The best feature of my exam room at Wellness Garage the glass "white board" that I inherited and repurposed from the gym that used to occupy our space.
Many times per day, I find myself drawing the same diagram:
or more neatly drawn and shared with our Diabetes Reversal Group:
I have written about Insulin Resistance before:
Insulin resistance is, in my opinion, the single greatest health issue of our time, and is increasing at epidemic rates.
When I review the mental model for insulin resistance with our members here is a quick summary of what I share:
Metabolic health is one of the most important drivers of optimal health.
Weight gain and metabolic health are tightly related: poor metabolic health leads to increased fat which further worsens metabolic health.
Dysfunction in metabolic health manifests as insulin resistance - the process where the pancreas must release higher and higher levels of insulin in order to maintain blood sugars.
Insulin resistance can happen in multiple organ systems: muscle, fat, liver as well as the pancreas itself.
The initial phase of insulin resistance is marked by normal blood sugar levels but increasing insulin levels - the simplest biomarker for this is the TG/HDL ratio which generally increases with hyperinsulinemia.
By the time the fasting blood sugar becomes abnormal - insulin levels are often 2-3 x normal - at the same time approximately 50% of the pancreatic beta cells are no longer functioning. In most people it takes 10 -15 years to reach this point.
This marks the beginning of the second phase of insulin resistance, that of decreasing insulin production from the pancreas, and mildly abnormal blood sugars. We call this pre-diabetes.
Type II Diabetes is diagnosed when fasting blood sugars are greater than 7.0 mmol/L.
At this point, pancreatic beta cell function has been reduced over 80%.
Insulin resistance is a major risk factor for cardiovascular disease, cancer, dementia, liver failure, kidney failure in addition to being the cause of Type II Diabetes.
Risks for insulin resistance include: age, genetics, obesity - especially visceral obesity, sedentary behavior, stress, poor sleep and of course poor nutrition.
I will be blogging more on this in the future as we prepare to digitize our Diabetes Reversal program.
In the meantime, if you have Type II Diabetes, pre-diabetes, metabolic syndrome or insulin resistance (and you live within driving distance of our clinic in White Rock), you may be interested in our Group Diabetes Reversal Program
For too many people with osteoarthritis (OA), life becomes a painful exercise in waiting for surgical joint replacement
Mild to moderate symptoms from OA are often described as “wear and tear” and people avoid activity and exercise, take pain meds and learn to live with the pain until it gets so bad that they meet the criteria for joint replacement.
This “usual care” paradigm is beginning to change.
Increasing evidence shows that there are a number of strategies that will improve pain from OA:
Targeted exercise has been pioneered by the Danes who have shown that a 6 week program teaching specific neuromuscular exercises can result in significant changes even 1 year after the program:
The benefit of these targeted neuromuscular exercises can even provide benefit for people with severre osteoarthritis.
Perhap the most interesting research from Denmark, was the landmark randomized double blind study of total knee replacement vs a comprehensive lifestyle approach.
In this study people were randomized to either a total knee replacement followed by a 12 weeks non-surgical lifestyle treatment program OR the 12 week non-surgical treatment program alone. This program consisted of five interventions: exercise, education, dietary advice, use of insoles, and pain medication.
Not surprisingly, the outcomes showed that the group that received surgery followed by non-surgical lifestyle treatment had better function and less pain that the group that did not receive surgery.
What was surprising was that 74% of the group that received non-surgical lifestyle treatment did pursue surgery in the one year follow-up.
In other words, a 12 week lifestyle program was enough for people to avoid or at least significantly delay surgery (and the potential adverse effects of major surgery).
This pioneering Danish work has been developed into a program called Good Life with Osteoarthritis in Denmark (GLA:D® Hip and Knee Osteoarthritis Program) and brought to Canada through the Canadian Orthopaedic Foundation in partnership with Bone and Joint Canada.
Developing a personalized, multifaceted lifestyle strategy to prevent and reverse symptoms related to osteoarthritis is a key component to the Wellness Garage approach to Vital Longevity.
Dr. Brendan Byrne