It’s All About Insulin
Illustration © D. Yael Bernhard
Some of the most intelligent, educated, and successful people I know are drug addicts. Every day they imbibe in a substance they crave, at a terrible price. Yet they keep doing it, because their erudition lies in other areas besides nutrition, and this clever drug tricks them into believing it’s harmless. Sadly, it is not.
These unsuspecting addicts are not even aware of the power this substance has over their brains, because nearly everyone around them is living the same reality. Laboring under a nationwide illusion, it’s hard to see the effects, though they’re everywhere, afflicting roughly 2/3 of Americans. Unfortunately, both the drug and its effects appear in many guises, making it that much harder to connect the dots. Only by understanding this seemingly innocent substance and its effect on human health can we recognize its manifestations.
The drug, of course, is sugar – the most widespread addiction on the planet. Its main hold on the brain is via dopamine receptors. Dopamine itself is a shape-shifter, showing up in addictive habits as varied as gambling, drinking, sexual indulgence, playing video games, watching television, surfing social media, eating pizza, and finishing off a pint of ice cream. Anything that activates the reward center of your brain may be a dopamine trigger. If you find eating it or doing it makes you want more, that’s dopamine.
Unfriendly gut bacteria also cause sugar cravings, as they thrive on the stuff. Hormonal imbalances can contribute as well, if hunger and satiety hormone receptors are blocked or malfunctioning.
Sugar-rich carbohydrates are appealing, even in their natural form. Who doesn’t love a sweet, juicy peach or a ripe melon? In their unnatural form, such as manufactured cereals, snacks, and desserts, they are engineered to be “hyperpalatable” with the use of excess sugar, salt, highly processed oils, and addictive “excitotoxins” such as MSG. The average American consumes 150 pounds of sugar per year – perhaps fifty times as much as the settlers who first populated this country.1 As our consumption of sugar has steadily increased (see my article The Not-So-Sweet History of Sugar), so has chronic inflammation and along with it, chronic disease. Six out of ten Americans today suffer from chronic disease, with another 25% afflicted by more than one chronic disease.
How does this happen? How does sugar cause inflammation? What’s the link between ice cream and immune deficiency, candy and cancer, fruit juice and fatty liver, cookies and cataracts?
It’s all about insulin.
Most folks correctly understand one of insulin’s primary roles as that which ushers sugar into cells, where it is used as energy. It functions well as long as we eat a healthy amount of carbohydrates. Current guidelines for carbohydrate consumption are grossly outdated, leading consumers to eat up to six servings per day of pasta, bread, grains, crackers, chips, cookies, cakes, and high-glycemic fruits. Prodding the pancreas to produce so much insulin may result in too much – a condition known as hyperinsulinemia. Eventually, the insulin-producing beta cells in the pancreas become exhausted, and do not produce enough. Even more dangerous, cellular insulin receptors may begin to resist it – a condition known as insulin resistance.
What happens to insulin when receptors refuse to take it in? It circulates, my friends, and breaks down into unstable molecules called reactive oxygen species, or ROS. Also known as free radicals, these unstable molecules lack an electron and look to steal them from other cells, wreaking havoc on cell membranes and damaging everything they touch. This is called oxidative stress. It’s like throwing a tennis ball in a shop full of fine glassware.
Fortunately, the body has a mechanism for repairing cellular damage – it’s called inflammation. Acute, temporary inflammation, such as a fever response to infection, is quick to act, and when its work is done, allows the body to return to a normal state. Chronic, low-grade inflammation, however, goes on and on, like a simmering flame that never goes out, continuously damaging cells and the systems they serve. Insulin resistance causes sterile inflammation – that is, inflammation not caused by a pathogenic infection – causing cumulative internal damage which may show up anywhere in the body as chronic disease. Among progressive healers and researchers, inflammation is known as “inflammaging” – as it is now understood to drive the aging process itself. Lower your inflammation, and you’ll look and feel younger, longer.
