7,19 €
Mehr erfahren.
- Herausgeber: Hammersmith Health Books
- Kategorie: Ratgeber
- Sprache: Englisch
- Veröffentlichungsjahr: 2020
Do you have high cholesterol? And/or high blood pressure? Gallbladder problems? Perhaps a diagnosis of fatty liver? Are you tired all the time? Do you crave sweet snacks? Are your hormones in turmoil? Do you have a bit too much fat around your middle? Your doctor may have tested you for type 2 diabetes and found this is not a problem… yet. But you almost certainly already have its precursor – insulin resistance. Nurse Practitioner Hanna Purdy shares her long experience in Public Health Nursing, as well as with improving her own family's health, to present this practical, evidence-based guide to what 'insulin resistance' means, what causes it and what to do about it, including how to start a ketogenic/low-carb diet, with the emphasis on the quality of food eaten and the impact good food can have on the body and mind. As she shows, insulin resistance is caused by chronic, sub-clinical inflammation and lies behind many common chronic illnesses that are now reaching epidemic levels even in children. Find out how to reverse it with an inflammation-reducing diet and other lifestyle changes, in an easy, sustainable way that is compatible with busy family life. And if you think insulin resistance is not your problem, are you really sure…?
Das E-Book können Sie in Legimi-Apps oder einer beliebigen App lesen, die das folgende Format unterstützen:
Ähnliche
iiiii
COULD IT BE INSULIN RESISTANCE?
Hanna Purdy
Foreword by Dr Jerry Thompson
For Anna, Ella and Oliver
Contents
About the Author
Hanna Purdy is a Nurse Practitioner with specialisms in Public Health Nursing and Occupational Health nursing, currently working as an Urgent Care nurse in Cornwall, UK. Even in Urgent Care she finds daily evidence of the effects of insulin resistance and advises patients on lifestyle changes to reverse it and the symptoms they are so often suffering.
She is the mother of three happy, almost completely sugarfree teenagers who know all about, understand and live Hanna’s approach to healthy eating. Her goal is to empower us all to recognise and overcome insulin resistance ourselves before it does us irreversible long-term damage.
Foreword
Few could have failed to witness the huge increase in obesity in our society over the last two decades, not least in our children. In parallel, we have seen a massive increase in diabetes, which now swallows up one-tenth of the NHS budget. Less well-known is the fact that fatty liver has increased rapidly and has now become the commonest chronic disease, affecting 20-30% of adults and, worryingly, up to 20% of children.
Hanna Purdy in her timely and well-researched book asks Could it be Insulin Resistance? Yes, it could be. In fact, it is the major underlying pathology behind all three of these mega problems and, as she explains, behind many other diseases as well. Never has insulin resistance been more important, and not just for those with disease but also for the seemingly healthy, especially those possessing a large belly.
Not only is insulin resistance important in itself but it is relatively straightforward to treat and Hanna does a first-class job explaining how to go about this. She includes a comprehensive discussion of what to eat and what not to eat. However, what often gets forgotten is when not to eat and this she covers brilliantly in the section ‘Don’t eat too often’. Understanding this section can make all the difference.
One thing I have noticed is, sooner or later, most patients have a blood test for lipids. This is done primarily for testing cholesterol but it can also diagnose insulin resistance. What few doctors realise is that insulin resistance is a far more useful xpredictor of disease than cholesterol, as Hanna explains, but sadly it receives less attention. Certainly if I were a patient I would be much more interested in my triglycerides and HDL (markers of insulin resistance) than my cholesterol.
Even if doctors do make this diagnosis, few would have the time to explain exactly what to do about it, but this book does just that.
Even for those familiar with insulin resistance there are surprises in this book. Hanna points out it can be implicated in snoring, in vertigo and tinnitus, in gout, in hypoglycaemia, in hormonal conditions such as thyroid disease and the menopause and in peripheral neuropathy. I suspect it is rarely tested for in these circumstances.
In obesity Hanna makes the point that it is almost impossible to lose weight if your insulin is consistently high. She rightly points out the pitfalls in treating type 2 diabetes with insulin which makes weight loss near impossible.
Finally, there is a useful section on possible problems when changing to a low-carbohydrate diet. I was unaware that extra salt was sometimes needed and sometimes extra water.
