, unable to sleep, and having elevated blood glucose and blood insulin levels in labs. There could be other life events and lab markers involved that influence the balance.
Below are some blood work values for a typical issue like weight gain around the waistline. These are not abnormal results, but are simply a snapshot in time that show some high-normal numbers. Repeat testing and comparison can signal a trend over time and is encouraged. If this blood work is repeated at 90 days and numbers are still rising, we have a better idea of what is going on. There may be a need to assess adrenal and hormone function, for example. These tests and their importance are reviewed below. If that doesn't interest you simply scroll down to The FIX to get going on a solution.
Recent tests results (fasting) with normal range values:
HgbA1c: 5.1 (4.8-5.6)
Insulin: 24.3 (2.6-24.9)
Glucose: 89 (65-99)
IGF-1 (Insulin-Growth Factor-1): 132 (74-239)
This jumble of letters and a number is short form for glycated hemoglobin or hemoglobin type A1c, which is a reflection of long term glucose levels over time. It usually reflects the prior 90 days average level of glucose and is expressed as a percentage. 5.1% is not abnormal, but for most people it is ideal to be below 5%.
Insulin, Glucose and IGF-1:
IGF-1 is a small peptide that works with insulin and IGF-2 in cell metabolism to promote growth via controlled cell signalling, and to induce cell death (apoptosis) when the cell reaches the end of its life cycle. The signal cascade is a relay system of reactions that starts interchangeably with these three, and the signals turn on or off more peptides and cell checkpoints like RAS, mTOR and Akt and can lead to 4 outcomes:
normal and abnormal cell proliferation
abnormal cell pro-survival (making bad copies of a cell that doesn't die off naturally like healthy cells do)
angiogenesis (new blood vessel growth)
invasion (bad cells moving to a new location downstream from the primary tumor site)
Proliferation is expected for normal cells in the case of a growing child with normal growth hormone levels, with the balancing act of regulated cell death to keep growth in control and to prevent a condition called Acromegaly: where growth is accentuated by higher IGF made by the body. Elevations of both IGF-1 and insulin in adults is not normal - we are done growing and thus do not need proliferation. Further, elevations in fasting IGF-1, 2, or Insulin in adults are correlated with tumor cell activity rather than normal healthy cell activity, for breast, prostate, pancreatic, colorectal, ovarian, and other cancer types. It has a higher incidence of causing cancer in Acromegaly. Interestingly, in people with Laron syndrome who are born with an IGF deficiency there is no incidence of malignancy. So does this mean that someone with insulin resistance as found in blood work with elevated fasting IGF-1, Insulin and glucose and HgbA1c could be making bad copies of their own cells? Yes, eventually. But in the early stages it presents as persistent hunger/low blood sugar and elevated insulin. The balance is off.
Insulin is used in drug form to control elevated blood sugar and is life-saving for Type 1 Diabetes. Like glucose it is both good in the right amount and bad when there is too much. In all situations where insulin and glucose are abnormally elevated over time, it contributes to the development of conditions such as obesity, insulin resistance and cancer? Insulin resistance begins when our healthy tissues (muscles, brain, etc) are not able to take up and use the available glucose for energy. There is no shortage of glucose, just an inability to sense the glucose by the receptors in the tissues of the body. It is similar to losing one's hearing over time -the volume needs to be turned up in the beginning, then more and more as hearing loss progresses. With insulin resistance, the pancreas senses the high glucose levels, goes to work and sends out more insulin to try to restore the balance. It causes a cycle of chronically elevated glucose triggering more insulin release. Yet the glucose isn't taken up by tissue receptors, resulting in glucose remaining elevated, then more insulin from the pancreas to address it, and so on. This is why these will be elevated in blood results. Insulin resistance and is found in Pre-Diabetes, Type 2 Diabetes, and Polycycstic Ovarian Syndrome, Obesity and Cancer. Insulin resistance can result from a genetic tendency, poor dietary intake, sedentary lifestyle, medications, and being overweight.
Friends, family and everyone else noticing that 'spare tire' - this is for you. Here are my initial suggestions. All of the above conditions (except for genetic causes) are treatable through the following lifestyle changes:
With daily aerobic exercise, this is the ideal goal::
A brisk walk after each meal for 15 minutes to drive glucose to muscles instead of storage as fat. Seeing as most of us are working from home due to the pandemic, this is a great opportunity to begin this habit.
If you are unable to fit this in after each meal, then it is also just as good to do this at the end of your day after 7pm for 45-60 minutes.
Timed, 13-hour daily fasting at minimum, starting at 7pm or earlier.
Adjusting your food intake for the long term to match that of the Mediterranean Diet
If you are currently doing this without success, I encourage you to repeat your labs in 3 months and determine the trend with your licensed healthcare provider. There may be more going on and a proper medical diagnosis is needed. In my work as a licensed naturopathic doctor, I work with people who have cancer or are working to prevent cancer recurrence. I discuss goals and tailor all of the above to the metabolism of that specific cancer, in addition to shutting down cancer growth signalling pathways wherever possible with other tools like supplements, botanical medicine and conventional oncology.
For everyone, whether you have cancer or not, the goal in all of the above approaches is to dial down the glucose insensitivity and thus reverse the insulin resistance. If you are already doing this and nothing is changing after three months, repeat your labs and schedule with me to discuss this in more detail.