The link between insulin resistance and chronic disease, including dental disease.
According to the CDC, by the year 2020 there will be approximately 250 million people affected by type 2 diabetes mellitus worldwide (1). Although the primary factors causing this disease are unknown, it is clear that insulin resistance plays a major role in its development. Evidence for this comes from (a) the presence of insulin resistance 10–20 years before the onset of the disease (2, 3); (b) cross-sectional studies demonstrating that insulin resistance is a consistent finding in patients with type 2 diabetes (3–6); and (c) prospective studies demonstrating that insulin resistance is the best predictor of whether or not an individual will later become diabetic.
Dr. By Gerald I. Shulman
Cellular mechanisms of insulin resistance
Sugar is an important – and popular – part of our daily diet but how does it impact overall health and dental health?
Along with starch, it falls within the carbohydrate group as it consists of carbon, hydrogen and oxygen atoms and acts as fuel for the body. In fact, carbohydrates are our main source of energy, converted by the body to power our cells and keep us alive and growing.
However, many of us are overindulging in the white stuff, with the average adult consuming approximately 63 grams (2.2 ounces), nearly 16 teaspoons, of sugar each day. That’s over twice the recommended daily intake.
Sugar and Dental decay are correlated, with high amounts of daily sugar intake contributing to dental decay, which
For adults and kids, diets High amounts of sugar do lead to higher rates of cavities but there is more to diets high in sugar.
Find out below exactly what sugar does to your body.
Sugar in the body
When we digest sugar, enzymes in the small intestine break it down into glucose. This glucose is then released into the bloodstream, where it is transported to tissue cells in our muscles and organs and converted into energy. Beta cells in the pancreas constantly monitor the amount of glucose in the bloodstream and release insulin to control it. This means that if you consume more sugar than your body needs right away, it can be stored for later to keep your blood sugar levels constant. If your body stops producing any or enough insulin, or if your cells become resistant to it, this can result in diabetes, leaving your blood-sugar levels to rise to dangerous levels.
Periodontitis is a chronic inflammatory condition that causes tissue and bone destruction and is one of the main causes of tooth loss in adults. Diabetes is a major risk factor for periodontitis. Diabetic patients are three times more likely to develop periodontitis. There is a two-way relationship between the level of hyperglycemia and severity of the periodontal condition. It is not completely clear through current evidence what exactly causes this relationship, but it is believed to be related to the decreased immune function of the diabetic patient. Research shows that people who have diabetes that is poorly controlled are more likely to suffer from other chronic inflammatory conditions, including periodontal disease.
Patients who have insulin resistance or have a diabetes diagnosis should seek regular dental care and be screened for signs of periodontitis due to the correlative relationship between glycemic control and active periodontitis. Your Lincoln dentist can not only help you to control your periodontal condition, but can help you find ways to reduce general systemic inflammation that can impact not just the diabetes, but other inflammatory processes.
Sugar on the brain
As humans, we are programmed to love sugar. Our primate ancestors evolved to seek out sweet foods for their high-energy content to increase their chance of survival when food was scarce. Nowadays food is much more readily available, yet we still can’t get enough of the sweet stuff.
The reason for this is all in the brain. When we eat sugar, the brain releases dopamine and serotonin, the hormones that boost your mood, which then stimulate the nucleus accumbens – the area of the brain associated with reward. This is a similar process that leads to drug addiction, which is why we get those sugar cravings. Regular sugar consumption can also inhibit dopamine transporters, which can lead to you needing to eat even more sugar to get the same pleasure-reward as before. In addition, fructose, which is used to sweeten many foods and drinks, doesn’t suppress hunger hormones like glucose does, meaning your body is unable to tell when you’ve eaten enough.
Where is sugar hiding?
Watch this one:
Sugar comes in many forms but they typically have names ending in –ose. As well as glucose and fructose naturally found in fruit, vegetables, and honey, lactose and galactose can be found in milk and dairy products, and maltose in barley. These natural sugars are fine in moderation as they also come with other nutritional benefits. For example, a piece of fruit will also contain fiber, which helps limit the amount of fructose the body absorbs.
Added sugar, used to improve the taste and textures of foods and drinks, is the type that is considered unhealthy. This usually comes in the form of sucrose, or as a sugar substitute such as sucralose, saccharin, aspartame or high-fructose corn syrup (HFCS). HFCS is artificially produced from corn and used in many processed foods and fizzy drinks. To find out how much sugar is in your food, check the ‘carbohydrates – of which sugars’ value on the label.
You are showing signs of insulin resistance; What does that mean? Will you develop diabetes or can this be reversed?
Some people are genetically predisposed to insulin resistance while others may have a lifestyle history that has led to insulin resistance. Insulin is the most important hormone in our body when it comes to fat storage and breakdown. Insulin takes the carbohydrates that we eat and converts them into glycogen for energy which is stored in our liver and muscles. Once the glycogen stores in the liver and muscles are filled, the body stores any excess glucose from the carbohydrates as fat. Eating a diet high in refined carbohydrates can lead to excess fat storage on the body. There is evidence that an exaggerated insulin response to sugar is linked to several chronic inflammatory conditions besides type II diabetes like PCOS, high blood pressure, non-alcoholic fatty liver disease.
