Part 4 of 4 (Part 1, Part 2, Part 3)

By Ron Rosedale, M.D.

Presented at Designs for Health Institute's BoulderFest August 1999 Seminar

Can Insulin Sensitivity Be Restored?

Insulin sensitivity can be restored to its original state, well, perhaps not to its original state, but you can restore it to the state of about a 10-year-old.

One of my first experiences with this, I had a patient who literally had sugars over 300. He was taking over 200 units of insulin, and he was a bad cardiovascular patient, so I put him on a low-carbohydrate diet.

He was an exceptional case, after one month to six weeks he was totally off of insulin. He had been on over 200 units of insulin for 25 years. He was so insulin resistant, but one thing good about it is that when you lower that insulin, that insulin is having such little effect on him that you can massively lower the insulin and its not going to have much of an effect on his blood sugar. Two hundred units of insulin is not going to lower your sugar any more that 300 mg/deciliter.

You know that the insulin is not doing much, so we could rapidly take him off the insulin and he was actually cured of his diabetes in a matter of weeks. He became sensitive enough and was still producing a lot of insulin on his own. Then we were able to measure his own insulin. It was still elevated, and it took a long time, maybe six months or longer, to bring that insulin down.

It will probably never get to the point of the sensitivity of a 10-year-old, but yes, your number of insulin receptors increases and the activity of the receptors, the chemical reactions that occur beyond the receptor, occur more efficiently.

How to Increase Insulin Sensitivity

You can increase sensitivity by diet, which is one of the major reasons to take omega-3 oils. We think of circulation as that which flows through arteries and veins, and that is not a minor part of our circulation, but it might not even be the major part. The major part of circulation is what goes in and out of the cell.

The cell membrane is a fluid mosaic. The major part of our circulation is determined by what goes in and out. It doesn't make any difference what gets to that cell if it can't get into the cell. We know that one of the major ways that you can affect cellular circulation is by modulating the kinds of fatty acids that you eat. So you can increase receptor sensitivity by increasing the fluidity of the cell membrane, which means increasing the omega-3 content, because most people are very deficient.

They say that you are what you eat and that mostly pertains to fat because the fatty acids that you eat are the ones that will generally get incorporated into the cell membrane. The cell membranes are going to be a reflection of your dietary fat and that will determine the fluidity of your cell membrane. You can actually make them over fluid.

If you eat too much and you incorporate too many omega-3 oils then they will become highly oxidizable (so you have to eat Vitamin E and monounsaturates as well).

There was an interesting study pertaining to this where they had a breed of rat that was genetically susceptible to cancer. Researchers fed them a high-omega-3 diet, plus iron, without any extra Vitamin E and they were able to almost shrink down the tumors to nothing because tumors are rapidly dividing. This is like a form of chemotherapy, and the membranes that were being formed in these tumor cells were very high in omega-3 oils. The iron acted as a catalyst for that oxidation, and the cells were exploding from getting oxidized so rapidly. So omega-3 oils can be a double-edged sword. In fact, most food is a double-edged sword.

Like oxygen and glucose, food keeps us alive and kills us. Eating is the biggest stress we put on our body and that is why in caloric restriction experiments you can extend life as long as you maintain nutrition. This is the only proven way of actually reducing the rate of aging, not just the mortality rate but the actual rate of aging.

It has actually been shown by quite a number of papers that resistance training for insulin resistance is better than aerobic training. There are a variety of other reasons too. Resistance training is referring to muscular exercises. If you just do a bicep curl, you immediately increase the insulin sensitivity of your bicep. Just by exercising you are increasing the blood flow to that muscle, and one of the factors that determines insulin sensitivity is how blood can get there. It has been shown conclusively that resistance training will increase insulin sensitivity.

Protein’s Role

Now, back to the macronutrients. As I said before, you don't want very much in the way of non-fiber carbs, but fiber carbs are great. You are going to get some non-fiber carbs though. Even if you just eat broccoli you are going to get some non-fiber carbs. That is OK since for the most part you are getting something that is really pretty good for you.

Protein is an essential nutrient. You want to use it as a building block because your body requires protein to repair damage and replenish enzymes. All of the encoded instructions from your DNA are to encode for proteins. That is all the DNA encodes for. You need protein, but you want to use it as a building block. I don't believe in going over and above the protein that you need to use for maintenance, repair and building blocks.

I don't think you should be using protein as a primary fuel source, though your body can use protein very well as a fuel source. It is good to lose weight while using it as a fuel source because it is an inefficient fuel source. Protein is very thermogenic, meaning it produces a lot of heat, which means that less of it is going into stored energy and more is being dissipated--just like throwing a log into a fireplace. Your primary fuel should be coming from fat.

You can calculate the amount of protein a person requires or at least estimate it by their activity level. The book "Protein Power" actually went very well in to this. You have to calculate how much protein is required by activity level and lean body mass. There is still some gray area as to how many grams per kilogram of lean body mass, depending on the activity that person requires.

It can range anywhere from one to two grams of protein per kilogram of lean body mass, maybe even a little bit higher if someone is really active. You don't want to go under that amount for very long. It is better to go over than to go under that amount for very long.

