Fasting Physiology – Part Ii
There are many misconceptions about fasting. It is useful to review the physiology of what happens to our body when we eat nothing. Physiology Glucose and fat are the body’s main sources of energy. If glucose is not available, then the body will adjust by using fat, without any detrimental health effects. This is simply a natural part of life. Periods of low food availability have always been a part of human history. Mechanisms have evolved to adapt to this fact of Paleolithic life. The transition from the fed state to the fasted state occurs in several stages. Feeding – During meals, insulin levels are raised. This allows uptake of glucose into tissues such as the muscle or brain to be used directly for energy. Excess glucose is stored as glycogen in the liver. The post-absorptive phase – 6-24 hours after beginning fasting. Insulin levels start to fall. Breakdown of glycogen releases glucose for energy. Glycogen stores last for roughly 24 hours. Gluconeogenesis – 24 hours to 2 days – The liver manufactures new glucose from amino acids in a process called “gluconeogenesis”. Literally, this is translated as “making new glucose”. In non-diabetic persons, glucose levels fall but stay within the normal range. Ketosis – 2-3 days after beginning fasting – The low levels of insulin reached during fasting stimulate lipolysis, the breakdown of fat for energy. The storage form of fat, known as triglycerides, is broken into the glycerol backbone and three fatty acid chains. Glycerol is used for gluconeogenesis. Fatty acids may be used for directly for energy by many tissues in the body, but not the brain. Ketone bodies, capable of crossing the blood-brain barrier, are produced from fatty acids for use by the brain. After four days of fasting, approximately 75 Continue reading >>
Recommendations For Insulin Using Patients When Fasting
Can patients who use insulin safely fast? The topic of fasting comes up often as patients may have to fast for laboratory tests, surgery, diagnostic procedures (e.g. colonoscopy), or religious reasons, or just to improve their blood sugars or lose weight. It can be a major challenge for just about anyone but can be particularly difficult for patients with insulin-dependent diabetes. Patients with insulin-dependent diabetes need to understand the management of diabetes during fasting to prevent hypoglycemia (blood glucose < 70 mg/mL or 3.9 mmol/L). Plus, the duration of the fast affects how much insulin is needed during that time. The management of people with diabetes who fast is mostly based on expert opinion rather than medical evidence gained from clinical studies. For patients using insulin who want to fast, there may need to be extra attention since healthcare professionals (HCPs) who are not experienced in dealing with fasting people with diabetes might not consult or even be aware of published recommendations [4]. Evidence-based guidelines are important and, although the evidence available in this area continues to increase, more randomized controlled trials are needed to fully answer questions related to controlling blood sugars when fasting. One of the best examples of large numbers of people fasting is for Muslims during Ramadan, who fast from 15 to 30 days.[7] People with T1DM will be advised not to fast because of the risks of severe complications. However, recent studies involving young adults suggest that if the patient is stable, otherwise healthy, has good hypoglycemic awareness and complies with their individualized management plan under medical supervision, then many of these patients can fast safely. One study involving 33 adolescent children with T1D Continue reading >>
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You Are “when” You Eat: The Benefits Of Intermittent Fasting (video)
