Canaries in the Mine

Chalk up another important study the media isn't talking about...The November issue of Diabetes Care published Trends in Hyperinsulinemia Among Nondiabetic Adults in the U.S. which found the mean fasting insulin of non-diabetic adults rose approximately 5% from the NHANES III survey in 1988-1994 to NHANES 1999-2000.

The researchers concluded in the abstract "In parallel with the obesity epidemic, concentrations of fasting insulin and prevalence of hyperinsulinemia have increased remarkably among nondiabetic U.S. adults."

As the researchers noted, focusing on fasting hyperinsulinemia has two advantages:

• it is as good a surrogate estimate of insulin resistance as are various combinations of fasting insulin and glucose concentration such as homeostasis model assessment or quantitative insulin sensitivity check index.
• of greater clinical relevance is the pathophysiological role that hyperinsulinemia plays in the development of the abnormalities and clinical syndromes that occur more commonly in insulin-resistant subjects. Thus, quantifying the changes in fasting insulin concentration over time provides information regarding both the increasing prevalence of insulin resistance and the potential clinical consequences of this phenomenon.

Put simply - we have a problem in the United States; if it is not reversed it will mean a higher incidence of chronic degenerative disease in our population in years to come.

The researchers provide a laundry list of what hyperinsulemia and insulin resistance is associated with in terms of health outcomes "increased risk of type 2 diabetes, coronary heart disease, essential hypertension, congestive heart failure, polycystic ovarian disease, nonalcoholic fatty liver disease, and cancers of certain sites such as prostate, colon and rectum, and breast.

These chronic diseases are major causes of death in the U.S. and other regions in the world. Furthermore, the burden of these chronic diseases has been growing in the U.S. and worldwide. Rapidly increasing trends in insulin resistance and compensatory hyperinsulinemia, if not properly controlled or altered, may predict adverse future courses of many health conditions that are linked to insulin resistance."

I would have liked to see a more thorough discussion in the full-text about the changes that have occured concurrently with these findings, but the researchers only noted that "[t]he alarming increase in hyperinsulinemia, particularly among groups with a lower prevalence of insulin resistance, such as young adults and non-Hispanic white women, underscores the urgent need to address the root causes."

No surprise the assumption remains that the population is getting fatter because we eat too much and exercise too little - "Because the major contributing causes of insulin resistance, such as obesity, poor dietary intake, and inadequate physical activity, are modifiable, clinical consultation and public health campaigns aimed to improve these health behaviors are needed."

As I've noted previously, it's more than just the calories that are causing our increasing waistlines, alarming rates of diabetes and other diseases, and continued decline in overall health. Until we address what is causing the alarming increase in hyperinsulinemia we're not going to solve the problem.

To be sure, the problem is our diet, but it's not the usual suspects - it's not the calories and it's not the saturated fat. It's what we're avoiding in our diet these days!

The researchers allude to the assumption that it's simply a matter of eating properly, but this completely ignores the fact that a higher increase in the prevalence of hyperinsulinemia was found in men, who the data show, ate less calories in 2000 than they did in 1994 (2618 vs 2666). Not only that, but the 2000 data also showed men ate less fat as both a percentage of calories (33.9% vs 32.1%) and in absolute grams (100g vs 93g); less saturated fat as both a percentage of calories (11.3% vs 10.8%) and in absolute grams (33.5g vs 31.5g); and ate a similar intake of carbohydrate (321.25g vs 320.7g) and slightly less protein (102.6g vs 97.5g).

The fact is, in the NHANES 1999-2000 men ate closer to the dietary recommendations than at any previous period surveyed, yet the prevalence of hyperinsulinemia increased more in men than women (38.3% vs 32.1%) while their diet was supposedly improving. Add to this, even with the slight decrease in calories, the men also got fatter - something explained by a chronic state of hyperinsulinemia and insulin resistance.

In 2002, according to the World Health Organization (WHO) data, 72.2% of adult men (age 15+) in the United States had a BMI greater than 25.

So what's going on?

I've said it before, and I'll say it again - our focus on macronutrients as a percentage of our diet is wrong; our obsession with reducing saturated fat is wrong; and our unwillingness to let the data really tell us what is wrong is going to be our undoing.

Folks, the answer is right in the data itself - if only the researchers would step back and look at it without preconceived assumptions about what we should eat, they'd be able to see the glaring and obvious changes we've made in our diet since at least 1970 that are making us fat and sick.

We're eating too much sugar, too many refined carbohydrates and not nearly enough quality protein.

Ahhh, yes, protein.

