Am I Insulin Resistant?

In my last post, I discussed Metformin and how it lowers insulin levels.  So how do you know if you are insulin resistant and have high insulin levels?  There are signs, symptoms, and laboratory results that can tell you.

The symptom that I see the most is pronounced carbohydrate cravings.  Because of hormonal changes that occur naturally as we approach the peri-menopause and menopause years, there is a natural pre-disposition to insulin resistance.  This is true of men in the same age range also.  The typical scenario I see is a middle aged patient who has difficulty losing weight and craves carbs like never before.  All of their weight gain seems to be in their mid section.

The sign that I see the most is called acanthosis nigricans.  It is a darkening of the skin in the crease on that back of the neck, and/or in the armpits and groin.  It is quite common to also see the development of skin tags in association with this.  In younger women who are still in their menstruating years, the development of acanthosis nigricans, skin tags, abnormal facial hair growth, and abnormal menses indicates that they have PCOS.  This is a syndrome that causes insulin resistance.

Another sign that is almost universally present with insulin resistance is the deposition of new abdominal fat.  Patients will tell me that this is where they gain their weight first.  This finding indicates an absolute health disaster waiting to happen.  If this is taking place in you, you should immediately initiate a low carbohydrate diet, and consider adding phentermine and metformin to assist you in your efforts to lose abdominal fat.

There are some lab tests that can assist in the diagnosis of insulin resistance.  At the office, I order these sometimes.  Often, all I need to diagnose insulin resistance is the signs and symptoms.  If I need to get labs, there are four tests that can be ordered: Hemoglobin A1c, Fasting Blood Sugar, Oral Glucose Tolerance Test, and NMR Lipoprofile.  All of our providers are skilled in determining whether or not patients need any of these tests, and we can make the appropriate recommendations to you.

In sum:  if you are a middle age person and you are experiencing increased carb cravings, weight gain in your midsection, and possibly acanthonsis nigricans, then we should discuss insulin resistance at your next visit.  You will need to begin restricting carb intake.  Labs may need to be ordered and the addition of Metformin to your medication regimen could be very helpful.  

Wickham

Can Medicine Lower Your Insulin Level?

As promised, I stated in my last post that I would shed some light on a medicine that lowers your insulin level.  As you might recall, high insulin levels lead to storage of body fat resulting in an increased body fat mass.  Excess body fat leads to disease - regardless of your weight or your BMI.  You can be of "normal weight and BMI" but have a high body fat percentage and this puts you at risk for type two diabetes, abnormal lipid panels, high blood pressure, vascular disease, etc.

This is the reason that I put so much emphasis on restraint when it comes to carbohydrate intake.  At the same time, I constantly emphasize getting the correct amount of protein in your diet, and I emphasize the fact that the consumption of most dietary fats is not the enemy.  The idea is this: carbohydrates can cause large increases in insulin, and protein and fat do not.  So, that covers the diet side of things.  Is there a medicine that helps bring down insulin levels?  The answer is yes.

Metformin is a medicine that has been on the market for about 50 years.  It is a medicine that is used to keep pre-diabeties (know as insulin resistance) from advancing to diabetes.  It works by making cell membranes more sensitive to insulin so that insulin passes easily from the serum to the inside of the cell - this lowers serum insulin levels.  It is this effect that aids in weight loss from decreasing body fat.  Think of it this way - a lower insulin level lowers the "fat storing signal" to your body.  In the presence of a carbohydrate restricted diet, the "fat burning signal" acts unopposed.  

Metformin can be used in conjunction with phentermine.  The major contra-indication is renal insufficiency or renal failure.  Most of my patients do not have this.  The major side effect is GI upset if you take it on an empty stomach - so take it after the biggest meal of the day.  It is cheap and we stock it at my practice.  The cost for a months supply is between $10 and $15 depending on the dose.

My next post will discuss how to know if you have insulin resistance, and therefore need a drug like metformin.  Don't forget - know your lean mass and fat mass with precision; have your Inbody 770 test performed in March - its only $20.

Dr. Simonds

Things That Go Together

There are some reasons why I teach diet the way I do.  In short, there are some things that often occur together and lead to weight gain from body fat, and some things that occur together that lead to weight loss from body fat.

The Triad of Body Fat Gain
1. Excess carbohydrate intake - particularly sugar, flour, and starch which leads to #2.
2. High insulin levels - this is the recipe for weight gain from fat and the induction of many diseases.
3. Lack of physical activity - this includes both planned exercise and just being more active in your activities of daily living (less sitting and more moving).

The Triad of Body Fat Loss
1. Decreased carbohydrate intake - removing sugar, flour, starch and replacing them with protein and fat.  This leads to elevated metabolic rate, and increased sense of satiety - more importantly it leads to #2.
2. Low insulin levels - this is the recipe for weight loss from decreasing body fat.  It also corrects disease states like type two diabetes.
3. Increased physical activity - I think you get the concept.

If you want to track your lean and fat mass closely to see how they are responding to your diet and exercise regimen, then you need to do the InBody 770 body composition analysis test.  During the month of March it is only $20!  Call the office to schedule the test.

Stay tuned - my next post will be about an inexpensive medicine that lowers insulin levels leading to greater fat mass loss.  It pairs will with phentermine and can increase your rate of weight loss.


Dr. Simonds

What Is Your Body Composition?

For those of you who know me, you have probably heard me talk about body fat.  You see, having a high body weight isn't a risk factor for disease - No, it's having a high body fat percentage that puts you at risk.  Your weight isn't the issue, your body fat percentage is.  Furthermore, excess fat accumulation in your abdomen (visceral fat) is an absolute recipe for disaster!  I don't care if you are a "normal" weight or are overweight - if you have too much body fat it is bad.

This is why I am so particular about teaching diet - the composition of your diet is of utmost importance.  If you have excess body fat (and you intend to reduce it) the bottom line on diet is this:

1. Its going to make you sick with diseases like diabetes, etc.
2. To stop the accumulation of fat, and to signal your body to burn fat,  you must restrict carbohydrate intake.
3. You must eat more fat and more protein at the expense of carbohydrate.

These are principles that I teach day in and day out - I never quit talking about it.

So, with all of this in mind, I would like to tell you about the InBody 770.  This is a device that I have in my Durham office that can give you a precise, detailed body composition analysis.  It will tell you exactly how much lean mass and fat mass your body has and how it is distributed.  It is a great way assess where you stand as far as your body composition, and to assess how your diet and exercise efforts are impacting your fat mass loss.  

If you would like to have the InBody 770 test performed, you can call the Durham office to set up a time - the phone number is 919.490.8899.  The cost is normally $40, but in the month of March it is only $20.  

I look forward to seeing you soon.

Wickham