Intermittent fasting is term coined by the research world that refers to an extended duration of minimal calorie intake. Believe it or not, humans are evolutionarily adapted to performing intermittent fasts – our ancestors performed extended fasts whenever food was unavailable, and feasted only when they could procure enough food to eat. However, in our modern world of abundance, deliberately fasting for an extended period of time is anything but “normal.” Fasting goes against every morsel of modern life, and is in direct opposition to the abundance-based food culture that we have worked so hard to create. In our world of fast food, on-demand food delivery and 24-hour convenience stores, choosing not to eat food can seem strange indeed. I spent my entire graduate career investigating the effects of intermittent fasting in rodents, in order to understand why calorie restriction and intermittent fasting are the gold standards for improving insulin sensitivity. As a result of this active body of research, tens of thousands of people across the world engage in intermittent fasting on a weekly basis, as a means of improving their body composition, losing fat mass, shedding pounds or observing a religious holiday. The research world has taken a large interest in calorie restriction and intermittent fasting, for the explicit purpose of identifying cellular mechanisms that may retard the aging process and promote excellent metabolic health. And in the process of studying intermittent fasting, researchers have uncovered a laundry list of health benefits that confuse even the most educated professors. The truth is that humans have been fasting for thousands of years. Modern research is playing catch-up, in order to understand why the health benefits are so impressive. The M Continue reading >>
Fasting Glucose To Insulin Ratio Is A Useful Measure Of Insulin Sensitivity In Women With Polycystic Ovary Syndrome1 | The Journal Of Clinical Endocrinology & Metabolism | Oxford Academic
The Journal of Clinical Endocrinology & Metabolism A Fasting Glucose to Insulin Ratio Is a Useful Measure of Insulin Sensitivity in Women with Polycystic Ovary Syndrome Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine (R.S.L.), Hershey Pennsylvania 17033 Search for other works by this author on: the Diabetes Research Laboratory, Simon Fraser University School of Kinesiology (D.F.), Burnaby, British Columbia, Canada V5A 1S6 Search for other works by this author on: the Division of Womens Health, Brigham and Womens Hospital (A.D.), Boston, Massachusetts 02115. Address all correspondence and requests for reprints to: Andrea Dunaif, M.D., Division of Womens Health, Brigham and Womens Hospital, PBB-Admin-5, 75 Francis Street, Boston, Massachusetts 02115. Search for other works by this author on: The Journal of Clinical Endocrinology & Metabolism, Volume 83, Issue 8, 1 August 1998, Pages 26942698, Richard S. Legro, Diane Finegood, Andrea Dunaif; A Fasting Glucose to Insulin Ratio Is a Useful Measure of Insulin Sensitivity in Women with Polycystic Ovary Syndrome, The Journal of Clinical Endocrinology & Metabolism, Volume 83, Issue 8, 1 August 1998, Pages 26942698, Women with polycystic ovary syndrome (PCOS) are profoundly insulin resistant, and the resultant hyperinsulinemia exacerbates the reproductive abnormalities of the syndrome. Agents that ameliorate insulin resistance and reduce circulating insulin levels could provide a new therapeutic modality for PCOS. Identifying the subset of PCOS women who are most insulin resistant may therefore be useful for selecting women who will respond to this therapy. We examined the correlation of basal and oral glucose-stimulated glucose and insulin levels and fasting and stimulated glucose/insu Continue reading >>
Do You Know Your Insulin Level?
People often keep close watch on their glucose numbers. But how many of us know our insulin level? Dr. Joseph Mercola says fasting insulin is “the number that may best predict your sudden death.” Sounds important. But what does it mean? Our bodies need some circulating insulin at all times, even when we don’t eat. Otherwise, our livers keep making glucose and dumping it into the blood. Livers do this to prevent blood glucose from going too low. So a fasting insulin level should never be 0, which it might be in a person with untreated Type 1. It shouldn’t go below 3. But a high insulin level is just as problematic. A high insulin level is a sign of insulin resistance or prediabetes. It can also signify early-stage Type 2. According to Dr. Mercola, too much insulin promotes weight gain by storing fat. It promotes insulin resistance, lowers magnesium levels, and increases inflammation. It also tends to lower HDL (“good”) cholesterol and raise levels of LDL (“bad”) cholesterol. All of these increase the risk of diabetes and heart disease. It may be that high insulin levels come before insulin resistance and help