I write a lot about protein, don't I?

The reason is that it's not just protein per se that we require, but specific amino acids from foods rich with protein. In fact, the very foods we are told to limit and/or avoid in our diet - eggs, beef, lamb, whole milk and dairy products made from whole milk. We're repeatedly told these foods have too much saturated fat and cholesterol - that we can get our protein from other foods, plant based foods, just as easily.

What we're not told is the additional cost of calories to actually consume enough amino acids, in the amounts we require for those considered "essential," if we're eating plant-based proteins instead of animal based proteins!

For example, two eggs will cost you 142 calories and provide 12.5g of complete protein, that is it has the correct amount of essential amino acids for each gram of protein consumed.

Want the same 12.5g of protein from a plant-based source?

A slice of whole wheat bread costs you 75-calories and provides 3.1g of protein. It's also not a complete source of protein since it has a limited amino acid - an amino acid that isn't high enough to provide enough to complete the ratio needed for "complete" protein. So, you need to add another food with that limited amino acid, like peanut butter. So then, two tablespoons of peanut butter will cost you another 188-calories and provide 8.03g of protein. It too is a limited protein - lacking enough of a different amino acid than the bread, but together they work to provide enough of the amino acids needed. But, also important here - combined they also cost you 263-calories for that 11.3g of protein.

You've now eaten more calories and less protein - 121-calories more, 1g less protein.

Hey, you have eaten less saturated fat and cholesterol - but more carbohydrate, which means you need more insulin to lower your blood sugars as they rise with more carbohydrate.

And, still the researchers are trying to understand why there is an increase in hyperinsulinemia in the adult population? Why we're getting fatter by the year? Why we're seeing more diabetes and complications of high blood sugars and insulin?

Good grief - it's right there is the data!

Our overall diet is WRONG for our metabolism, courtesy of the dietary guidelines of the last thirty years that have persisted in telling us to limit animal foods, eat more plant-based foods and limit cholesterol and saturated fat.

We need to re-appreciate the role of protein in our daily diet - specifically complete protein sources. Until we do we're going to continue to see alarming increases in obesity, insulin resistance, hyperinsulinemia, and diabetes; and watch as our children are afflicted younger and younger.

We are simply not designed to eat the diet recommended; and now, after thirty odd years those recommendations are haunting us - mocking us as we reach for yet another bean burrito or whole grain cereal and skim milk in the mistaken belief it's all about calories in and calories out, making sure we don't eat too much saturated fat and choose more plant-based foods.

Like the canaries in the mine, slowly dying in the presence of odorless but harmful gases, we're slowly dying in the presence of seemingly logical yet harmful dietary recommendations. All the researchers can keep repeating is eat less and move more; while encoraging us to eat more more whole grains, more fruits and vegetables, more skim milk and non-fat dairy, more beans, more soy and limit saturated fat by eating less meat.

Millions of Americans are consciously trying to lose weight and eat a better diet - the data tells us they are indeed trying to and succeeding in reducing fat and calories; it also tells us that in the process of doing this, they're eating less protein and along the way, choosing incomplete sources of protein, thus they're slowly bankrupting their health and well-being for the long-term.

Let's not forget, the more you weigh, the more protein you require each day. So before you jump in with both feet to a diet that restricts your calories and is based on the dietary guidelines - remember this - doing so is going to significantly reduce your protein intake.

Just do the math.

If you weigh 250-pounds, you require (as per the IOM dietary reference intakes) a minimum of 90.9g of complete protein each day. Let's say you're eating 2,500-calories a day with 16% of those calories from protein - then you're eating about 100g of protein each day right now - pretty darn close to what you require each day and most likely just about right when you consider you're eating protein from many different sources, both complete and limited.

Go on a diet based on the recommendation for 1800-calories a day, with 30% fat, 55% carbohydrate and 15% protein, your protein intake just dropped to 67.5g a day - inadequate according to the IOM requirements for protein intake - in fact, you'll be missing your protein requirement by 26% each day.

Now consider this - until you reach a body weight of 185-pounds (lose 65-pounds) that level of protein intake will continue to be chronically inadequate - all the while forcing your metabolism to work with less than it requires each day. We're not talking calories here - we're talking about the protein - the basic building blocks of every cell in your body and enzymes, hormones, immunoglobulins, neurotransmitters, nutrient transport and storage compounds and cell membrane receptors. How long do you really think your body will want to try to function at such a significant metabolic disadvantage?

And researchers are stumped as to why we're growing fatter and sicker?

It's right there, staring us in the face, in the data.

Eat your protein!