Here’s how the progression works: Flooding your body with sugar – and foods that break down into sugar, including alcohol, grains, flour, fruits, soft drinks, and sweeteners – on a regular basis leads to elevated insulin. Over time, the body becomes less sensitive to insulin and begins to resist it. Excess insulin breaks down into free radicals, which in turn causes chronic inflammation. Inflammation leads to long-term damage to the epithelial lining of blood vessels, leading to cardiovascular disease; to joints, leading to pain and arthritis; to the brain, leading to degenerative changes; to the digestive tract, leading to IBS or colitis; and to the retina, leading to the formation of cataracts. These are just a few examples of the many ways insulin resistance and chronic inflammation affect long-term health. These conditions are largely preventable and to some degree reversible, simply by lowering insulin and reducing inflammation. The further upstream you start, the better the downstream results.
The opposite of insulin resistance is insulin sensitivity. This is the desired goal – to encourage your receptors to open up and let insulin in so it can do its job and deliver glucose into the cell to produce energy; and to clear insulin from the bloodstream as quickly as possible, reducing oxidative stress and inflammation.
Insulin sensitivity is one of the hallmarks of “blue zones” around the world, where a high percentage of people live to the age of 100. Remarkably, not only their lifespans but their healthspans extend far beyond the global average, enabling them to remain active and lucid members of society into their tenth decade and beyond.
Yet here in America, where the average lifespan is steadily shrinking, to forsake sugar is to swim upstream socially, or even risk becoming a social outcast. It takes a powerful act of will – not to quit sugar, for the addiction may be broken in just ten days – but to push your way past the pressure to conform to a deeply entrenched climate of complacency. Recently I was invited to a lunch gathering at the home of a couple I know. The husband is a retired nutritionist, and his wife is also quite savvy about diet and health. They served a delicious salad as big as a bird bath, with a festival of colorful veggies and edible flowers. Everyone enjoyed it together with hummus and cheeses. Then one of the other guests presented the dessert she had brought: a large babka – a rolled pastry made from yeasted dough with a filling of chocolate and nuts. Traditionally from Jewish communities of Eastern Europe, this popular dessert is sometimes eaten for breakfast (the thought of which makes me shudder). The woman proudly placed it in the center of the table, then went into the kitchen for plates.
To me, the mass of sugar, gluten, and who knows what other chemicals on the table was not at all appealing. It wasn’t hard to resist this “treat,” as my belly was already satisfied, and I no longer have sugar cravings. Baked goods such as this don’t even look like food to me. It might as well have been a sponge, or a piece of wood.
“That looks about as appetizing as this chair,” I said to my host.
“Please don’t eat my chair,” she said wryly. “We need it.”
When the babka was passed around, I politely declined, claiming I’m allergic to sugar and gluten. Aren’t we all?
“Insulin resistance is the single biggest problem facing humanity today in terms of our health, its economic cost, its social impact, its cognitive impact . . . the list goes on.”
– Dr. Mark Hyman
Another lesser-known but vitally important role of insulin involves fat storage. As a signaling hormone, insulin is responsible for turning fat storage on and off. Simply put, as long as sugar is available in the bloodstream, insulin lets your body know easy fuel is on hand. Fat-burning is therefore turned off, and excess sugar is stored as triglycerides – that is, unhealthy cholesterol. This fat is typically stored around the belly, where it acts as a hormonal organ itself. Visceral fat cells produce inflammatory cytokines, spew out excess estrogen, and lead to more insulin resistance. When your body is in fat-storage mode, your metabolism slows down and your appetite increases.
Blood glucose tests don’t show this trajectory until you’re well on your way toward diabetes or obesity – or both, known as “diabesity." Not until you already have insulin resistance will your blood sugar become elevated. Hemoglobin A1C tests, the standard in mainstream medicine, only show an average of blood sugar over the course of three months, not daily spikes of excess insulin or fasting levels. Fasting insulin tests are an important indicator, and may be easily acquired. Most insurance companies cover this blood test. Just ask.
