I had been fit, healthy and full of beans when I moved to the UK, more than 20 years ago. In just 2 years I felt lethargic and had frequent episodes of brain fogs. This had negative impact on my work as a doctor.
My mind had become completely obsessed with food: I was hungry all the time and thought food might boost my energy. I was in and out of the doctors’ mess for buttered toast and had frequent trips to the hospital shop for chocolate bars and fizzy drinks. I gained 30 kg in weight (from 67 to 97Kg).
I was concerned about my health, but no help could be offered. The GP was satisfied since my routine blood tests came back as normal. A referral to a hospital consultant also could not find anything wrong with me. I continued on the slow downward spiral until the day when I shifted from being a very busy doctor to a very sick patient, within just few minutes.
I was covering the medical emergencies on a cold December night. It was busy: beside a steady flow of acute medical patients we had to attend three crash (cardiac arrest) calls, within the hospital. Just before we finished with the third I heard a junior colleague saying: “Dr Ibrahim do you want to use your asthma puffer (inhaler), because you are very wheezy?” That feedback was the first clue that I was going through a serious medical problem. Within few minutes my breathing become laborious and my colleagues had to take me immediately to the radiology department. They were shocked to see my windpipe was kinked like a “starter handle” due to severe compression on the neck.
I was very lucky to be in the hospital. I had ruptured thyroid cyst; complicated by massive bleeding that compressed my windpipe to near suffocation. I felt much better after urgent surgery, during which most of my thyroid gland was removed. My family visited and stayed around until late in the evening.
At midnight exactly, I deteriorated again with severe asthma-like symptoms. Seeing the surgical house-officer I asked him to remove my surgical stitches immediately in the ward, before he call his seniors. Those were my last words before I went into a deep coma.
I woke up 5 days later in the intensive care unit with the tube still in my windpipe saying to myself, “this is not good enough.”
Apparently I had another bleeding into the surgical wound evacuated under general anaesthesia. I deteriorated further following the second surgery and was hence admitted to the intensive care unit. I was on a ventilator and when I woke up my vital signs were poor: pulse was slow at 30 and the blood pressure was low at 70/30. It took several days before my signs normalised.
To reflect on reasons behind my health deterioration when I moved to the UK.
I had been working long, anti-social hours in the NHS, my diet and lifestyle were poor: processed food from the vending machine and very unhealthy food from the hospital canteen. My stress levels were through the roof and I wasn’t sleeping well, besides a sedentary lifestyle. This resulted in 30 kg weight gain together with symptoms of lethargy, food craving, brain fogs and persistent hunger. I later became short of breath and developed arthritic knee pain. I was so unfit that I could hardly walk the half mile from my home to the train station. I had to get taxis everywhere.
I would assume that ‘pro-inflammatory’ food such as high fructose corn syrup (HFCS) in soft drinks and soda, refined carbohydrates in biscuits, trans fat in fast food, set a full-blown inflammatory response throughout my body. This usually shows up as raised inflammatory markers such as CRP, IL 5, IL 8, TNF-alpha.
Inflammation blunts your insulin sensitivity: You are less responsive to the action of insulin that opens the door for sugar to enter your cell. As a result, your pancreas compensates by producing more insulin. The hyper insulin state results in multiple serious clinical sequels.
Insulin, the fat storage hormone, leads to accumulation of fat in your body and hence obesity and becoming overweight. It stimulates arterial cells to divide and can result in narrow arteries and high blood pressure. Again cell division is the underlying cause behind many cancers. It also results in polycystic ovary syndrome (PCOS), with excessive body hair and infertility, in women.
The pancreas keeps pumping more insulin in order to keep blood sugar steady, within normal limits. Inevitably the compensatory mechanism fails at some stage and blood sugar start to rise steadily to pre-diabetic levels and later to diabetes.
Changing from being insulin sensitive to insulin resistant takes time. It might be many years that separate a pre-diabetic state from full-blown diabetes. Without having the diagnostic power to identify insulin resistance early we are going to miss a great opportunity to prevent conditions like diabetes, hypertension or even cancer.
I am sure you would think that I was very angry when I realised that both my GP and the hospital consultant that saw me missed the diagnosis of insulin resistance!
