Metabolic Syndrome 5 Part Deep Dive Part V

Oct 22, 2023

Part 5 – changing the game


So far, we have gone through a fair bit of information, and I’m sure if you’re like me looking at it for the first time, it might seem complex and you might have to read over a section or two a couple times.

In this final part of the article I’d like to go through some strategies on how to turn this around. Yes, there are medications out there that can help. For example, a GLP-I agonist can help people eat less and lose weight and can help decrease liver fat. SGLT2 inhibitors also help by increasing urinary excretion of glucose but it has minimal effect on liver fat. Even gastric bypass or gastric banding reverses type 2 diabetes and reverses insulin resistance.

Gastric banding curing diabetes
Here you can see in picture A. in black, pre- Surgery fasting glucose was above 9 and after surgery their fasting glucose dropped to below 6. Also notice their weight loss. In Picture B you can see that however, the normalization of glucose in type 2 diabetes occurred within days after bariatric surgery, before substantial weight loss. (15)

These surgeries aim at making your stomach smaller so you can’t eat as many calories or food as you were able to before the surgery. If the rapid changes in metabolism following bariatric surgery are the consequence in calorie balance, hepatic insulin sensitivity of type 2 diabetes should be correctable by change in diet alone.

low calorie diet reversing diabetes
This study was done on people with type 2 diabetes who ate a very low calorie diet. Within 7 days, liver fat decreased by 30%, becoming similar to that of the control group, and hepatic (liver) insulin sensitivity normalized. Pic A – You can see fasting glucose has dramatically dropped in under 2 weeks. Pic B – Liver glucose production has gone down Pic C – Liver triglycerides have gone down And the graph is shown over an 8 week low calorie diet. (15)

From this we can see that one tool we can use straight away is to reduce calories as a means to control blood glucose levels and to start reversing the fat in the liver and also to start dropping down triglycerides.

There has been a lot of work and research also done with fasting, as this is the ultimate calorie restriction. When we don’t eat, insulin won’t be released. Fasting might not be for everyone, and special consideration must be taken if you have had an eating disorder in the past.

Alternate-day fasting lowered levels of fasting insulin and insulin resistance to a greater degree than calorie restriction among adults with overweight or obesity and insulin resistance, according to finding published in Obesity.

There was a 52% reduction in fasting insulin at 12 months among alternate-day fasting vs. a 14% reduction among the calorie restrictors. At the same time point, insulin resistance declined by 53% for the fasting on alternating days and by 17% for those restricting calories. (16)

Intermittent fasting is based on eating all your food for the day in a restricted feeding window. For example, you can eat all your food between 11am-7pm then eat nothing at all from 7pm-11am. You can drink water, have tea or a black coffee. In human studies on intermittent fasting, fasting blood glucose has been reduced by 3-6%, while fasting insulin has been reduced by 20-31%. (17)

The thing to take from calorie restriction, intermittent fasting and alternate day fasting is excess fuel supply and decreased oxidation are key features of insulin resistance with profound consequences on cellular metabolism.
So, when we eat less and especially the foods that cause the problems, via calorie restriction or a form of fasting, the more you can control your blood glucose and in turn insulin levels are lower and the healing process can begin.

Another good point to add here is to make sure you eat whole foods that are nutrient dense and filling to get the most out of it. Just because you fast or restrict calories doesn’t mean you get to eat burgers and chips or pizza or any other refined foods when you do eat.

While we’re on the topic of food, let’s talk about the 2 sources of foods we know cause most problems. Cutting them out will really make a difference.

The first is glucose, which you find in most refined carbohydrates. Refined carbs include sugars and refined grains that have been stripped of all bran, fibre, and nutrients, such as white breads, pasta, pastries, white flour, white rice, sweet deserts and many breakfast cereals. Also know as high glycaemic foods that spike your blood glucose.

Secondly is fructose. Remember sucrose which is table sugar and also the same sugar which is added to processed food is a 50/50 mix of glucose and fructose. Think of foods like soft drinks and other sweetened drinks including sports drinks, think lollies and chocolate, baked goods, cereals, low fat foods. So really most processed foods even “healthy” store bought salad dressings have it hidden in there.

While each of us are very different and may range from insulin sensitive to full blown insulin resistance, we all tolerate carbohydrates differently, for example a professional cyclist can eat up to 6000-7000 calories a day which is more than 3x the average person. And of that they eat about 60-70% of their calories as carbs, that’s at least 3600 calories from carbs and they would be very insulin sensitive. 

So, how far should you take cutting carbs you ask? A really cool way diabetics use and which is now becoming a part of the biohacking arena, of people trying to be the healthiest they can, and use technology to track and hack their lives, is with a constant glucose monitor (CGM).

This is a little device, about the size of a 50c coin with a really fine needle, it is placed on the back of your arm and worn for an average of 2 weeks. So, at any time you can swipe your phone to it and through an app, it will give you your blood glucose levels. Beats pricking a finger every time you want to know. It also will show you your glucose levels over a 24-hour period, so you can see how the food you eat effects your glucose levels.

I have seen that one person can have a big spike to a certain food and another can have a minimal spike. Now we can see how carb tolerance we are, and can manage what we need to cut out, to have better glucose levels throughout the day.

Tips to reduce carbs and fructose throughout the day:

  • Cut out all liquid sugar – soft drinks, cordials, sports drinks, added sugar to tea and coffee etc.
  • Cut out sweets – lollies, chocolate, ice-creams and sweet deserts.
  • Cut out refined grains – white flower breads and pastas, cereals, baked goods like cookies, muffins etc
  • Cut out other processed foods with added sugar
  • Cut out starchy and high glycaemic vegetables

You may not need to do it all, but this is how far you can go. Even limiting sweet fruits can help.