cause it. If you already have diabetes, why should you know your insulin level? Mainly, it helps diagnose what is happening with you. Your blood glucose may be high, but how much of the problem is too little insulin? How much is insulin resistance? A fasting insulin level test is valuable in several situations: • Diagnosing prediabetes and metabolic syndrome. “Prediabetes” is one result of insulin resistance. Insulin resistance causes high cholesterol, high glucose, and high blood pressure. A high level of fasting insulin indicates insulin resistance and can encourage a person to make changes to lower it. • Separating Type 2 from LADA (latent Continue reading >>
Fasting Insulin
A blood test for fasting insulin can be one of the most important that you get. It’s important because it shows the degree of insulin resistance: the higher the number, the more insulin resistant. A very high number generally means type 2 diabetes. A number merely higher than normal can signify metabolic syndrome or pre-diabetes. Hyperinsulinemia, or too much insulin in the blood, is one of the main causes of chronic disease in the modern world, including heart disease, cancer, kidney disease, and of course diabetes. Being sedentary leads to insulin resistance, and exercise can prevent it. Insulin resistance is strongly associated with obesity, but normal weight people, especially those who are skinny-fat, can have it too. A diet high in sugar and refined carbohydrates, especially when combined with seed oils, leads to hyperinsulinemia and insulin resistance. My fasting insulin test Doctors don’t routinely test for fasting insulin; they normally do so only if they suspect diabetes. I’ve had a few tests of fasting blood glucose that were high, in the range of 100 to 110. That’s an odd result, because I eat a low-carbohydrate diet and lift weights, and have a body fat percentage that I don’t know exactly but is likely <15%. It’s probably due to the so-called dawn phenomenon, or physiological insulin resistance, which is normal. When on a low-carbohydrate diet, the liver can become insulin resistant in order to make glucose for the rest of the body. To be honest, the causes of the dawn phenomenon are not fully elucidated, and experts give varying explanations. But the fact is that many people who eat low-carb report it. Another reason for a high fasting glucose can be stress and cortisol; if you go for a blood draw on a morning when you’re rushing off to work Continue reading >>
14 Ways To Lower Your Insulin Levels
Insulin is an extremely important hormone that's produced by your pancreas. It has many functions, such as allowing your cells to take in sugar from your blood for energy. However, too much insulin can lead to serious health problems. Having high levels, also known as hyperinsulinemia, has been linked to obesity, heart disease and cancer (1, 2, 3). High blood insulin levels also cause your cells to become resistant to the hormone's effects. When you become insulin resistant, your pancreas produces even more insulin, creating a vicious cycle (4). Here are 14 things you can do to lower your insulin levels. Of the three macronutrients — carbs, protein and fat — carbs raise blood sugar and insulin levels the most. For this and other reasons, low-carb diets can be very effective for losing weight and controlling diabetes. Many studies have confirmed their ability to lower insulin levels and increase insulin sensitivity, compared to other diets (5, 6, 7, 8, 9). People with health conditions characterized by insulin resistance, such as metabolic syndrome and polycystic ovary syndrome (PCOS), may experience a dramatic lowering of insulin with carb restriction. In one study, individuals with metabolic syndrome were randomized to receive either a low-fat or low-carb diet containing 1,500 calories. Insulin levels dropped by an average of 50% in the low-carb group, compared to 19% in the low-fat group (10). In another study, when women with PCOS ate a lower-carb diet containing enough calories to maintain their weight, they experienced greater reductions in insulin levels than when they ate a higher-carb diet (11). Low-carb diets have been shown to increase insulin sensitivity and reduce insulin levels in people with obesity, diabetes, metabolic syndrome and PCOS. Apple cider v Continue reading >>
What's The Ideal Fasting Insulin Level?