Changing your diet isn’t the only way to lower insulin. Your muscles are covered with insulin receptors that are eager to receive fuel. But in order to activate these receptors, the muscles must be used. Resistance or weight training is an especially effective way to increase insulin sensitivity. Open those receptors, and your insulin level can drop significantly.2 Be sure to keep your electrolytes up while exercising. Salt water with a squeeze of lemon will keep your metabolism humming!
Other hormones, such as adiponectin, act upon insulin as well. Adiponectin is produced in the gut, and helps control insulin secretion. Peptides (short-chain amino acids) known as GLP-1 (glucagon-like peptide 1) also have a regulatory effect on insulin. Known as “the appetite whisperer,” this is also produced in the gut – not by you, but by your gut bacteria. GLP-1 is the same compound found in a much higher dose in weight-loss drugs such as Ozempic and Wegovy. Like the drug, GLP-1 produced naturally in your gut has an influence on appetite, cravings, and satiety – but its natural form doesn’t cause the troubling side effects that come with the drug, nor does it cost over $10,000/year at the expense of taxpayers. Certain probiotics3 as well as bitter foods such as arugula, dark leafy greens, and green tea stimulate the production of GLP-1. Prebiotic foods such as onions and apples, sunchokes, artichokes, dandelion greens, jicamas, and cooked chilled potatoes also feed beneficial gut bacteria, which in turn boost GLP-1. For these reasons and more, a healthy microbiome is crucial to insulin sensitivity.
Enzymes also catalyze the production of insulin, particularly amylase, found in saliva. In response to the taste of something sweet in your mouth (including artificial sweeteners), amylase signals the pancreas to release insulin. Nutrient-sensing pathways such as this tend to become less efficient as we age, and also decrease within the course of a day. Your insulin sensitivity is greatest in the morning, and diminishes toward sunset. For this reason, it’s best to eat your highest-carb meal in the middle of the day (not for breakfast), ideally shortly before exercising, even if just a short walk.
Salt plays a role in insulin levels, too. Low-sodium diets may cause a drop in blood volume, causing the kidneys to produce salt-retaining hormones. This creates a whole cascade of effects, including reduced insulin sensitivity. Conversely, as insulin levels drop, salt is excreted through the kidneys. Unlike sugar, salt is an intrinsic need for survival; you cannot train your tastebuds to crave less.
“We know that low salt intake leads to insulin resistance and increases insulin levels, and insulin resistance causes glucose to build up in the blood instead of being absorbed by the cells for energy, triggering a long, problematic chain of physiological events – excessive hunger, overeating, greater fat storage in your fat cells, and internal energy crisis.”4
– Dr. James Nicolantonio
There’s a quiet revolution simmering in the world of nutrition about salt. We may have been completely misled about the benefits of salt restriction.5 More about this complex and fascinating subject in a forthcoming article. For now, all you need to know is this: the less sugar and starch you eat, and the lower your insulin, the better.
As recently as 100 years ago, diabetes was a rarity – and was rarely survived. Today almost a billion people have diabetes – a condition that is both preventable and reversible – at a cost of over $300 billion per year, or 1 out of every 4 U.S. healthcare dollars.6 Diabetes is also associated with numerous other health conditions, including cardiovascular disease, impaired wound healing, neuropathy, blindness, Alzheimer’s disease, and more.
Imagine putting all this money to better use – such as free gym memberships, exercise equipment, and educating the public about sugar and insulin!
Preserving insulin sensitivity is a matter of lifestyle choices. It’s tempting to ride the current of commonly-held beliefs, but stopping to think about where you’re headed is worth the effort. Comparing the amount of sugar you eat to what other people consume probably won’t serve your health goals. To break this addiction, think like a non-conformist. It’s liberating to forge your own path, and beneficial to others to be a positive role model. Swimming upstream now may save you from drowning in health problems later. A few facts to strengthen your resolve:
• Sugar inhibits DNA repair and the expression of longevity genes. It slows down autophagy, the process by which the body rids itself of dead and dying cells.
