Do you have trouble losing weight (or continuing to lose weight or easily regain it) despite all efforts to diet and exercise? Do you seem to be hungry all the time even after a full meal or late at night? Are you sluggish or exhausted all the time and seem to have trouble motivating yourself? Are your cholesterol or triglyceride levels elevated? While unawareness of actual amounts of calories or types of foods consumed daily, inactive lifestyles, tendency to worry excessively, an underactive thyroid gland (leading to slow metabolism), abnormal adrenal function, abnormal digestion or other conditions may also exist, the underlying problem may be "insulin resistance" or the "metabolic syndrome". .

Insulin resistance (IR) is defined as a disorder of metabolism of carbohydrates (as well as fats and proteins) we ingest. Insulin is secreted by the pancreas after a meal to control the distribution of the components of the foods we eat to the cells of our bodies, especially liver and muscle, to allow them to have and utilize energy. Such cells can become dulled or "resistant" to the insulin secreted requiring the pancreas to secrete even more. This increased insulin occurs in the face of increased resistance to this insulin with marked consequences in our metabolism.

According to a 2002 Centers for Disease Control (CDC) report, an estimated 22% (about 50 million) Americans have IR. The CDC considers it a major public health epidemic because IR has been associated with an increase in serious diseases including hypertension, diabetes, heart disease, stroke and possibly some cancers. The CDC also reported in 1999-2000 that 64% of Americans were overweight.

The reasons why IR develops are not fully known, but it is strongly associated with being overweight or obese, conditions related to dietary indiscretion, genetic, hormonal and environmental factors. Stress, overwork, incorrect food combinations and over reliance on "fast" or processed foods are factors. IR increases with age and body weight and can affect any ethnic group. It may occur in even thin people and adolescents. Smoking has also been implicated.

Key features of IR include:

1. central (abdominal) obesity
2. abnormal cholesterol values (low HDL, high LDL, high triglycerides)
3. high blood pressure
4. changes in blood sugar (hyperglycemia or hypoglycemia) sometimes referred to as glucose or carbohydrate intolerance)
5. chronic inflammation of tissues and activation of the immune system
6. abnormal blood clotting
7. abnormal liver tests and "fatty liver"
8. small amounts of protein in urine (microalbuminemia)
9. gout

In early IR, blood sugar tends to be low (hypoglycemia) because of the high levels of insulin; this causes tiredness, foggy headedness, cravings, increased and hard to satisfy appetite (hunger after meals or late at night), increased urination and other symptoms. At this stage the adrenal gland compensates by secreting more cortical to keep the glucose levels up to provide energy.

Later stages of untreated IR may show continued high insulin levels and increasing resistance to it or a drop in insulin levels as the pancreas cannot keep up the demand to produce it. Both can lead to the development of diabetes because the sugars from the foods we ingest cannot be burned into energy. Fat metabolism also becomes disturbed with increased deposition of fat (increased weight) and unfavorable changes in lipoproteins (LDL, HDL, triglycerides). All these factors can increase the risk of heart disease and stroke.

Diagnosis of IR is made by laboratory tests or by suspicion in a person who is overweight, has trouble losing weight, has a family history of diabetes, abnormal blood pressure, cholesterol or liver tests. Symptoms or associated conditions may include:

1. fatigue, often profound
2. body temperature variations (hot or painful feet/limbs, burning skin, cold hands/feet)
3. muscle or joint aches, foot or leg pain
4. dizziness, headaches, snoring, chronic sinusitis
5. tingling or numb hands/feet- "peripheral neuropathy" (especially when no other cause can be found)
6. mood or sleep disorders (depression, anxiety, sleep apnea or insomnia)

Measuring a fasting insulin and glucose level or a glucose tolerance test usually confirm the diagnosis. Adrenal, thyroid gland and digestive/stool tests may also be abnormal.

The good news is IR is treatable and fully reversible (which also reduces the risk of diabetes and heart disease)! The key to treatment is weight loss and regular exercise. One study showed that just 15 minutes of vigorous walking four times per week could reverse IR. Any exercise is helpful. Exercise increases muscle mass over fat, increases utilization of glucose by muscle and other tissues and burns calories.

Diet changes are critical and are centered around reduction in total calories, change in amount and types of fat and reduction in overall carbohydrate ingestion. For a long time, it was (incorrectly) thought that weight reduction (and heart disease prevention) required mainly a total reduction in fat alone. This often resulted in increased ingestion of carbohydrates (starches) to compensate for the calories. The current USDA "food pyramid" was based on these ideas and is now being challenged by several researchers as being incorrect.

Studies now show no evidence that total fat reduction prevents heart disease or necessarily leads to sustained weight loss and also that too high a starch diet (potato, bread, pasta, rice) can lead to increased weight, IR, cholesterol problems and diabetes. Also it is now well known that not all fats are alike or bad for us. Studies now show monounsaturated (olive oil) or polyunsaturated (other vegetable oils) fats and nuts (especially walnut) actually prevent heart disease. These are best used cold (uncooked, unheated) and should be a major part of our diets. Fish and their oils are also excellent. One fish meal a week was shown to prevent heart disease in men.

Some studies and experience show carbohydrate-protein balancing (the "glycemic index" or "load") is the best way to prevent IR and weight gain. The ideal carbohydrate to protein ratio should be about 2-3:1. A typical meal (mostly starch and little protein or good fat: salads, starchier veggies alone with bread, pasta or rice) may be 5-10:1!Some people thrive on such diets; some do not.

There is a sad and unexplained monotony to most diets, an over reliance on "fast and prepared, processed food and an avoidance of fruits and less starchy vegetables (especially leafy, dark green). These are critical to micronutrient/vitamin, fiber and caloric aspects of our diets. Also, the more complex (less starchy or processed) the starch, the slower the absorption of the sugar derived from it and the less an insulin response to it, a key to treating IR.

The importance of variety in our diets cannot be overemphasized. Try different foods and food combinations. Whenever possible, eating out should be the exception, not the rule. This gives us back control over our food volume, choices, combinations and preparations. Increase the less starchy vegetables (darker greens) and lower the starchier ones (potato, rice, pasta, breads).

This relates to our fast-paced, time-pressured lives and heavy advertising pressures for many products. I think we have lost our relationship to our foods: where they originate from, how they should be chosen and prepared and just what it takes to really feed ourselves the right and bests foods for ourselves and our individual needs. All these take time (intuition, education and experience), and time is what we seem to have the least of in our world today. Take time!!!

Reversal of IR can also be aided by a variety of helpful nutritional supplements and herbals. These aid liver and muscle metabolism, detoxification of cells, increase insulin sensitivity and promote antioxidant metabolism and support cell function and energy utilization: - B vitamins (especially B5, 6, 12), chromium, vanadium, Co Q 10, carnitine, pycnogenol, plant sterols (fats from plants) and essential fatty acids (flax, borage, walnut, fish, etc.). - herbal include gymnema, bitter melon, fenugreek, guggul, devil’s club (!), jambul seeds and others.

The health food industry has conveniently designed single products that incorporate a number of these substances. Of course, our foods (the right diet!) are always the best place to obtain them!

Adrenal (cortical) and thyroid (especially T3) testing is important as these glands control energy metabolism and utilization in the body. Comprehensive stool testing can help define the degree of digestive health, a factor in how we process our foods and nutrients.