WHY YOUR PATIENT MAY NOT BE LOSING WEIGHT Warren ...

88TH ANNUAL POSTGRADUATE CONVENTION | LLU HOMECOMING

ALUMNI ASSOCIATION, SCHOOL OF MEDICINE OF LOMA LINDA UNIVERSITY

Insulin ResistanceWHY YOUR PATIENT MAY NOT BE LOSING WEIGHT

Warren Peters, MD, MPH, FOMA

Center for Health Promotion



Your Patient

• 49 year old female

• High School science teacher

• Healthconscious

• Physicallyactive

• Eats healthy, low meat intake

• Menopausal, 50 pounds over weight

• A1C 6.0

• Fasting insulin 25

• She can not lose weight no matter what she does



Affected By Two Major Revolutions

2. The Industrial Revolution

• Machines do the work

• Less need for physical activity

• Fewer famines

• Plentiful food

1. The AgriculturalRevolution

• Ability to raise and store grasses and root crops

• Less need to hunt and gather.

• More time for arts, religion, politics, and leisure



Span of Human History

The beginning

Agricultural Revolution,

the last ½ inch

INDUSTRIAL

REVOLUTION

100 yards

The last

¼ inch



Before The Revolutions

• Lucky Humans- “insulin resistant” could survive famines and had more surviving descendants.

• Unlucky Humans - were not “insulin resistant” and died during famines. Fewer surviving descendants.

• Insulin was and is an essential physiological biological tool



The Bright Side of Insulin

• Increase IGF1

• Increase resistin

- Inflammatory markers (IL-6,TNFα

• Creates dysbiosis

• Toxic to neurological tissues (Alzheimer’s Disease)

• Blocks lipolysis during conditions of obesity

• Efficiently sends fuel to muscle cells

• Stores excess fuel as fat

• Lipolysis –burns fat more slowly during famine conditions.

The Dark Side of Insulin



A Major Clash Between Environment and Biology Modern “Lucky Humans” have Three Environmental Challenges

• Less Physical Work

• Fewer Famines

• Plentiful Food



The Fat Trap

Information from Bonadonna RC AJP 1990 and Jenson MD Diabetes 1989

SERUM INSULIN

LIP

OL

YS

IS

(fa

t b

urn

ing

)

5 10 15 20 250



The Fat Trap

• Our science teacher’s dilemma

• A “healthy” vegetarian diet may be her problem

• All carbohydrates were not created equal.

• Some rapidly raise blood sugar and insulin levels

• Higher insulin levels = less weight loss

• “Average” levels are too high to catch pre-diabetes.

• Hyperinsulinemia develops 3 years before “pre-diabetes”



Dietary Therapy

• Lower Insulin ü Metformin 500-1000 mg twice per

day

ü Botanical

- Berberine, cinnamon

Curcumin ,bitter melon

• Decrease appetite for sugar and starchy and sweet foods

ü Phentermine

- Phendimetrazine, Tenuate

ü Qsymia

ü Saxenda

ü Contrave

• Avoid foods that raises blood sugar and insulin

• Eat non-starchy vegetables, avoid sweet tropical fruits

• Choose healthy high fat, high fiber foods

Pharmaceutical Therapy



And Yes, Add Fake Physical Work

• Exercise drives sugar into muscle cells

• But a high insulin level blocks this effect



Patient not losing weight?

• Check that insulin level

• Take action. Avoid corn, wheat, rice, potatoes, sweet tropical fruits, and of course sugar

• Watch the fat burn

WHY YOUR PATIENT MAY NOT BE LOSING WEIGHT Warren ...

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