This is an excellent and much-needed book and if this knowledge were widely understood and put into action by the medical profession it would prevent an avalanche of disease, save the NHS millions of pounds and we would all be far healthier.
Dr Jerry Thompson
GP and Ecological doctor
Introduction
We are currently facing a crisis with chronic illness all over the world. It seems that the majority of adults and more and more children, teenagers and young adults are suffering from chronic symptoms that affect their everyday life. In the UK, where I am writing, the National Health Service (NHS) is battling under enormous pressure with the rising costs that these chronic problems lead to. Treating diabetes alone costs an estimated £14 billion a year, with 3.5 million people in the UK currently diagnosed with type 2 diabetes.1 Many more are likely to be pre-diabetic and destined to face problems sooner or later. Over 9 million people in the UK are battling with musculoskeletal symptoms of some sort, many of them unable to work and often on long-term medication with difficult side-effects. Hundreds of thousands of people suffer from other types of chronic pain, with fibromyalgia alone estimated to affect 1.5 to 2 million people in the UK.2 Fibromyalgia, a very complicated syndrome with chronic widespread pain, anxiety, depression and fatigue, seems to be getting increasingly common, with younger and younger sufferers.
Currently one in six people in the UK are suffering from a mental health problem.3 Millions regularly take medication for conditions such as anxiety, depression and panic attacks. Cancer is also becoming more common. According to Cancer Research UK, one in two people will develop cancer at some point in their lives. The causes of cancer and the reasons for the increasing xiinumbers of cases are still being debated, with the aging population being one of the proposed reasons. However, many scientists believe that there are other more significant reasons, with our lifestyle being the most likely factor in the development of cancer.4,5,6
The situation is more or less the same across many other countries. The Centers for Disease Control and Prevention (CDC) in the US publishes yearly Adult Obesity Prevalence Maps for 50 states in the US. According to them, more than 20% of adults in all states are now obese. In 2015-2016, over 93 million adults and 13.7 million children and young people in the US were reckoned to be obese.7 At the same time, the number of obesity-related cancers is increasing and not only in the US, but around the world. The incidence of non-alcoholic fatty liver disease (NAFLD) is increasing rapidly and it is estimated that it will soon be the most likely indication for liver transplantation.8,9 According to a review published in 2018, 25% of adults worldwide suffer from NAFLD.10 Many of the patients affected are still relatively young.
According to the World Health Organization (WHO), nearly 300 million people worldwide suffer from depression and 50 million from dementia. Nearly 18 million die each year from cardiovascular disease. These are very concerning figures.
The explosion in chronic disease is something I see every day in my current work as a nurse practitioner
Not only is the scale of these problems crippling the NHS here in the UK – something that affects everybody – but the suffering these conditions causes to individuals and their families is unimaginable… until it happens to you and yours. As I have said, the situation is the same in many parts of the world. We are all wondering why this is happening. In GPs’ surgeries we can see the consequences of this problem every single day and it feels so overwhelming. I see this as a patient myself, but also as a xiiiregistered nurse for over 20 years, and in my current work as a nurse practitioner treating many patients with these complicated symptoms. What can we do about all these symptoms? How can we help our patients?
To be able to answer those questions we need to understand the reasons why this is happening. Here, the most important thing to understand and remember is the fact that chronic conditions don’t just happen, but are signs that we are doing something wrong. Almost always with any chronic symptom, there is something in our lifestyle causing it and all the associated suffering. When digging deeper, looking at common lifestyle issues, hearing from patients who have managed to find help for chronic conditions with lifestyle changes and, looking at many studies, it is obvious that one of the most important, if not the main, cause of all this suffering is the food we eat. To be more specific, the issue is processed food, sugar and excess carbohydrates, and the underlying problem they lead to – insulin resistance. There are other causes too for insulin resistance and we will look at all of these, but it seems that sugar and processed food, and the hormonal imbalance and inflammation they cause in our body, are the main reasons why many of us are so unwell.
One of the very first lessons I learned as a nurse in my anatomy and physiology course many years ago, was what an incredibly well organised and finely tuned system the human body is, not only in its functions, but also in its amazing ability to heal and repair itself in the right circumstances. To ensure all the functions necessary for life, a very fine balance must be maintained at all times all over the body. The wise practitioners of ancient Chinese and Indian medicine understood this. They continue to see illness as the result of a problem in this balance and know that to return the body’s functioning back to health, it is important to look at the cause of this imbalance and change that. We seem to have forgotten this in our modern, Western medicine; instead of xivlooking for the root of the problem, we try to treat the symptoms only and don’t get very far.
