Which came first: insulin resistance or obesity?

Which came first: insulin resistance or obesity?

There is a consensus among the researchers that insulin resistance (inability of cells to use the glucose) is the central element of obesity and its complications. On the other hand, researchers don’t seem to agree which came first: insulin resistance or obesity. Or put differently: does insulin resistance cause obesity or vice versa?

Two camps have formed around this dilemma:

  • the traditionalists claim that obesity is the result of chronic energy surplus: we eat more than we need and we use less than we eat. The underlying notion is that obesity is caused by the lack of self-control of the obese. Once an individual is obese, insulin resistance kicks in;
  • the enlightened camp sees the chronic energy surplus as a physiological result of abundance of carbs in our diets. Too much carbs causes disruptions on glucose-insulin axis, which in turn leads to the closing of the vicious circle – insulin resistance, which is not only a risk factor in itself, but a kind of self-fulfilling prophecy. Namely, once we are insulin resistant and cells can’t efficiently use glucose, two things happen: surplus glucose gets stored to fat, while cells scream for more energy, making us de facto hungry – even after we’ve just eaten a big plate of pasta.

Investigating these topic is problematic: the study design is hard to come by without serious ethical and methodological concerns, but luckily nowadays there are other ways to find out. One of the modern techniques to do so with studying genes. Using »Mendelian randomization« and knowing what a particular gene’s function is, we can examine cause and effect in exposure to certain phenomena. For example: if a gene causes effect A and A causes B, there can be some statistical significance that we can use.

So what does that mean in terms of insulin resistance? The quantity of insulin, secreted upon ingesting certain amount of glucose, is a matter of the biological diversity of individuals, underlined by our genes. Some people will secret more, some people less insulin at the same amount of glucose.

The Clinical Chemistry journal has recently published a very interesting study, showing that obesity is linked to the gene, responsible for glucose-stimulated insulin secretion: people with the gene that causes larger insulin secretion are more likely to be overweight (Astley et al., 2018; Noakes, 2018).

Do you have the gene? Genetic tests like this are not yet easily accessible, but usually it’s not hard to know for yourself. If you have problems controlling your appetite, crave carbs, tend to gain weight fast – these are all the signs you should look for. No, these signs will not definitely confirm that you have the gene, but you should take note and consider changing your diet. LCHF / keto will most likely improve control over your appetite, diminish cravings and help you lose weight.

Which came first: insulin resistance or obesity?

ASTLEY, C.M. et al. 2018. Genetic Evidence That Carbohydrate-Stimulated Insulin Secretion Leads to Obesity. Clinical Chemistry, vol. 64, no. 1, pp. 192.

NOAKES, T.D. 2018. So What Comes First: The Obesity or the Insulin Resistance? And Which Is More Important? Clinical Chemistry, vol. 64, no. 1, pp. 7.

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