July/August 2008 | Mark Hyman
James also happened to be thick around the middle. After listening to his troubles, I said, “You don’t eat breakfast, do you? And, you feel tired after eating, so that’s why you skip food during the workday? And when you do feel sluggish, you go to the vending machine for a quick sugar fix, and in a few minutes you feel better, don’t you?”
Shocked, he asked, “How did you know?” I explained that he was fighting with his genes and was insulin resistant. In other words, his hormones were severely out of balance. He couldn’t control his metabolism of carbohydrates because he had too much insulin. Consequently, his blood sugar was out of whack, which led to all of his symptoms — and was also taking him down the slippery slope toward high blood pressure, heart disease, obesity, cancer, brain aging, dementia and more.
BODIES OUT OF BALANCE
In fact, most Americans are living out of harmony with their natural biological rhythms, because the small molecules that help keep your body in balance have gone haywire.
These molecules — the hormone-messenger molecules of the endocrine system and the neurotransmitter-messenger molecules of the brain and nervous system — are involved in almost every function of the body, and they are critical to our well-being.
The hormone and neurotransmitter system is yet another one of the body’s core systems we must address in order to prevent disease and power our vitality (see “The 7 Keys to UltraWellness,” below). Understand how and why these systems get out of balance and you will begin to see why so many Americans walk around tired, depressed and overweight. And why no amount of pharmaceutical intervention is going to solve the problem.
All of our hormones and brain-messenger chemicals must work together in a finely orchestrated symphony to keep everything in balance. For example, the hypothalamus and pituitary glands in your brain are the command-and-control centers for all the endocrine (hormone) glands. They send signals to distant parts of the body to control everything from your stress response through your adrenal glands, your blood-sugar balance through your pancreas, your thyroid hormone via your thyroid gland, and your sexual function through your reproductive organs. They also control growth, sleep, mood and much more.
Neurotransmitters, meanwhile, send messages throughout the body to every cell, organ and tissue and help you do everything from moving your arm to feeling happy or sad. So it’s not hard to see why having an appropriate supply of these chemicals is so essential to our well-being.
Indeed, when our hormones become imbalanced, the health consequences can be severe. There are three big epidemics of hormonal problems in America today: too much insulin (from sugar), too much cortisol and adrenaline (from stress), and not enough thyroid hormone. These all interconnect with and affect the other major category of hormones — our sex hormones.
Imbalances or disturbances in any one of these interconnected systems can influence the way our brains function and lead to everything from depression and dementia to anxiety and attention deficit hyperactivity disorder (ADHD). They also are linked to two other major epidemics we currently face: obesity and inflammation.
My patient James is hardly an unusual case. More than 100 million Americans suffer from insulin resistance. That number has grown to epidemic proportions for one simple reason: We have strayed from eating in harmony with our genes.
Historically, as a hunter-gatherer species, people ate the equivalent of only 20 teaspoons of sugar a year (exclusively from fruits, berries, tubers and the like). These days, each of us eats a whopping 158 pounds per year — or about 50 teaspoons a day! There’s absolutely nothing in our genetic makeup that could have prepared our bodies to handle this kind of dramatic change, or many of the other similarly dramatic lifestyle changes to which we’ve been simultaneously exposed.
Think about it: Humans evolved in a world without grocery stores and fast-food restaurants. For virtually all of human history, our ancestors had to work to find food and had very limited access to refined foods or excess calories.
But with the appearance of 15,000 low-fat foods (a.k.a. high-sugar, high-calorie foods) on the market over the last 15 to 20 years, and our increasingly sedentary — and stressful — lifestyle, we have essentially abandoned the conditions for which our historically conditioned metabolisms are well suited. And in the process, we’ve created the perfect conditions for an epidemic of obesity, diabetes, heart disease and brain disorders.
Our bodies normally produce insulin in response to food in our stomach, particularly sugar. And, since our genetic structure evolved at a time when sugar was rarely consumed, our insulin response is designed to handle vastly lower levels of sugar than what we eat today.
Our bodies respond to our new diet of low-fat, highly processed and refined foods the only way they know how: They keep pumping out insulin — which, in excess, happens to function as a pro-inflammatory substance.
Eventually, we become resistant to all this excess insulin in our blood, just as we would become resistant to a drug. The body needs more and more of it to do the same job it once did with far less. So our insulin-production system spirals out of control, pumping ever more into our bodies, which become inflamed and metabolically imbalanced.
