What’s Making Us Sick, and How to Fight It

Many Americans are sick. Increasingly, people have diseases like diabetes, cancer, heart disease, and Alzheimer’s; many more struggle with high blood pressure, cholesterol, and triglycerides, too much belly fat, low testosterone, menstrual irregularities, infertility, fatty liver, sleep disorders, depression, and anxiety. Doctors are busy treating symptoms, often not realizing all these illnesses have one thing in common: Every one of them is caused or aggravated by a condition known as insulin resistance. And you could have it - over half of all adults in America are insulin resistant.

Glucose is your blood sugar. Insulin is a hormone, arguably the most important hormone of all. Insulin determines what your body does with the calories you consume. Do you store them as fat or burn them as fuel? Insulin is a major determining factor of how your body functions, what your body composition is (percentage of body fat vs. percentage of muscle and bone), even how hungry you are and what you’re craving. Insulin is an anabolic (tissue-building) hormone made and secreted by the pancreas that regulates blood glucose levels.

One of my favorite work assignments is to make rounds as the cardiologist in charge of the Cardiovascular A Service at Saint Luke’s Hospital of Kansas City. I get to work with young doctors and medical students, who teach me as much as I teach them. During their decades-long medical education, they will receive virtually no training in nutrition. This is unfortunate because we have an increasingly evidence-based understanding of how the right diet and lifestyle can help us avoid or treat nearly all the most common diseases and ailments that shorten our lives and make us miserable. When I am on rounds, I encourage the team - a cardiology fellow, residents, interns, pharmacists, and medical students - to read Why We Get Sick by Benjamin Bikman, PhD, and Metabolical by Robert Lustig, MD. The theme of these books is that a high-sugar diet of ultra-processed foods is at the root of most chronic diseases. Both teach that the sure-fire and inexpensive path to a sexy waistline and robust metabolic health is a diet of whole-natural foods devoid of fast and processed foods.

What and how often we eat affects our hormonal balance. In turn, those hormones, especially insulin, ramp up the appetite and store calories as fat inside the abdomen. Consuming refined carbohydrates drives insulin levels up. Eating frequently keeps insulin levels high. Protein stimulates only a small insulin spike. Fat is the only macronutrient that has no effect on your blood sugar or insulin level. So fat is your friend if it’s from nuts, seeds, avocados, extra virgin olive oil, and fish. On the other hand, processed carbs (added sugar and refined grains) are the evil villain; when you eat these foods, the insulin spike tends to turn those calories into belly fat, which eventually causes inflammation and disease.

A seemingly “healthy” breakfast of a whole wheat bagel and orange juice spikes your blood sugar, causing your insulin to rocket up. For lunch, you have a sandwich, a bag of chips, and a Diet Coke. The afternoon snack is a muffin, then for dinner, you have spaghetti with ice cream for dessert. This is the Standard American Diet. It keeps your insulin levels sky-high all day, and in no time your body becomes numb to the effects of chronically high insulin, causing your cells to become insulin resistant.

Insulin resistance causes most of the diseases that we are prone to get in the modern world. To make matters worse, insulin resistance makes you tired, fat, irritable, and constantly craving more sweets, carbs, and junk food. High insulin levels also raise blood pressure and cholesterol levels and cause inflammation and fluid retention. How the blood glucose and insulin levels go up and down is influenced by how easily digestible the food is; how much sugar, white flour, and other refined carbohydrates it contains; how much fiber you consume; how well you slept last night; how much exercise you’ve done recently; your genes; your body composition; and even your gut microbiome - the trillions of microbes inside your intestines that help you digest food and boost your immunity.

People who have diabetes and are taking insulin are often prescribed a continuous glucose monitor (CGM). It measures and records your glucose levels 24 hours a day, sending results to an app on your smartphone. Until recently, CGMs were very expensive, about $400 per month, and only people with diabetes and good insurance had access to this game-changing technology. In the past year, less expensive CGMs have become available that can be affordable for people without diabetes.

I have been wearing a CGM monitor for much of the past 12 months, and I love it. A CGM is the most powerful behavior modification tool ever. For instance, sometimes when I was on call and got hungry, I would wolf down a bag of corn chips for a snack. When I did that while wearing a CGM, I was shocked to see that this tasty snack spiked my glucose to 150 mg/dL. That CGM feedback convinced me that I need to avoid chips.

Insulin changes blood sugar into triglycerides and stores it as fat in the abdomen and in your liver. The fat in your belly, called visceral fat, churns out inflammatory hormones, makes you insulin resistant, and causes disease and aging. On the other hand, subcutaneous fat - the kind that you can pinch or jiggle - is generally harmless.

Your muscles are the primary engine that burns 80% of the sugar in your bloodstream. So any sort of physical activity will combat insulin resistance because it removes glucose from the bloodstream without the need for insulin. Along with more exercise, the best way to restore insulin sensitivity is to avoid sugar and refined carbs. Also try to follow a gentle fasting routine whereby you don’t consume any calories or artificial sweeteners for at least 12 hours every night, especially the three to four hours before bedtime. Fat is stored energy; thus, your body fat is what you burn when you fast. More fasting = less belly fat.

Avoid drinking any beverage that contains sugar, including fruit juice, which floods your body with fructose - a particularly addictive and metabolically damaging sugar that generates an insulin spike and gets stored as belly fat. One exception I make is low sodium V8 juice, which has only 7 grams of sugar in 8 ounces and is loaded with healthy nutrients. Fruit in moderation is OK because it has lots of fiber and other nutrients that offset the sugar.

In Good Health,
James O'Keefe, MD