In search of factor X – Hyperinsulinemia

Hyperinsulinemia is the leading cause of obesity and fatty liver disease. What’s causing it?

Both obesity and insulin resistance can occur for the same cause known as metabolic syndrome.

Metabolic syndrome

The first information about it appeared in the 1950s when a relationship between high triglycerides and cardiovascular diseases was discovered. In 1961, Dr Ahrens showed that this was mainly due to consuming too many carbohydrates, rather than fat in the diet as expected.

Other analyzes carried out around the same time confirmed that many people with relatively low blood glucose levels suffered from severe hyperinsulinemia. This was understood as a mechanism to compensate for increased insulin resistance. In 1963 it was noticed that patients after a heart attack had elevated levels of triglycerides and suffered from hyperinsulinemia. Hypertension was linked to hyperinsulinemia in 1966. Until 1985, it was found that hypertension was largely related to an unidentified cause, which was high insulin levels.

By the end of the 1980s, all the main features of the metabolic syndrome had been identified – abdominal obesity, insulin resistance, dyslipidemia (high triglycerides and low HDL levels), and hypertension. It was first described by Dr Gerald Reaven of Stanford University in 1988 as a syndrome of unknown pathophysiology.

Criteria for the diagnosis of the metabolic syndrome

Metabolic syndrome is diagnosed when there are at least 3 of the 5 following abnormalities:

• abdominal obesity (waist circumference in European men ≥ 94 cm, and in women ≥ 80 cm) and additionally the coexistence of at least 2 of the following deviations:
• triglycerides ≥ 150 mg/dl or treatment with dyslipidemia and cholesterol
• HDL (<40 mg / dL males, <50 mg / dL females or treatment of dyslipidaemia)
• blood pressure ≥ 130/85 mm Hg or treatment of arterial hypertension
• fasting glycemia ≥ 100 mg / dL or treatment of type 2 diabetes

Each of the above increases the risk of developing cardiovascular diseases in the future. The Metabolic Syndrome identifies patients with a common group of risk factors. Although obesity is often associated with metabolic syndrome, it also occurs in approximately 25% of people of normal weight and glucose tolerance level.

Why is LDL cholesterol not a criterion?

High LDL cholesterol is definitely not one of the criteria for the diagnosis of metabolic syndrome, and its presence is caused by other causes. It is estimated that approximately 26.2% of the population in Poland meets the criteria for the diagnosis of metabolic syndrome. So it cannot be said that it is rare since about 10 million people in our country are affected by it. The metabolic syndrome increases heart disease to a large extent by almost 300%. Recent research has extended the concept of a common cause syndrome to sympathetic dysfunction, endothelial dysfunction, and increased inflammation.

Insulin resistance is considered to be the main feature of metabolic syndrome. It is for this reason that the emergence of the term insulin resistance syndrome and hyperinsulinemia is recognized as a compensatory mechanism. However, all of this does not answer the question about the cause of insulin resistance. Dr Reaven assumed that chronic hyperinsulinemia was not without blame. Hyperinsulinemia can cause high blood pressure by salt and water retention in the body. Hyperinsulinemia stimulates the synthesis of triglycerides in the liver, which are released into the bloodstream as VLDL. Hyperinsulinemia causes obesity and it was supposed to cause insulin resistance.