We need to understand this point: that chronic symptoms are a result of an imbalance in the body and in many cases this is a hormonal imbalance caused by too much insulin. We cause this imbalance by eating the wrong foods, or by some other lifestyle issue, such as lack of sleep or other type of stress. The key to all this is to change our lifestyle; there is no medication to restore the balance. Our modern lifestyle sees many of us eating ultra-processed ready-made foods rather than following a natural diet. The most important problem is our intake of carbohydrates, and especially of sugar. We will be looking deeper into this issue to understand why it is a problem.
Chronic symptoms are very often the result of a hormonal imbalance caused by too much insulin
I am hoping to teach my readers, as I do my patients, the basics of how our metabolism works and why too much insulin can be a problem. We humans are naturally healthy; we are not meant to be chronically ill. Chronic illnesses and/or symptoms are not part of normal life or normal aging, and they don’t ‘just happen’. Instead of looking only for medication to suppress symptoms, we should always try to find their causes in our lifestyle and what we are doing generally, and to do something about them. We need to learn from our symptoms what it is that our body is trying to tell us and to work out what we can do to feel better. This way we can start to concentrate on our health instead of fighting our illnesses.
I know that many chronic illnesses are still often considered incurable and progressive, but this is very often not the case. As I have said, conditions such as type 2 diabetes are caused by lifestyle issues, so they can be reversed by lifestyle changes. There is no other cure, no magic pill to take; changes in lifestyle are xvnecessary to reverse symptoms and restore health. Even when medical treatments are necessary in the presence of difficult illnesses, such as cancer, with lifestyle measures supporting the body during the illness, we are often much better prepared for the demands of the treatment, and are stronger, making the treatments much more likely to be successful.
When choosing the right food and drink, we are choosing to be healthy. Food is our medicine. In my work I have seen so many times how choosing the right food is the best start to improving all chronic health problems, all symptoms. Of course, we cannot always cure everything completely, but with proper nutrition it is always possible to significantly reduce the severity of any symptom. When our diet is the right one, often many other lifestyle factors automatically improve too. With proper nutritious ‘fuel’, we have more energy and endurance for our day. We find the will and time to exercise. It is also much easier to combat any dependencies, such as drinking, smoking or sugar addiction, when we eat right. Stress also is way more manageable with good food to give us more inner power. It is easier to stay positive.
The problem is, however, that many of us don’t know what a healthy diet is and we are not aware of the huge problems caused, especially by sugar and excess carbohydrates. What should we eat in order to stay healthy and why is eating right often so difficult? One day we are told to eat this and another day that. To be able to understand what the healthy choices are, we need to know how the body works, how the food we eat is metabolised (processed in the body), how the hormones involved affect every single cell in our body and why this balance can go wrong.
Everyone has a physician inside him or her; we just have to help it in its work. The natural healing force within each one of us is the greatest force in getting well. Our food should be our medicine. Our medicine should be our food…
Hippocrates
xviGenes are often brought up when talking about chronic illnesses. Many believe that they are diabetic because it is ‘in my genes’ or likely to suffer from high blood pressure because it ‘runs in the family’. It is of course true that genes do play a big part. Some of us are more prone to get cancer while others face heart disease as a result of a bad diet, for example. We are not all the same. Whatever illness is written in our genes, we can prevent it (in most cases) by turning off those genes, with proper nutrition and other lifestyle choices. Our DNA is not necessarily our destiny. The expression of our DNA can be turned off or on. This is what is called ‘epigenetics’. Nutrients from our diet, especially, are a major source of epigenetic changes so food actually can change the way our genes behave even though we cannot change the sequence of our DNA.
Whatever illness is written in our genes, we can prevent it (in most cases) by turning off those genes
The information in this book is based on my own individual experience, and that of my family and friends, but also more widely on that of many of the patients I have seen and helped as a nurse. It is also based on some great books, articles and presentations I have come across while doing my research, and also many studies, available for anyone to read. I have included a list of many of these at the back of the book (page 177).
