Insulin resistance protects against…insulin! T2D 26

By Jason Fung, MD

Virtually all doctors agree that elevated insulin resistance is very bad for human health, being the root cause of type 2 diabetes and metabolic syndrome. So, if it is so bad, why do we all develop it in the first place? How can such a mal-adaptive process be so ubiquitous?

As of 2015, over 50% of the American population has diabetes or pre-diabetes. This stunning statistic means that there are more people in the United States with pre-diabetes or diabetes than without it. It’s the new normal. Why does it develop it so frequently? There must be some protective purpose to it since our bodies are not designed to fail. Humans have lived for millennia before the modern diabesity epidemic. How can insulin resistance be protective?

You can discover many things by taking a different perspective. The golden rule states “Do unto others as you would have them do unto you.” A well-known quote says, “Before you judge me, walk a mile in my shoes”. In both cases, the key to success is change perspective. Invert (turn upside down) your perspective, and see how your horizons are immensely broadened. So let’s look at the development of insulin resistance from the opposite angle. Let’s not consider why insulin resistance is bad, but rather, why it is good.

It is a well-established fact that high blood glucose levels are harmful. But here’s a question seldom asked. If the high glucose level is toxic in the blood, why wouldn’t it also be toxic inside the cells? As glucose enters the cells faster than it can be used for energy, it accumulates inside the cell.

Insulin’s moves glucose from the blood into the cells, but doesn’t actually eliminate it from the body. It merely shoves the excess glucose out of the blood and forces it into the body. Somewhere. Anywhere. Eyes. Kidneys. Nerves. Heart.

Let’s consider an analogy. We all need food, but if there’s too much lying around, it simply rots. As the amount of rotten garbage piles up, we need to throw it out. Moving it under the sink, where it is out of sight, is not ultimately useful. We might not be able to see it and pretend that our kitchen is still nice and clean, but eventually the entire house is starting to stink.

The same logic applies to the excessive glucose. Using medications like insulin to hide the blood glucose into the tissues of the body is ultimately destructive since it cannot be disposed of properly.

A trip to DiabetesVille

Imagine that you live in a town called DiabetesVille. Like cells in our body, there are many houses on Liver Street, Kidney Road, and Pancreatic Avenue among others. Everybody is friendly and normally leaves their door open and unlocked. Three times a day, a glucose truck comes down the street and Mr. Insulin delivers a small cup of glucose to each house. Life is going well, and everybody is happy.

But gradually, over time, Mr. Insulin comes around more and more often. Instead of three times, he comes six times a day. Instead of dropping off a little cupful of glucose, he drops whole heaping barrels of the stuff. He needs to empty his truck every night, or else he’ll lose his job. For a while, you take the excess glucose into your house and life goes on.

Finally, your house is completely filled with glucose, which is starting to rot and stinking up the house. Like everything else in life, the dose makes the poison. A little glucose is OK, but too much is toxic.

You try to reason with Mr. Insulin, but to no avail. Every house on every street is experiencing the same situation. When that glucose truck comes down the street, Mr. Insulin really needs to get rid of this toxic waste. Every time a door is open, he shovels in another barrelful of glucose.

Now, what would you do? You’d bar your door, is what you’d do! You’d shout, “I don’t want this toxic glucose! I’ve got too much already, and I don’t want anymore.” You lock the front door so that it is difficult for Mr. Insulin to shove more toxic stuff into your house. It’s not a bad thing; it’s a good thing. You are simply protecting your house from Mr. Insulin’s toxic glucose load. That’s insulin resistance!

An outside observer would only see that Mr. Insulin is trying to do its job of moving glucose into the house, but is unable to do so. He may erroneously conclude that this house is ‘resistant’ to insulin because the door is broken (lock and key paradigm). But in reality, the problem was that there was already too much glucose inside.

Mr. Insulin is now finding it harder and harder to get rid of his glucose load and is worried he’s going to get fired. So, he asks his brothers to help him. The Insulin brothers team up to break down the door so they can shovel in barrels of glucose into your unwilling home. This works, but only for a while, as you race to reinforce your front door with steel bars to increase resistance.

Suppose we eat a diet very high in sugar over many years. Glucose and fructose are entering our body in excess of our energy needs, stimulating insulin. Glucose is flooding the liver, which stores some as glycogen. When glycogen stores are full, the liver turns on de novo lipogenesis and creates new fat. But the rate of production exceeds the liver’s capacity to export it, so fat is accumulating in the liver, where it should not be.