I agree, I was angry but had a lot of sympathy with my doctors of quarter a century ago. Insulin resistance was not fully understood at that time. They didn’t ask for the right test that would discover this condition early. Since the hospital protocol allow for two tests only: blood glucose (BG) and haemoglobin A1C (HbA1C) and both remain normal until late.
The only marker that reveals the diagnosis early is your ‘fasting insulin’ level. With insulin resistance your pancreas produces more insulin, to compensate for the poor response. As the condition worsens, insulin level rises progressively to peak levels.
Reflecting back on my past medical history, I felt I was let down by the system as my insulin resistance wasn’t discovered early enough to prevent me going through two surgical operations and life threating complications. Early diagnosis of insulin resistance would also prevent pre-diabetes, diabetes, high blood pressure and cancer in many other people.
I developed insulin resistance not only because of the junk food and drinks I consumed from the vending machine but also from the unsociable hours shifts and associated sedentary life. Stress is also a key factor in developing insulin resistance.
We mount a stress response if faced by real or imagined danger, such as being chased by a tiger. This put your adrenaline and cortisol levels high to enable you to fight or flight. During the process energy is diverted to be stored as belly fat (strategic reserve for the impending war). If you suffer from chronic stress this not only makes you insulin resistant, but can also set the stage for a wider range of diseases such as obesity, diabetes and heart diseases.
I was lucky that my insulin resistance ceased to cause problems beyond the bleeding thyroid cyst. But I am sure I had slipped into a pre-diabetes state that I battled with for some time, following the thyroid surgery.
Despite being a doctor, I didn’t have a clue about what to do to sort out insulin resistance. This was due to lack of knowledge and absence of clinical guidance: Conventional medicine does not recognise the continuum between disease and normality. I had to embark on trial and error until eventually came to realise that the solution rests on two interventions: a high fibre diet and regular exercise.
Everyone knows fibre is important for bowel function: fibre makes you regular. Some assume fibre is a waste product of food and hence waste of time. Fibre is the missing element in our modern diet that contains 15 gram per day compared to 100 gram in the cavemen’s diet.
Fibre is abundant in fruits, vegetable, whole grains and legumes. Available in 2 types: soluble and insoluble fibres. Soluble fibre slows down absorption of glucose and fats and hence results in a slow insulin response. It is fermented by the friendly bacteria in the colon to produce short chain fatty acids that nourish the colon wall and protect against cancer. The insoluble fibres consist of non-glucose carbohydrate such as cellulose. It is a bulk-forming agent that speeds up passage of food through the gut.
You need to have a mixture of the two types of fibres in order to reap the full benefits. You find soluble fibre in oats cereals, apples, flaxseed, lentils, cucumber and berries. While insoluble fibre exist in whole wheat, nuts, celery, carrots and dark leafy green vegetables.
Exercise has a great impact on your health. Aerobic exercise such as walking, running and swimming improves your insulin sensitivity, speeds up your metabolism and helps you burn more fat. However muscle strength training increases your muscle mass that acts like a sponge to suck up energy to meet their increasing demands. This prevents obesity and other weight related health problems.
Studies have also confirmed that Alzheimer’s dementia is due to insulin resistance of the brain: the brain cells become numb to the effect of insulin and hence lose their primary energy source. This is recognised clinically as type 3 diabetes. On these basis a ketogenic diet (high fat) was found to have great benefit.
In summary, insulin resistance is a very common condition that puts people at risk of serious diseases such as diabetes, heart disease or cancer. It is still not widely diagnosed and conventional medicine still focuses on testing for blood glucose that remains within normal limit until very late.
Insulin resistance symptoms usually presents with subtle symptoms such as general tiredness, brain fogs, food craving and frequent hunger. It leads to excessive weight gain and affected people may have dark spots on their armpit, neck or face, called acanthosis nigricans.
You should insist on full investigation, if you think you are suffering with this condition. This should include fasting glucose – glucose 2 hours after a glucose meal – and haemoglobin A1C (reflects control of glucose level over the last 3 months). These tests are available on the NHS.
It is very important to have a fasting insulin level – the most sensitive marker – available in private labs in London. You may also need to have specialised tests that reflect more disease risk and help to monitor your progress – available in giant US labs.
Insulin resistance is manageable by a combination of a high fibre diet and regular exercise, and to observe a healthy lifestyle. You may also need to explore the underlying genetic or metabolic causes and resolve them.
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