My aim is to give my readers tools to look after themselves properly, but because a book, being general, is not a good substitute for a face-to-face consultation with a doctor or nurse when battling with illness, I have to remind you to consult your health professional before making big changes, especially if you are taking medication.
References
1. Diabetes UK. Cost of diabetes. 15 Jan 2019. www.diabetes.co.uk/cost-of-diabetes.html and Diabetes prevalence. 15 jan 2019. www.diabetes.co.uk/diabetes-prevalence.html (accessed 28 June 2020)
2. NHS England. Musculoskeletal conditions. www.england.nhs.uk/ourwork/clinical-policy/ltc/our-work-on-long-term-conditions/musculoskeletal/ (accessed 28 June 2020) and Fibromyalgia. www.nhs.uk/conditions/fibromyalgia/ (accessed 4 July 2020)
3. Mental Health Foundation. Mental health statistics: UK and worldwide. www.mentalhealth.org.uk/statistics/mental-health-statistics-uk-and-worldwide (accessed 28 June 2020)
4. Arcidiacono B, Irritano S, Nocera A, et al. Insulin Resistance and Cancer Risk: An Overview of the Pathogenetic Mechanisms. Experimental Diabetes Research 2012; 2012: article ID 789174.
5. Boyd DB. Insulin and Cancer. Integr Cancer Ther 2003; 2(4): 315-329.
6. Crawford A. Increasing evidence of a strong connection between sugar and cancer. Medical Xpress Weill Cornell Medical College. March 20, 2019. https://medicalxpress.com/news/2019-03-evidence-strong-sugar-cancer.html (accessed 3.7.2020)
7. Centers for Disease Control and Prevention. Adult obesity prevalence maps. www.cdc.gov/obesity/data/prevalence-maps.html and Adult obesity facts www.cdc.gov/obesity/data/adult.html (accessed 28 June 2020)158
8. Non-alcohol fatty liver disease (NAFLD), NHS England www.nhs.uk/conditions/non-alcoholic-fatty-liver-disease/ (accessed 28 June 2020)
9. Snel M, Jonker JT, Schoones J, Lamb H, et al. Ectopic fat and insulin resistance: pathophysiology and effect of diet and lifestyle interventions. International Journal of Encocrinology 2012; Article ID: 983814. insulin-resistance-and-ectopic-fat-a-diabetes-management.pdf
10. Cai J, Xu M, Zhang X, Li H. Innate Immune Signaling in Nonalcoholic Fatty Liver Disease and Cardio-vascular Diseases. Annual Review of Pathology: Mechanisms of Disease. 2018; 14: 153-184.
Chapter 1
What is insulin resistance?
Understanding your metabolism
I am going to start with a simple explanation of how our metabolism works. By metabolism we mean all the different essential chemical reactions in the body that keep it functioning. These include the production of energy, for which we need fuel from food, and growth and repair, for which we need building blocks, also from our food. Energy and building blocks come from what we call ‘macronutrients’, the major proportion of our diet: protein, fats and carbohydrates. Carbohydrates consist of chains of sugars, such as glucose and fructose. Proteins are made of chains of amino acids. Fats consist of chains of fatty acids. Essential amino acids and essential fatty acids are those macronutrients we must get from our food as our bodies cannot make them. It is worth noting that there are no ‘essential’ carbohydrates.
There are no ‘essential’ carbohydrates
All these macronutrients – fat, protein and carbohydrates – are broken down by the body before being absorbed.
Carbohydrates and sugars
Carbohydrates/sugars and fat are the macronutrients mostly used 2as fuel for our metabolic reactions. Carbohydrates/sugars, are found mainly in plant-based foods: vegetables, fruit and grains. There are different types of sugars, including glucose, fructose and galactose. Fructose is naturally present in fruit and honey. Lactose is the sugar found in dairy products and is made up of two simpler sugars – glucose and galactose in equal amounts. Maltose is found in foods such as grains, and therefore in beer, and is made up of two glucose molecules. Starch in foods such as potatoes, bread and rice, consists of long chains of glucose molecules. Essentially then, all carbohydrates are sugars; when we eat carbohydrates, they are broken down into sugars for absorption. There are some differences in how these different sugars are handled by our body as we shall see in more detail below. In summary, glucose causes our blood sugar levels to rise immediately, stimulating the production of insulin. Fructose, on the other hand, is processed by the liver where it is converted mainly to glycogen for storage. There is no limitless storage space, however, and any excess fructose is converted into fat (a process known as de novo lipogenesis) in the liver.