Insulin tries to move the toxic glucose into the liver, but it doesn’t want it either. The liver cells try to protect themselves against this excessive glucose load by increasing insulin resistance. This is a protective mechanism.

What, exactly is insulin resistance protecting us from? Its very name gives the answer away. Insulin Resistance. It’s a reaction against excessive insulin. It’s protecting us from the excessive insulin. Insulin causes insulin resistance.

This sets off a vicious reactionary cycle, where insulin resistance leads to further hyperinsulinemia, leading only to further resistance. But the root cause is the hyperinsulinemia, not the insulin resistance. The cells of they body tissues (heart, nerves, kidney, eyes) are all busy increasing their resistance to protect themselves from insulin. The resistance is only a response to the hyperinsulinemia.

Dr. Endo steps in

Back in DiabetesVille, Mr. Insulin and his gang are not able to unload their huge glucose burden. All the doors have been triple barred and guarded by dogs. Glucose is spilling over into the streets. Unsure what else to do, the specialist Dr. Endocrine steps in. Dr. Endo decides that the glucose is indeed toxic, and the streets must be cleared immediately.

Despite the fact that there are hoards of Insulin clansmen prowling the streets, Dr. Endo decides that the best solution is to use even more insulin! Since Mr. Insulin has no more family, Dr. Endo hires more henchmen to do the job. They shove more toxic glucose into the reluctant houses, clearing off the streets.

At least Dr. Endo cannot see the problem anymore so he can pretend he is doing a great job and give himself a pat on the back. Look! The streets are nice and clean. All the toxic glucose has been cleared. The fact that it has been crammed into all the houses escapes his attention.

This works for a short period of time, but eventually, the houses fill up again, and increases their resistance. Even the extra Insulin cronies cannot shove any more glucose in. What does Dr. Endo do? Get rid of some of the glucose instead of just moving it around? Stop glucose from coming into the city? Hardly. He has only learned one solution to every problem – give more insulin! To the man with a hammer, every problem looks like a nail. Year after year, the dosage of insulin relentlessly goes up.

The core problem of insulin resistance has been caused by excessive glucose and insulin. Yet the currently accepted solution is to prescribe even more insulin in order to lower blood glucose. Instead of eliminating the glucose, it merely moves it around the body into all the organs.

As these organs fill up with even more glucose, insulin resistance increases. However the higher dose of insulin only succeeds in creating more insulin resistance. The dosage of insulin is relentlessly increased to keep blood glucose levels down. Even while the symptom of high blood glucose improves, the disease of type 2 diabetes worsens. Taking higher and higher doses of insulin only means that the insulin resistance is getting worse and worse.

What happens over time? All our organs start rotting from excessive glucose. Insulin resistance develops precisely to shield against this toxic glucose load. The reason insulin resistance universally develops in all organs and in all peoples of the world is because it is protective mechanism. It’s a good thing, not a bad one. This is the answer to the question we posed in Chapter 3. Diabetes affects virtually every tissue in the body because we are cramming glucose into every nook and cranny.

A New Paradigm

The current paradigm of insulin resistance is a malfunctioning lock and key model. Glucose is stuck outside the cell and cannot get through the gate leading to ‘internal starvation’. Fifty years of devotion to this paradigm has utterly failed. In the interim, diabetes has risen to global epidemic proportions.

Understanding insulin resistance as an overflow phenomenon holds enormous treatment implications. Our current generation of medications, including insulin, sulphonylureas, and metformin do not address the underlying pathophysiology of type 2 diabetes. These medications, based on the old, failed paradigm are designed to ram glucose into the cells at all costs.

The primary problem is not insulin resistance. Instead, the root cause is hyperinsulinemia, forcing glucose into every tissue in the body. Giving more insulin to a patient with excessive insulin is harmful. We are inadvertently overcoming the tissue-protective insulin resistance that is developing.

Like giving alcohol to an alcoholic, prescribing insulin in a disease of excessive insulin is not a winning strategy. That’s exactly how we are losing the war on type 2 diabetes. This is how the ancient disease of type 2 diabetes has become the 21st century plague. It is because our fundamental understanding of the disease is flawed.

The problem is not insulin resistance. It’s the insulin, stupid!!

By The Fasting Method

For many health reasons, losing weight is important. It can improve your blood sugars, blood pressure and metabolic health, lowering your risk of heart disease, stroke and cancer. But it’s not easy. That’s where we can help.

Jason Fung, MD

By Jason Fung, MD

Jason Fung, M.D., is a Toronto-based nephrologist (kidney specialist) and a world leading expert in intermittent fasting and low-carb diets.

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