When you do eat foods, you want to make selections that Jonathan Bailor calls “sane foods”

The S stands for Satiety – foods that fill you up while eating less of them, and keep you fuller for longer.

The A stands for Aggression – how quickly these foods are able to be stored as body fat.

The N stands for Nutrition – how much nutrients these foods provide.

The E stands for Efficiency – how many of those calories can be stored as body fat.
his approach is to fill up on nutrient dense foods that keep you fuller for longer and that have less chance of being stored as fat.

There are three main factors that contribute to a “sane” food, and they are, they need to be higher in water, fibre, and protein. The more natural and closer to its original form the saner it is.

Here is Jonathan Bailors SANE food list.

The saner the foods and the more they’re from whole foods, usually they won’t be inflammatory. The more you slide to the foods that are insane the more chances they will be inflammatory, and we know that inflammation wreak havoc for our mitochondria.

We can also eat certain foods that increase mitochondrial function. Some key nutrients include L-carnitine and creatine. So grass-fed beef, eggs, poultry, beans, nuts and seeds are all high in these two nutrients.

Foods high in omega-3 improve mitochondrial function by boosting respiratory enzymes and they are also very anti-inflammatory. So, be sure to add good quality seafood to your diet, fish like wild caught salmon, halibut, sardines and anchovies. Also grass-fed meat has higher omega-3 content and so do free range eggs.

We have discussed how exercise can really move the dial when it comes to insulin resistance, with its ability to help with glucose disposal and increasing insulin sensitivity. Our muscles are the biggest sink for glucose. Also, the effect it has on mitochondrial function. So be sure to incorporate aerobic exercise and some strength training to your schedule. No matter what your fitness level is, you’ll always be able to start at whatever level you are at, and build on to it.

In a study of 101 breast cancer survivors, those who engaged in a combination of strength-training and endurance exercise for 16 weeks experienced a 27% reduction in insulin levels. (18) 
A 12-week study in middle-aged sedentary women found that the women who walked for 20 minutes after a large meal had increased insulin sensitivity, compared with women who didn’t walk after a meal.
Another study looked at 113 overweight men at risk of type 2 diabetes. The group who took the most steps per day had the greatest reduction in insulin levels and lost the most belly fat, compared to the group who took the lowest number of steps daily. (19)

There are really a lot of benefits from regular exercise and some studies show better results with exercise than some medications. Some other benefits of regular exercise include:
- Reduced risk of heart attack
- Reduce body fat which leads to less inflammation produced by fat cells
- Lower LDL-C, lower triglycerides, and increase HDL-C
- Stronger bones, muscles and joints and lower risk of developing osteoporosis
- Lowers Blood pressure
- It has a profound positive impact on depression and anxiety while also relieving stress and
  improving memory.

When people think about insulin resistance, they think about macronutrient (protein, fat and carbs) composition, calories, exercise and fasting but might not consider that sleep is, as important as it is. In fact, sleep is a major determinant in insulin sensitivity.

Some studies have shown that sleep restriction over just a few days can lead to acute insulin resistance.

Deep sleep regulates insulin levels and blood glucose levels. Deep sleep is the most restorative and rejuvenating sleep stage. The amount of deep sleep can vary from 0-35% of your total sleep time. You should aim for 15-20% or more of deep sleep, which is roughly about 1.5 hours.

To help get more deep sleep, keep your sleep schedule consistent by going to bed and waking at the same time every day. Exercise regularly. Avoid heavy meals, stimulants like coffee, and bright screens late in the evening. Try to avoid these at least 1-2 hours before bed.

Appetite, weight, and food consumption are all regulated by sleep - lack of sleep makes you eat 300-550 more calories per day, and makes you eat more high sugar and high carb foods.

OK, this has been quite the article, jam packed with a ton of science, and the mechanisms of how we go from healthy and insulin sensitive to progressing through the different stages of insulin resistance to the point it messes with enough systems and starts causing imbalances left, right and centre, to now you have metabolic syndrome. If someone continues on this path eventually these systems won’t be able to manage your blood sugar levels and now you have type 2 diabetes, which comes with its own risk factors which we have discussed, but to remind you here’s a picture below.

Metabolic Syndrome cluster
Picture from Gerald Shulman

So, to sum it up:
- First step is you want to know that you’re insulin resistant long before it shows up in a traditional way. You don’t want to wait until your haemoglobin A1C is 6.5, and you’re being diagnosed with T2D. This means get tested if you are concerned or showing 3 or more of the risk factors. Dr. Peter Attia finds it a concern when you have just one. When you get your blood tests, ask for your fasted insulin, well all the tests I have listed above are well worth doing, but we want to know what your insulin is doing as it will be high in the back ground well before your blood glucose are too effected.

meal tolerance with insulin sensitive and insulin resistance
This study looked at insulin sensitive people (blue) vs insulin resistant people (yellow). They were both given the same high carbohydrate meal and their glucose and insulin were measured. You can see on the left, there isn’t a massive difference in their glucose measurements. But look at their plasma insulin on the right! Picture from Gerald Shulman

The gold standard test would be the oral glucose tolerance test (OGTT), and getting your insulin measured at the same time is super important.

- The second big takeaway is how important exercise is. Remember just 1x 45-min bout of zone 2 training which is roughly 65% of VO2 max (where you can still hold a conversation but not able to sing). This immediate and direct effect on glucose disposal over time with consistency will have an even greater effect.

- And thirdly is the enormous role dietary intervention can have on improving insulin sensitivity and reversing insulin resistance. Specifically reducing fructose and glucose until homeostasis is achieved.

With that said, it’s a wrap from me here. I hope this information helps and empowers you to look at things a little differently and make some better choices, and take your health back into your own control.