[2013 update. I'm leaving this post up for informational purposes, but I think it's difficult to determine the "ideal" insulin level because it depends on a variety of factors including diet composition. Also, insulin assays are not always comparable to one another, particularly the older assays, so it's difficult to compare between studies] Insulin is an important hormone. Its canonical function is to signal cells to absorb glucose from the bloodstream, but it has many other effects. Chronically elevated insulin is a marker of metabolic dysfunction, and typically accompanies high fat mass, poor glucose tolerance (prediabetes) and blood lipid abnormalities. Measuring insulin first thing in the morning, before eating a meal, reflects fasting insulin. High fasting insulin is a marker of metabolic problems and may contribute to some of them as well. Elevated fasting insulin is a hallmark of the metabolic syndrome, the quintessential modern metabolic disorder that affects 24% of Americans (NHANES III). The average insulin level in the U.S., according to the NHANES III survey, is 8.8 uIU/mL for men and 8.4 for women (2). Given the degree of metabolic dysfunction in this country, I think it's safe to say that the ideal level of fasting insulin is probably below 8.4 uIU/mL. Let's dig deeper. What we really need is a healthy, non-industrial "negative control" group. Fortunately, Dr. Staffan Lindeberg and his team made detailed measurements of fasting insulin while they were visiting the isolated Melanesian island of Kitava (3). He compared his measurements to age-matched Swedish volunteers. In male and female Swedes, the average fasting insulin ranges from 4-11 uIU/mL, and increases with age. From age 60-74, the average insulin level is 7.3 uIU/mL. In contrast, the range on Kit Continue reading >>
The Sweet Spot For Intermittent Fasting
The Sweet Spot for Intermittent Fasting Lower insulin means greater fat loss Intermittent fasting — the practice of going without food for some (undefined) period of time — has many health benefits. It can help prevent heart disease, speed fat loss, and slow or reverse aging. There are a number of physiological mechanisms involved. It reduces inflammation and oxidative stress, leads to increased numbers and quality of mitochondria, and increases autophagy, the cellular self-cleansing process. Many of the beneficial effects are entwined with lower levels of insulin. The function of insulin is to promote energy storage and the growth of the organism. When insulin is increased, fat is stored in fat cells, and other cells take up glucose from the blood. Most importantly, when insulin is increased, lipids can’t leave fat cells. Since fat loss is all about getting lipids out of fat cells to be burned, losing fat requires some attention to how diet, exercise, and fasting cause insulin to rise or fall. Take a look at the following graph, taken from a paper by Volek et al. It shows that even small increases in insulin, within the normal range, virtually abolish lipolysis, or the breakdown of fat. This is where intermittent fasting comes in, as one of its effects is to lower insulin levels and thus increase lipolysis. The question is, how long do you need to fast before insulin comes down? Eating causes insulin to rise, the amount of the rise being dependent on a number of factors, such as type and amount of food eaten and the insulin sensitivity of the person doing the eating. High amounts of carbohydrates and lower insulin sensitivity cause a greater rise in insulin. Insulin increases and stays higher for several hours after eating — that is, during the “fed” state. Continue reading >>
Identifying Prediabetes Using Fasting Insulin Levels.
Abstract OBJECTIVE: To determine whether patients with prediabetes can be accurately and easily identified in clinical settings using a predictive clinical and laboratory model. METHODS: This retrospective study examined demographic and laboratory data from patients who had undergone 2-hour glucose testing for suspected prediabetes or diabetes between 2000 and 2004. Patients who met the diagnostic criteria for diabetes mellitus were excluded. Prediabetes was defined as a fasting glucose concentration > or = 100 mg/dL and < or = 125 mg/dL or a 2-hour postprandial glucose concentration > or = 140 mg/dL and < 200 mg/dL. Multivariate logistic regression was conducted to identify calculated or measured clinical and laboratory attributes that predict the presence of prediabetes, including fasting insulin quartiles, homeostasis model assessment of insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index. RESULTS: Of 965 patients, 287 (29.7%) had prediabetes. The study population