The internet is filled with information with different opinions and advice on insulin resistance and how you can control it. Is there one answer for everyone? No. Everyone has different genetic predispositions to insulin resistance. What works for one person may not work for another. For example, you may know someone who can eat whatever they want, including bread, cake and pasta, yet have perfect lab results and not gain a pound. Other people eat nothing but veggies and fruit, lean protein and exercises daily but still have “abnormal” lab results. Why is this? It is possible that no matter what a person eats, they may be genetically predisposed to metabolic syndrome, a precursor to diabetes. Metabolic syndrome includes five major signs: obesity, high blood pressure, high triglycerides, high blood sugar, and low HDL (good cholesterol).
This genetic variability is what keeps so many people working in the healthcare field so busy. Our knowledge about what causes chronic diseases and how we can prevent or reverse them changes every day.
Dr. Peter Attia is a great resource for information on insulin resistance. He is a physician and former surgeon who is passionate about the subject of increasing human longevity. Dr. Peter Attia describes insulin resistance as: an impaired response of the body to insulin, resulting in elevated levels of glucose in the blood (a key component of type 2 diabetes and metabolic syndrome). Insulin resistance often will lead to developing cardiovascular problems, obesity and ultimately diabetes.
He compares insulin to gravity. Like gravity, insulin is
In the article on insulin and gravity, Dr. Attia also posed a very good question asking, “What if our understanding between obesity and diabetes is wrong? Maybe we are fighting the war wrong—fighting obesity rather than insulin resistance?”
Medication vs Lifestyle changes
In many cases, doctors may recommend medications as well as lifestyle changes to manage or treat a condition. In some cases, medication is necessary, but why? Is taking a medication like putting a band-aid on something that we could prevent or reverse with lifestyle changes alone? Being an advocate for yourself, ask your doctor questions about what changes you can make that can enhance your treatment or eventually help you to no longer need the medication can improve the quality of your life and help to reduce the chance of further health complications from side effects.
There are thousands of posts online about the relationship between dietary carbohydrates and insulin resistance. Some of this information can lead readers to believe that those who eat a very low-carb diet can induce insulin resistance. This is not true. Low-carb diets are not necessarily a bad thing for many people, but it is important to know that it may not work for everyone. People who do high-intensity exercise or who are pregnant require more carbohydrates than those who lead a less-active lifestyle. The important thing to remember is that moderation is the key.
Although pregnant women generally have a slightly higher daily requirement of carbohydrates, if there is consumption of an excess of refined carbohydrates, this can lead to gestational diabetes which is dangerous for both mother and child.
The best sources of dietary carbohydrates for everyone are unprocessed, complex carbs found in potatoes, sweet potatoes, fruit, and rice. Bread, pasta, cookies, and potato chips are not good sources of carbs.
Still confused about what to do? What’s the bottom line about insulin resistance? Can it be reversed?
Unfortunately, there is not a one-size-fits-all recipe for good health. We can try to live the healthiest lifestyle possible, but the truth is that some people are just more prone to health problems than others. Remember that even if the health claim you read about online has worked for 10,000 other people, it may not work for you and although it may be difficult to eat the “perfect diet,” it is possible to control insulin resistance by avoiding refined carbohydrates and exercising on a daily basis.
Daily exercise does not have to be intense or difficult. Doing something simple to stay active like taking an evening walk can help release feel-good hormones and reduce stress hormones like cortisol which contribute to inflammation and insulin resistance.
Even if you aren’t inclined to be a total health nut, consistently making good choices will eventually become a habit. If we get in the habit of making good choices like eating fresh fruits and veggies and exercising, it will start to feel as natural as brushing your teeth. Make some of your favorite high-calorie foods like cheesecake or bacon cheeseburger and fries a treat rather than a part of your daily routine. When you indulge, you’ll enjoy them more.
Sticking to a healthy eating plan can seem like a daunting task for many of us who are busy with work, kids and extracurricular activities. Try to plan meals ahead and have plenty of good choices available so that it is just as quick as grabbing a bag of potato chips. It may not be possible to completely “cure” your diabetes, but is possible to control it. Changing your diet and exercising regularly have been shown to help reduce the amount of medication needed (insulin, metformin, etc).
On Dr. Attia’s website, one individual shared that his physician was considering removing his Type 2 diabetes diagnosis. He lost over 140 pounds in 500 days and now has normal lab results. He anticipated that at his next checkup, he and his doctor would review his bloodwork and potentially remove his diabetic diagnosis. How cool is that? Hard work really does pay off!
Remember that what worked for one person may not work for you, but don’t get discouraged. It is most definitely worth trying to be as healthy as possible for the quality and longevity of your life. Hopefully, you will be inspired help control your insulin resistance by making some changes to your diet and exercise habits.
About the author of this blog
Dr.Kathryn Alderman is Your Biological Dentist in Lincoln, NE
At Nebraska Family Dentistry, Dr. Kathryn Alderman is your local biological dentist serving patients at various locations in Lincoln, NE. Dr. Alderman is passionate about helping patients live healthier, happier lives and knows that having a healthy mouth can greatly impact a person’s overall well-being. Dr. Alderman will carefully review your medical history and help you treat your dental conditions using materials and techniques that will benefit your overall health. If you have concerns about older metal restorations that may require replacement or the safety of dental treatment for patients with specific medical conditions or dental anxiety, This Lincoln, NE biological dentist would be happy to meet with you and answer any questions you may have.