Proteins and amino acids
Amino acids are used to grow, repair and rebuild cellular proteins in tissues all over our body, so essential amino acids are just that – essential. Proteins are also important in the production of different hormones and enzymes. Good sources of proteins are meat, poultry, fish and eggs, as well as some nuts and seeds. Animal-based foods contain all the essential amino acids, so they are known as ‘complete’ proteins. Plant-based foods don’t – an important consideration for vegans when planning their meals.
Fats
Fats are important for energy but are also needed for cell growth and repair (the membranes surrounding every single cell are made 3of fat) and for hormone production. They are also essential for the absorption of fat-soluble vitamins (vitamins A, D and E). The fatty acids needed for these processes can be derived from natural sources such as butter, olive oil, fatty fish and meat, cheese, nuts and seeds. The metabolism of fat is different from that of carbohydrates and protein; the main difference is that it does not involve the hormone insulin.
Introducing insulin
Hormones are the body’s chemical messengers, involved in all the physiological processes in the body, including metabolism and immune functions. There are many hormones that regulate our metabolism. These tell us whether we are hungry or full up and when to eat; they respond to the food we eat, burn it or store it. Of all these hormones, the main ones are insulin, glucagon, leptin and ghrelin. Ghrelin is a hunger hormone that causes us to feel hungry, thereby affecting our appetite and food intake. Leptin acts in just the opposite way: it stops feelings of hunger once the body’s energy needs have been met. All of these hormones have very important roles, but here we will concentrate on insulin.
Insulin is produced by the beta cells in our pancreas. It regulates many metabolic processes that provide cells with essential energy. Its main function is to transfer sugar from the blood into the cells in muscles, liver and all other tissues, to be used in the production of ATP, the basic form of energy on which all our cells run. When we eat and our blood sugar (glucose) level rises, the pancreas responds by releasing insulin into our bloodstream to help transport the glucose into our cells.
Insulin is also involved in storing glucose as glycogen and fat. As I have said, any glucose that the cells don’t need is stored away, by insulin. Insulin signals the liver but also the muscles and fat cells, to store this excess glucose for later use as glycogen (short term) and also as fat (longer term). Insulin also inhibits the use of 4these stores for energy. It prevents the breakdown of stored fat; when insulin levels are high, nothing will come out of storage. This is because if insulin is present, its opposite hormone – glucagon – is not released. As a result of the effects of insulin, our blood sugar levels return to normal after a meal, until we eat again. Between meals, when we don’t eat, our insulin levels fall and as a result, glucagon is released. Glucagon prevents blood sugar levels from falling too low by stimulating the liver to break down stored sugar (glycogen) or stored fat, to be used for energy. There is naturally a good balance between insulin and glucagon and between eating and fasting. We either store food for energy when we eat, or burn it when we don’t eat. Insulin and glucagon need to be in balance to keep blood glucose stable at an appropriate level.
When insulin levels are high, nothing will come out of storage
All of these hormones are very important, as is the carefully regulated balance of the whole endocrine (hormone) system. Any problems with one hormone affect other hormones and, in turn, the metabolic balance stops working the way it should. Insulin affects other hormones and, because it is a part of the body’s energy ‘feeding system’, it is easy to understand how any problems with its proper functioning cause problems with other hormones too and with the whole metabolic system.
Table 1: The main functions of insulin and the effects of insulin resistance
Insulin functionHow it worksWhat happens in insulin resistanceMaintains blood sugar levelsInsulin is acting like a key to all the cells for the glucose to enter, to be used as energyBlood sugar levels remain elevated, the energy production in cells is affected5Helps liver to store excess glucoseInsulin helps the liver to store excess glucose as glycogen for later use
Insulin signals the liver to stop producing glucose when it is no longer needed
The glucose production in the liver might go out of control with the liver producing glucose even when it is not neededHelps build up and maintain muscle massInsulin helps the muscle cells to store excess glucose as glycogen
Insulin maintains muscle mass by stimulating the uptake of amino acids
Possible loss of muscle massHelps in fat metabolismInsulin helps to store excess glucose as fat in the liver and fat cells when glycogen stores are full
Insulin also inhibits the breakdown of fat in adipose tissue