primarily consisted of white, obese, female patients. A multivariate model revealed that compared with the referent lowest quartile of fasting insulin (mu = 4.9 [+/-SD] +/-1.2 microIU/mL), subsequent insulin quartiles increased the likelihood of identifying prediabetes (quartile 2: mu = 8.0 +/-0.8 microIU/mL, odds ratio [OR] = 2.076, confidence interval [CI] = 1.241-3.273; quartile 3: mu = 12.2 +/-1.7 microIU/mL, OR = 3.151, CI = 1.981-5.015; quartile 4: mu = 25.9 +/-12.4 microIU/mL, OR = 5.035, CI = 3.122-8.122). Older age and increased diastolic blood pressure also contributed modestly to this model. Further analysis using the area under the curve revealed that at a fasting insulin level > 9.0 microIU/mL, prediabetes would be correctly identified in 80% of affected patients. A s Continue reading >>
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Insulin: Reference Range, Interpretation, Collection And Panels
Insulin is an anabolic hormone that promotes glucose uptake, glycogenesis, lipogenesis, and protein synthesis of skeletal muscle and fat tissue through the tyrosine kinase receptor pathway. In addition, insulin is the most important factor in the regulation of plasma glucose homeostasis, as it counteracts glucagon and other catabolic hormonesepinephrine, glucocorticoid, and growth hormone. Table 1. Reference Range of Insulin Levels [ 1 ] (Open Table in a new window) A standard insulin test is positive for endogenous insulin and exogenous insulin. In addition, there is a minimal cross-reaction with proinsulin and insulinlike growth factors 1 and 2, with the degree of variability depending on the brand of the testing toolkit and technique used. Insulin testing is used to assist in identifying causes of hypoglycemia (plasma glucose levels < 55 mg/dL), especially upon signs and symptoms of hypoglycemia (neurohypoglycopenic and autonomic symptoms). In this scenario, a 72-hour fasting test is performed. [ 2 ] Insulinoma: High insulin and C-peptide levels Nonbeta cell tumors: Low insulin and C-peptide levels and high insulinlike growth factor 2 level [ 3 ] Excessive insulin administration: High insulin levels and low C-peptide levels Insulin secretagogue administration (sulfonylurea and glinides): High insulin and C-peptide levels Congenital hyperinsulinism (mutation in insulin-secreting gene): High insulin and C-peptide levels Autoimmunity to insulin or insulin receptor (common in patients receiving insulin or those who have autoimmune diseases such as systemic lupus erythematosus [SLE] or Hashimoto thyroiditis): Postprandial insulin is bound to antibodies and dissociated 1 hour later, resulting in an extremely elevated insulin level and high insulintoC-peptide ratio [ 4 ] T Continue reading >>
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The One Number That May Best Predict Your Risk Of Sudden Death
There are seven numbers you should track if you want to monitor your health—five are determined by simple blood tests, and the other two you can determine at home The five blood tests you should regularly obtain are fasting insulin, cholesterol/HDL ratio, serum ferritin, uric acid, and vitamin D; two good indicators for assessing your overall “metabolic fitness” and heart attack risk are your percentage body fat and your waist-to-hip ratio Optimizing your vitamin D level is crucial for health because vitamin D influences about 3,000 of your 30,000 genes, helping to prevent a multitude of diseases from cardiovascular disease to the common cold Minimizing dietary sugar, especially fructose, will go a long way toward optimizing nearly ALL seven of these numbers—if you could do only one thing, this would be the one! By Dr. Mercola The Globe and Maili recently published an article outlining "the 5 numbers that most impact your health." I think they have the right idea, but but I disagree with their test selections. If you really want to monitor your health, I believe the numbers you should be tracking are the seven listed in the table below. These are far more important than tracking your total cholesterol, blood pressure, or BMI, as recommended by the Globe and Mail. Let's take a closer look at these values and what they may reveal about your health. 1. Fasting Insulin (I) 2. Cholesterol/HDL Ratio (C) 3. Percentage Body Fat (F) 4. Serum Ferritin (F) 5. Waist/Hip Ratio (WH) 6. Uric Acid Level (U) 7. Vitamin D Level (D) 1. Fasting Insulin Level Your fasting insulin level reflects how healthy your blood glucose levels are over time. Insulin helps sugar move from your blood into your cells, where it can be used or stored. Chronically elevated blood glucose leads to insu Continue reading >>
What Does My Fasting Insulin Level Mean?
