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How did I Become Insulin Resistant?

Genetics and Insulin Resistance and Weight lossInsulin Resistance occurs for several reasons.  First, genetic predisposition may make people have cells which are more resistant to the action of insulin.  Furthermore, our body types are inherited and typically people who are predisposed to store fat in the abdominal or central area of the body - called the Apple distribution - are at increased risk. People with a strong family history of diabetes are at increased risk as well.

Insulin Resistance develops due to weight gain, especially the deposition of fat inside the abdomen that physicians call intra-abdominal fat or visceral fat.  This visceral fat has very close proximity to the liver and portal circulation – which is where the blood supply of the liver is centralized.  These visceral fat cells directly release hormone-like substances called cytokines and adipokines into the portal circulation which encourage insulin resistance.

Body fat is not just an inert storage depot of calories.  In fact, body fat is an endocrine organ (hormonal organ) that influences other cells.  Someone may gain twenty to thirty pounds when they go through a lifestyle or medical event like stopping smoking, pregnancy, menopause, or additional job or family stress that leads to stress eating. Sometimes even schedule change that does not allow time for healthy meal planning and exercise can be a factor.  People can understand that they have gained weight because their calorie intake exceeded the calories they were spending.  They find they can’t focus on healthy diet or exercise now, but believe at sometime in the future they will be able to, and the weight will come back off.

However, over a period of time, these patients find that their metabolism has changed.  The visceral (abdominal) fat tissue secretes hormones which make weight gain easier and weight loss much more difficult.  That is why all of the lifestyle adjustments that used to work when you gained five pounds -- like increasing exercise or cutting out some desserts or cutting back on alcohol – simply no longer are effective.

Very interestingly, I have observed that people who were always very slender and really don’t have much subcutaneous fat (fat under the surface of the skin), will gain almost all of their weight viscerally and abdominally.  This is because once we are adults, we do not make new fat cells, but instead the ones we have just get larger and fuller and more likely to secrete adipokines. 

All of us have fat to insulate and protect our internal organs and if the visceral fat is the area where one has the majority of the body’s fat cells, the visceral fat will enlarge.  My patients, who may have a relatively minor amount of weight gain such as five to ten pounds, can have all of the metabolic consequences of insulin resistance because they store this extra fat viscerally (in the abdomen) and not subcutaneously (under the skin).

Medications can affect your metabolism as well, causing insulin resistance. Several medications used to treat psychiatric conditions and even some that treat blood pressure or heart conditions can promote insulin resistance.  Sometimes it is not safe to change these medications and the patient needs to do other things to combat the insulin resistance.

Importantly, nutrient deficiency and insufficiency can produce or aggravate insulin resistance.  Vitamin D deficiency, magnesium deficiency, Vitamin B12 deficiency and others can aggravate and can even cause insulin resistance.  That is why we are so aggressive in correcting these very common nutrient deficiencies, because it’s already hard enough to lose the weight.


Page 3: Insulin Resistance: Hormonal Changes

Related Article: Insulin Resistance: What's My Metabolism Doing?

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