That’s bad, but it gets worse: Remember, hormones are message carriers. And what is all this insulin saying to the rest of our body? It’s rushing through our bloodstreams spreading the message that we are starving. The result: We start craving foods with high sugar content — the very same foods that caused the problem in the first place.
THIS IS YOUR BODY ON INSULIN
Perhaps the situation wouldn’t be so bad if insulin metabolized only sugar. We once thought that was insulin’s only role — to help sugar enter your cells to be metabolized, transforming the stored energy of the sun (in plant foods) and the oxygen we breathe into the energy we use every day to run our bodies.
But here is what too much insulin really does to your body, your brain and your health:
Insulin is a major switching station, or control hormone, for many processes. It dictates how much fat the body will store. As long as your insulin levels are high, you will fight a losing battle with weight loss. It acts on your brain to increase appetite — specifically, an appetite for sugar and refined carbohydrates.
- Insulin increases inflammation and oxidative stress and ages your brain, leading to what is being called type 3 diabetes — also known as Alzheimer’s.
- Insulin increases LDL (“bad”) cholesterol, lowers HDL (“good”) cholesterol, raises triglycerides and increases your blood pressure. Insulin resistance causes 50 percent of all reported cases of high blood pressure.
- Insulin stimulates the growth of cancer cells.
- Insulin leads to mood and behavior disturbances such as depression, panic attacks, anxiety, insomnia and ADHD.
- Insulin makes your blood sticky and more likely to clot, leading to heart attacks and strokes.
- Insulin causes sex-hormone problems and can lead to infertility, facial hair growth, acne and scalp hair loss in women; in men, it can cause low testosterone, breast growth and more.
The good news is that balancing blood sugar and correcting insulin resistance is well within our reach, and the effects are dramatic: Diseases ranging from depression to dementia can be stopped and even reversed if intervention occurs early enough.
While there are some new medications that can help, such as Glucophage, Avandia and Actos, they have side effects and are only a band-aid approach to chronic conditions unless used with a comprehensive nutritional, exercise and stress-management plan that balances your neuro-endocrine system by helping it work the way it was designed.
Here is what to do to rebalance insulin, both nutritionally and through your lifestyle:
- Eat whole, real foods, mostly from plant-based sources. Our bodies evolved and were designed to flourish on fruits, vegetables, beans, nuts, seeds, whole grains, and lean animal protein such as fish, chicken and eggs.
- Remove toxic foods from your diet. Toxic foods, such as trans fats, high-fructose corn syrup, and all processed foods with ingredients you don’t easily recognize, interfere with your metabolism and create blood-sugar imbalances.
- Eat organic. Pesticides, antibiotics and hormones slow down your metabolism.
- Avoid sugar and flour products. They slow your metabolism and contribute to inflammation.
- Eat early and try to eat protein with each meal. Starting off the day with protein — nuts or nut butters, eggs, a protein shake, or even leftovers from the night before — jump-starts your metabolism and helps to avert overeating throughout the day.
- Eat frequently. Fueling your body regularly throughout the day speeds up your metabolism. Make it a priority to have three meals and a couple of snacks every day.
- Finish eating at least two hours before bed. If you fall asleep with food in your stomach, your body is more likely to store it, not burn it.
- Sleep seven to eight hours a night. A lack of sleep generates increased levels of ghrelin, the hunger hormone that triggers you to crave and eat more refined carbs and sugar.
- Build and maintain muscle. Your biggest metabolic engine is your muscle mass — basically, this is where your metabolism lives — so use it or lose it. Working with weights, exercise bands and resistance machines, and doing yoga all prevent your muscles from wasting away.
- Exercise intelligently. Try including interval training into your exercise program two or three days a week: Exercise at 90 to 95 percent of your peak heart rate for 30 to 60 seconds, then three to five minutes at 60 to 65 percent of your peak heart rate, alternating for a total of 30 minutes. Exercising at this intensity will trigger a metabolic effect that will cause you to burn more calories all day and while you sleep.
- Deeply relax daily. Stress hormones such as cortisol increase blood sugar, amplify appetite and cause weight gain around the middle, all of which promote insulin resistance. Find some time each day to sit quietly, breathe deeply or meditate.
As a result, you’ll need much less insulin to accomplish the task of balancing your blood sugar. Best of all, once you correct your insulin levels, you may find that many related, inflammation-based health problems (see “The Fire Within,” below) and hormonal imbalances subside.