I have not been diagnosed with diabetes but recently my doctor had me take a fasting insulin blood test. The results came back with a 24.7. It was on the portal that I can log into to see my results and I can't get a hold of the doctors office for a few days. What does this mean? A fasting insulin level is not very useful, and doesn't really tell one much. It may be an indicator of insulin resistance, but it isn't the ideal test. The ideal test is a complex test done using an insulin and glucose infusions. The likely cause of a raised insulin is being overweight, and the clinical features of this are skin tags around the neck and upper body or acanthosis(darkness around the neck).Insulin resistance can be improved with weight loss, and is not a cause for weight gain The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content. Continue reading >>
Fasting Insulin Levels And Metabolic Risk Factors In Type 2 Diabetic Patients At The First Visit In Japan
OBJECTIVE To investigate the relationship between fasting insulin levels and metabolic risk factors (MRFs) in type 2 diabetic patients at the first clinic/hospital visit in Japan over the years 2000 to 2009. RESEARCH DESIGN AND METHODS In total, 4,798 drug-naive Japanese patients with type 2 diabetes were registered on their first clinic/hospital visits. Conventional clinical factors and fasting insulin levels were observed at baseline within the Japan Diabetes Clinical Data Management (JDDM) study between consecutive 2-year groups. Multiple linear regression analysis was performed using a model in which the dependent variable was fasting insulin values using various clinical explanatory variables. RESULTS Fasting insulin levels were found to be decreasing from 2000 to 2009. Multiple linear regression analysis with the fasting insulin levels as the dependent variable showed that waist circumference (WC), BMI, mean blood pressure, triglycerides, and HDL cholesterol were significant, with WC and BMI as the main factors. ANCOVA after adjustment for age and fasting plasma glucose clearly shows the decreasing trend in fasting insulin levels and the increasing trend in BMI. CONCLUSIONS During the 10-year observation period, the decreasing trend in fasting insulin was related to the slight increase in WC/BMI in type 2 diabetes. Low pancreatic β-cell reserve on top of a lifestyle background might be dependent on an increase in MRFs. RESEARCH DESIGN AND METHODS A cross-sectional and longitudinal study was conducted that included 22 medical clinics (i.e., general practitioners) or general/university-affiliated hospitals from different areas in Japan, using the same software (CoDiC) to compile electronic medical records, as a working study group, the Japan Diabetes Clinical Data Continue reading >>
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The One Test Your Doctor Isn’t Doing That Could Save Your Life
Insulin resistance doesn’t happen overnight. When most of your diet includes empty calories and an abundance of quickly absorbed sugars, liquid calories, and carbohydrates like bread, pasta, rice, and potatoes, your cells slowly become resistant to the effects of insulin. Your body increasingly demands more insulin to do the same job of keeping your blood sugar even. Eventually your cells become resistant to insulin’s call, resulting in insulin resistance. The higher your insulin levels are, the worse your insulin resistance. Your body starts to age and deteriorate. In fact, insulin resistance is the single most important phenomenon that leads to rapid, premature aging and all its resultant diseases, including heart disease, stroke, dementia, and cancer. Insulin resistance and the resulting metabolic syndrome often comes accompanied by increasing central obesity, fatigue after meals, sugar cravings, high triglycerides, low HDL, high blood pressure, problems with blood clotting, as well as increased inflammation. Even without these warning signs, one test can determine high insulin levels years or even decades before diabetes develops. Early detection can help you reverse these symptoms, yet doctors rarely use this crucial test that can detect high insulin levels. Why Doctors Miss the Initial Warning Sign of Insulin Resistance Doctors have been trained to measure a person’s fasting blood sugar, or the glucose levels present in your blood, at least eight hours after your last meal. Most don’t express concern until results show blood sugar levels reaching 110 mg/dl. That’s when they start “watching it.” Then, once your blood sugar reaches 126 mg/dl, your doctor will diagnose you with diabetes and put you on medication. The important thing to note is that bloo Continue reading >>