If you can cure a diabetic of diabetes, you can do the same thing to a so-called non-diabetic person and still improve that person. I want to improve my insulin sensitivity just as much as I do my diabetics because insulin sensitivity is going to determine, for the most part, how long you are going to live and how healthy you are going to be. It determines the rate of aging more so than anything else we know right now.

Supplements

What about supplements such as Chromium?

All of my diabetics go on 1,000 mcg of chromium, some a little bit more if they are really big people. The amount is usually 500 mcg for a non-diabetic, though it depends on their insulin levels.

I use a lot of supplements. What you really want to do is to try to convert the person back into being an efficient burner of fat. Earlier we talked about when you are very insulin resistant and you are waking up in the morning with an insulin level that is elevated, you cannot burn fat but instead are burning sugar.

One of the reasons that sugar goes up so high is because that is what your cell is needing to burn, but if it is so insulin resistant it requires a blood sugar of 300 so that just by mass action some can get into the cell and be used as fuel. If you eliminate that need to burn sugar, you don't need such high levels of sugar even if you are insulin resistant.

You want to increase the ability of the cells in the body to burn fat and make that glucose burner into a fat burner. You want to make a gasoline-burning car into a diesel-burning car. Did anyone ever look at the molecular structure of diesel fuel in your spare time? It looks almost identical to a fatty acid. There is a company right now that can tell you how to alter vegetable oil to use in your Mercedes. It's just a matter of thinning it out a little bit. It is a very efficient fuel.

Triglycerides

You can look at other variables that will give you some idea too, such as triglycerides. If people are very sensitive to high levels of insulin, they come in with insulin levels of 14 and they have triglycerides of 1000. You would treat them just as you would if they had an insulin level of 50. It gives you some idea of the effect of the hyperinsulinemia on the body.

You can use triglycerides as a gauge, which I often do. The objective is to try to get the insulin level just as low as you possibly can. There is no limit. They classify diabetes now as a fasting blood sugar of 126 or higher. A few months ago it might have been 140. It is just an arbitrary number. Does that mean that someone with a blood sugar of 125 is non-diabetic and fine? If you have a blood sugar of 125 you are worse than if you had a blood sugar of 124--same with insulin. If you have a fasting insulin of 10, you are worse off than if you had an insulin of 9. You want to get it just as low as you can.

Does This Apply to Athletes?

With athletes, think about the effect of carbohydrate loading before an event. What happens if you eat a bowl of pasta before you have to run a marathon? What does that bowl of pasta do? It raises your insulin. What is the instruction of insulin to your body?

To store energy and not burn it. I see a fair amount of athletes and this is what I tell them, you want everybody, athletes especially, to be able to burn fat efficiently. So when they train, they are on a very low-carbohydrate diet. The night before their event, they can stock up on sugar and load their glycogen if they would like.

They are not going to become insulin resistant in one day. Just enough to make sure, it has been shown that if you eat a big carbohydrate meal that you will increase your glycogen stores, that is true and that is what you want. But you don't want to train that way because if you do you won't be able to burn fat, you can only burn sugar, and if you are an athlete you want to be able to burn both.

Few people have problems burning sugar if they are athletes, but they have lots of problems burning fat, so they hit the wall. And for certain events, like sprinting, it is less important, truthfully for their health it is very important to be able to burn fat, but a sprinter will go right into burning sugar. If you are a 50-yard dash person, whether you can burn fat or not is not going to make a huge difference in your final performance.

Beyond your athletic years, if you don't want to become a diabetic, and don't want to die of heart disease and don't want to age quickly, it is certainly not going to do you any harm to be able to burn fat efficiently in addition to sugar.

Vanadyl Sulfate

Vanadyl Sulfate is an insulin mimic, so that it can basically do what insulin does by a different mechanism. If it went through the same insulin receptors, then it wouldn't offer any benefit, but it doesn't, it actually has been shown to go through a different mechanism to lower blood sugar, so it spares insulin and then it can help improve insulin sensitivity. To really lower a person’s insulin, I give 25 mg 3 times a day temporarily.

Glutamine Powder

I also put people on glutamine powder. Glutamine can act as a brain fuel, so it helps eliminate carbohydrate cravings while they are in that transition period. I like to give it to them at night, and I tell them to use it whenever they feel they are craving carbohydrates. They can put several grams into a little water and drink it and it helps eliminate carbohydrate cravings between meals.

A high-protein diet will increase an acid load in the body, but not necessarily a high-fat diet. Vegetables and greens are alkalinizing, so if you are eating a lot of vegetables along with your protein it equalizes the acidifying effect of the protein. I don't recommend a high-protein diet; I recommend an adequate protein diet.

Fat in the Diet

I think you should be using fat as your primary energy source, and fat is kind of neutral when it comes to acidifying or alkalinizing. In general, over 50 percent of the calories should come from fat, but not from saturated fat. When we get to fat, the carbohydrates are clear-cut. No scientist out there is really going to dispute what I've said about carbohydrates.