Experience this, and you’ll be experiencing functional medicine in action: It’s really about harnessing the power you have to reset your metabolism and restore your body’s natural balance simply by stopping the things that knock you off kilter. And by doing the simple things that empower you to thrive.
INVESTIGATE YOUR INSULIN
Could your insulin levels be out of whack? The more “yes” answers you provide to the questions below, the more likely it is that you have problems controlling your blood sugar. That means your body is pumping out dangerously high levels of insulin (and, potentially, suffering other hormonal and inflammatory problems as a result).
- Do you feel dramatic mood and energy swings?
- Do you crave sugar or salt?
- Are you overweight and putting on more and more belly fat?
- If you are a woman, do you have premenstrual syndrome, painful or heavy periods, and low sex drive?
- Are you depressed?
- Do you sleep poorly?
- Do you feel tired but wired?
- Do you rely on coffee in the morning and a few glasses of wine at night just to wake up and calm down every day?
- Do you have thinning hair or dry skin and feel sluggish in the mornings?
THE FIRE WITHIN - WHERE HORMONES AND INFLAMMATION INTERSECT
One of the most insidious consequences of hormonal imbalances, and insulin resistance in particular, is inflammation, which is now thought to be at the root of all chronic illness we experience — from heart disease, obesity and diabetes to dementia, depression, cancer and even autism.
Inflammation and immune balance is yet another one of the body’s core systems we must address to prevent disease and power our vitality (see “The 7 Keys to UltraWellness,” below). We may feel healthy, but if this inflammation is raging inside of us, we’re in trouble.
The real concern is not our acute inflammatory response to injury or infection, but the chronic smoldering inflammation that slowly destroys our organs, compromises our ability for optimal functioning and leads to rapid aging.
The real effects of statin drugs like Lipitor in reducing heart disease may have nothing to do with lowering cholesterol and everything to do with their unintended side effect of reducing inflammation. But is that the right approach to address the problem? No. This treatment approach is a classic example of what I call “downstream” medicine: Modern medicine tends to get caught up in treating the symptom — inflammation, in this case — without actually stopping to think: What is actually triggering this inflammation? Where is it coming from?
Common treatments such as anti-inflammatory drugs (ibuprofen or aspirin, for example), or steroids like prednisone, though often useful for acute problems, interfere with the body’s immune response and inevitably lead to serious side effects. In fact, as many people die from the side effects of taking excessive amounts of anti-inflammatory drugs like ibuprofen as die every year from asthma or leukemia. In other words, stopping the inappropriate use of these drugs would be the lifesaving equivalent of finding a cure for asthma or leukemia. Hard to believe, but true.
So, what is the “upstream” medical approach to inflammation? First, identify the triggers and causes of inflammation, such as sugar, processed foods, hidden food allergens, environmental allergens, toxins, stress, being sedentary and hidden infections. Then, remove as many as possible, and help the body’s natural immune balance reset by providing the right conditions for it to thrive.
Taking a comprehensive approach to reducing inflammation at its source is one of the most important things we can do to support the core systems of the body, and I consider it a cornerstone to good health.
In fact, the future of medicine may no longer have specialties like cardiology or neurology or gastroenterology, but new specialists like “inflammologists” who focus on precisely these sorts of root causes of disease. In the meantime, it’s up to you to keep a close eye on your own “fire within” — and to take the steps (like those described above) that will keep them from smoldering out of control.
For more on inflammation, see “Fighting Inflammation” in the July/August 2004 archives.
THE 7 KEYS TO ULTRAWELLNESS
Simply put, when your core systems are out of balance, they make fertile ground for the roots of illness. When they are in balance, they become the keys to creating wellness and vitality:
- Environmental Inputs (diet, lifestyle, toxins, stress and trauma)
- Inflammation and Immune Balance (the hidden fire within)
- Hormone and Neurotransmitter Balance (insulin, thyroid, adrenal balance; sex hormones and mood chemicals)
- Gut and Digestive Health (digestion, absorption, assimilation, intestinal ecosystem and the gut-immune system)
- Detoxification Imbalances and Function (getting rid of wastes and dealing with toxins)
- Creating Energy (the source of life energy and metabolism — antioxidant balance)
- Mind-Body/Body-Mind Connection (change your mind, change your body; change your body, change your mind)