• Sugar feeds cancer cells and suppresses your immune system – specifically killer T-cells – and increases angiogenesis, the process by which tumors develop a blood supply to enable their growth. The standard PET scan detects cancer by injecting radioactive glucose into the bloodstream, because sugar goes straight to cancer cells. This shows up on the ensuing image scan.
• Sugar is addictive. For our early ancestors, this was a survival mechanism for storing fat. But sugar was eaten much more sparingly in ancient times, in fruits that were much more fibrous, and honey that was hard to come by.
• Sugar = profit. Food manufacturers use the addictive nature of sugar to manipulate consumers, hiring “craving experts” to generate “heavy users.” Their goal is to hijack your brain with sugar, salt, and fat to make FLS (food-like substances) that maximize consumption of their products.
• Sugar causes inflammation in the brain, causing or contributing to depression, anxiety, behavioral issues, cognitive decline, Parkinson’s disease,7 and even aggression.
• Fructose, the sugar found naturally in fruit, honey, and table sugar, requires extra energy to be digested, may interfere with appetite-regulating hormones, and may contribute to leaky gut and IBS.
• Liquid sugar is especially harmful. Fruit juice and sweetened beverages are rapidly absorbed, causing insulin to spike. Soft drinks and beverages sweetened with fructose or corn syrup may lead to non-alcoholic fatty liver disease (NAFLD), which may necessitate liver transplant – tragically, even in teenagers.
• Viruses, yeast, and unwanted bacteria also thrive on sugar, including those that cause tooth decay.
• Environmental toxins such as BPA plastics and arsenic can block endocrine receptors, causing insulin to malfunction and leading to diabetes. Avoid drinking and eating from plastic dishes and containers, especially cheap, pliable water bottles.
On the positive side, lowering insulin and maintaining insulin sensitivity brings all the rewards of reduced inflammation: clearer vision, freedom from migraines; smoother hormones; stronger teeth; diminished cravings and appetite; pain-free joints; easier digestion; lower cholesterol; healthier skin; reduced risk of cancer; improved immunity; efficient liver function; and of course, better blood sugar. In terms of long-term health, insulin sensitivity just might be your most precious asset. When inflammation recedes, all your cells function better. And when the tide of awareness about insulin sensitivity finally begins to turn, our whole society will be healthier, our economy stronger, and our relationships and families happier.
One consumer at a time, it’s already happening.
Swimming upstream makes you stronger. You’re not only saving yourself, but setting a good example for others. Young people especially need role models for building a foundation of good lifelong habits. They deserve a chance to be healthy, and so do you. It’s never too late, or too early, to start.
To your good health –
Yael Bernhard
Certified Integrative Health & Nutrition Coach
Have you seen my other Substack, Image of the Week? Check it out here, and learn about my illustrations and fine art paintings, and the stories and creative process behind them.
Yael Bernhard is a writer, illustrator, book designer and fine art painter with a lifelong passion for nutrition and herbal medicine. She was certified by Duke University as an Integrative Health Coach in 2021 and by Cornell University in Nutrition & Healthy Living in 2022. For information about private health coaching or nutrition programs for schools, please respond directly to this newsletter, or email dyaelbernhard@protonmail.com. Visit her online gallery of illustration, fine art, and children’s books here.
Information in this newsletter is provided for educational – and inspirational – purposes only.
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Erratum: the recording of this article contains an error, stating that all hormones are proteins. That is incorrect. Insulin is a form of protein.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235686/
https://pubmed.ncbi.nlm.nih.gov/33820962/
Nicolantanio, Dr. James, The Salt Fix, Harmony Books, 2017, pg.94. Dr. Nicolantanio is a cardiac research scientist and Doctor of Pharmacy who is renowned for his ground-breaking research on salt.
Ibid, pg. 72
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9370710/