Blood Sugar, Inflammation, and Dis-ease

It is universally accepted throughout the scientific and medical communities that just about every chronic degenerative condition we know of today (heart disease, diabetes, arthritis, cancer, etc.) has an inflammatory component to it (a causative relationship is still questioned by many, however).  Increased levels of oxidative stress and free radical damage are concomitant with the inflammation.  It has also been stated that elevated levels of blood sugar (glucose) and insulin have a strong association with increased inflammatory processes in the body.  Statistics suggest that over 25% of the population is now either diabetic or sitting on the doorstep of becoming diabetic (“pre-diabetic).   This develops over time as one does not regulate his/her blood sugar throughout the day and night.  The higher your glucose levels, the more insulin has to be produced by the pancreas to bring blood sugar down to a more homeostatic level.  The higher the insulin levels, the more de-sensitized cells become to insulin (please note that elevated insulin levels are not the only contributing factor to decreased cell sensitivity, but it does play an important role in the process). Consequently, the less efficient an individual’s metabolism becomes at regulating blood sugar effectively.

 
Elevated insulin is correlative with elevated markers for inflammation, particularly with C-Reactive Protein (CRP).   A similar situation presents itself when blood sugar drops below normal, what we call hypoglycemia.  When in this state, the body calls on adrenaline to release stored glycogen (sugar) from the liver to bring blood glucose levels back up to an acceptable level.  If the individual in question has had blood sugar handling issues for a while – many people have this issue for years and have no idea it is happening – they are not likely to be storing glycogen effectively in the liver.  The next hormone called upon is cortisol.  Cortisol’s role is to break down musculoskleletal tissue so that the amino acids can be converted into glucose (gluconeogenesis) to bring blood sugar back up.  The trouble with this is that when breaking down musculoskeletal tissue, free fatty acids are also released into the blood stream.  These free fatty acids can actually prevent glucose from entering cells to be used for fuel.  As well, cortisol synergizes with estrogen, prolactin, and a number of other inflammatory hormones to perpetuate the stress/inflammatory cycle, perpetuate cellular damage, tissue destruction and catabolic, degenerative processes.  This is one simple physiological cascade that creates an environment that is favorable for the body’s regenerative process to become degenerative.
 
What is “Normal” & “Healthy” Insulin, Glucose, & Insulin Sensitivity?
 To put things into context, it must be pointed out that laboratory reference ranges are only statistical averages. I have written about this before in my article/post entitled My Blood Test Says What?  Glucose and insulin readings are not excluded from this fact.  Most labs’ reference range for insulin is between 0-30. In my opinion, this is completely ridiculous.  Most functional medicine experts agree that anyone with a fasting insulin level greater than 10 has very serious health issues and is already very likely to be pre-diabetic or diabetic.
 
In my experience, a more ideal range for fasting insulin is 0-5, or as close to zero as possible.  I like to see fasting glucose levels between 80-100; 80-90 if you want to be super strict about it.  In addition, the time it takes to reach maximal blood glucose levels (rate of appearance) following a true glucose challenge and the time it takes to return back to the fasted state (rate of disappearance) must also be considered.  To accurately calculate one’s Insulin sensitivity and pancreatic beta cell function, one can use the following formulas, which I was first exposed to years ago when studying the work of John Berardi, PhD.  You can read more about Dr. Berardi and his work by visiting http://www.precisionnutrition.com/about/john-berardi    
 
Insulin Sensitivity =
Fasted Insulin (mU/L) / 22.5 x E to the X e-ln(Fasted Glucose (mmol/L))
 
or
Fasted Insulin (pmol/L) x (Fasted Glucose (mmol/L) / 135)
 
Pancreatic Beta Cell Function =
(20 x Fasted Insulin (mU/L)) / (Fasted Glucose (mmol/L)-3.5)
 
or
(3.33 x Fasted Insulin (pmol/L) / (Fasted Glucose (mmol/L)-3.5)

            Insulin Sensitivity 

     Lower score = more sensitive
     Normal insulin sensitivity: score should be below 2 
     Excellent insulin sensitivity: score will be around 0.5

            Pancreatic Beta Cell Function

     Higher = better pancreatic function and insulin release
     Normal pancreatic function: score should be about 100 
     Excellent pancreatic function: score will be above 200

Once you’ve collected these measures, you will have an objective indication of what your physiology is capable of when it comes to blood sugar regulation.  I typically recommend doing these tests at least once per year (perhaps once every 6 months is better) to see how your nutrition and training is impacting your insulin sensitivity over the course of time.  I have personally found these formulas to be very valuable over the years in aiding clients in fine-tuning both nutrition and exercise programs to meet their individual physiological needs.

[Note: these formulas are not the be all end all for assessing insulin sensitivity and pancreatic beta cell function]
 
Taming the Wild Beasts — Glucose and Insulin (and others)
 In order to regulate blood sugar, what is absolutely fundamental in my experience, is to know what foods will support optimal cellular energy production (i.e. – efficient use of glucose at the cell level), in what combination YOU need to eat these foods, and to identify optimal nutrient timing for YOUR physiology.   These factors are highly subjective and depend on the overall physiological state and load of the individual in question.  This means that properly regulating glucose levels is not achieved by the same nutritional strategy for everyone.   In fact, I have witnessed how two different people can overcome severe dysglycemia (blood sugar handling issues) with nutritional strategies that are quite different from one another.  I have also witnessed the SAME person’s nutritional requirements change dramatically to accomplish the same task.  
 
Free Radicals, Inflammation, & Aging – Oh My!
Free radicals are any atom or molecule with an unpaired electron in its outer most shell.  They are sort of like the sparks that fly off the top of a camp fire.  Free radicals interact with their surroundings (cells, tissues, organs) and cause damage to them.  They are a normal part of the innate immune defenses but excess levels of free radical activity will cause run-away inflammation and destruction of cells and tissues, and perpetuate degenerative processes in the body.  This is a negative cycle that perpetuates upon itself until someone is taught how to eat to effectively regulate his/her blood sugar with FOOD throughout the day and night.  Excess Insulin, and the various hormones that it synergizes with, all have very strong pro-inflammatory effects on the body and exaccerbate the stress response.
 
Of course, regulating blood sugar and decreasing inflammation is not only about FOOD.  It is also a matter of lifestyle choices.  The locomotor system was designed for movement and regular exercise is strongly associated with improved insulin levels.  When a person exercises in the right way, with the right exercises for their body and the appropriate acute exercise variables assigned to the program – sets, reps, tempo, load, and rest intervals – glucose is utilized much more efficiently at the cell level.  Effective glucose utilization at the cell level is in and of itself “anti-inflammatory” in nature (perhaps “non-inflammatory” is a better way to refer to it).  As well, lifestyle choices are imperative in decreasing inflammation in the body.  Staying up until 2 a.m. will not support optimal physical repair of the body’s tissues.  One cannot continuously disrupt circadian rhythms (day-night cycles) and think that they will regulate that with food.  That is a lifestyle choice that would also be in need of modification in order to fully decrease the inflammatory potential of the body-mind. 
 
Summary
Normalizing glucose and insulin through sound nutritional implementation, appropriate exercise, and optimal lifestyle choices creates an environment favorable for sufficient adaptation and the creation of health, and as a result decreases free radical formation and inflammation.
 
Recommended Reading & Resources:
 
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