There is the science behind it. You can't dispute it. There is a little bit of a dispute as to how much protein a person requires. When you get to fat, there is a big gray area as to which fat a person requires. We just have one name for fat, we call it fat or oil. Eskimos have dozens of names for snow and east Indians have dozens of names for curry. We should have dozens of names for fat because they do many different things. And how much of which fat to take is still open to a lot of investigation and controversy.

My take on fat is that if I am treating a patient who is generally hyperinsulinemic or overweight, I want them on a low-saturated-fat diet, because most of the fat they are storing is saturated fat. When their insulin goes down and they are able to start releasing triglycerides to burn as fat, what they are going to be releasing mostly is saturated fat. So you don't want them to take anymore orally. There is a ration of fatty acids that is desirable if you took them from the moment you were born, but we don't. We are dealing with an imbalance here that we are trying to correct as rapidly as we can.

Most of us here have enough saturated fat to last the rest of our life. Truthfully. Your cell membranes require a balance of saturated and poly-unsaturated fat, and it is that balance that determines the fluidity. As I mentioned, your cells can become over-fluid if they don't have any saturated fat.

Saturated fat is a hard fat. We can get the fats from foods to come mostly from nuts. Nuts are a great food because it is mostly mono-unsaturated. Your primary energy source ideally would come mostly from mono-unsaturated fat. It's a good compromise. It is not an essential fat, but it is a more fluid fat. Your body can utilize it very well as an energy source.

Grain-Fed Animals are not Healthy

Animal proteins are good for you, but not the ones that are fed grains.

Grain-fed animals are going to make saturated fat out of the grains. Saturated fat in nature occurs to a very tiny degree. In the wild there is very little saturated fat out there. If you talk about the Paleolithic diet, we didn't eat a saturated fat diet. Saturated fat diets are new to mankind. We manufactured a saturated fat diet by feeding animals grains. You can consider saturated fat to be second-generation carbohydrates. We eat the saturated fats that other animals produce from carbohydrates.

Zone was a good diet compared to the American diet. Is it an optimal diet? No. Is it optimal for what is known today about nutrition? It is not. Initially the author spoke about how it made no difference if you got your carbohydrate from candy or vegetables.

What he is doing now is changing his recipes so that the 40 percent carbohydrates are coming primarily from vegetables, and the carbohydrates are going way down because he knows that if they don't, it's not as good a diet.

I recommend 20 percent of calories from carbs, depending on the size of the person, 25 percent to 30 percent of calories from protein, and 60 percent to 65 percent from fat. You can get beef that is not grain-fed.

Insulin is Not the Only Cause of Disease

There are other considerations in disease, such as iron. We know that high iron levels are bad for you. If a person's ferritin is high, red meat is out for a while until the level goes down.

There is a great deal of difference between a non-grain-fed cow and a grain-fed cow.

Non-grain fed will have only 10 percent or less saturated fat. Grain-fed can have over 50 percent.

Also, a non-grain-fed cow will actually be high in omega-3 oils. Plants have a pretty high percentage of omega-3, and if you accumulate it by eating it all day, every day for most of your life, your fat gets a pretty high proportion of omega-3. I would try for 50 percent oleic fat, and the other fats would depend on the individual, but about 25 percent of the other two.

In a heavy diabetic I would probably go down on the saturated fat and go 60 percent oleic, and 1 to 1 on the omega-6 to 3 ratio--that would be therapeutic. The maintenance ratio would be about 2.5 to 1 for the omega-6 to 3 ratio. I would try to do most of this through diet. There are some practicalities involved. I would ask the person if they like fish and if they practically puke in front of me they are going on a tablespoon of cod liver oil, the best brand is made by Carlson, which doesn't taste fishy at all.

Most people end up going on a supplement of omega-3 oils because they are not going to eat enough fish to get an adequate amount. It is a little hard to get that much entirely from diet.

Sardines are a very good therapeutic food. They are baby fish so they haven't had time to accumulate a bunch of metal. They are smoked so they are not cooked and the oil is not spoiled in them. You have to eat the whole thing, not the boneless and skinless. You need to eat all the organs as they are high in vitamins and magnesium.

DNA Glycates

If people are worried about chromosomal damage from chromium, what they should really be worried about instead is high blood sugar. DNA repair enzymes glycate as well. Insulin is by far your biggest poison. They disproved that study that was against chromium many times. They showed that it only happens if you put cells in a petrie dish with chromium but in vivo studies prove otherwise. The lowering of insulin is going to be better than any possible detriment of any of the therapies you are using. Insulin is associated with cancer, everything.

Insulin should be tested on everybody repeatedly. It isn’t strictly because there haven't been drugs until recently that could effect insulin, so there is no way to make money off of it. Fasting insulin is one way to look at it, not necessarily the best way, but it is a way that everybody could get it done. Any family doctor can measure a fasting insulin.

There are other ways to measure insulin sensitivity that are more complex. We use intravenous insulin and watch how rapidly the blood sugar crashes in a fasting state in 15 minutes, and that assesses insulin sensitivity. Then you give them dextrose to make sure they don't crash any further. There are other ways that are utilized to directly assess insulin sensitivity, but you can get a pretty good idea just by doing a fasting insulin.

Designs for Health Institute

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