Previously I established a model of the progressive loop that is insulin resistance:

In the presence of both elevated lipids and elevated blood sugar & insulin, the cell becomes insulin resistant. This allows the cell to switch from its normal mode (preferentially dealing with blood sugar) to a mode in which it ignores that elevated blood sugar so that it can deal with elevated fat.
Visualizing this a little differently, we see the inputs and outputs of the cells operating as a progressive loop:

At this point we have an understanding of the internal factors that drive insulin resistance: elevated lipids and elevated blood sugar/insulin combine to drive an insulin resistant state. Knowing this, our task today is to think through what external factors may be driving the elevation of these internal factors – that is, our task is to think through how factors in the environment, along with our decisions for how we interact with these environmental factors (i.e. our actions), affect the internal factors described above. If we understand what these (relatively) controllable factors are, then we can take action to avoid this dysfunction and instead maintain our body within a state of metabolic homeostasis.
- Our first task today is to consider the potential dietary changes that could be implemented to address this pathophysiologic state.
- Our second task is to acknowledge other factors that may be contributing to these pathways, including our routine behaviors and mindsets.
Understanding how dietary factors drive the insulin resistance progressive loop
Given the simplified version of what is a complex pathway as shown above, let us examine how a typical modern, industrialized meal may drive the progression of insulin resistance. To do this we will take a look at some typical food items, beginning with common industrial foods.
The consumption of a typical modern meal (e.g. a sandwich, pizza, or burger) results in the flooding of fat and glucose into the bloodstream.
The consumption of a typical modern, industrial meal results in the release of both fat and glucose into the bloodstream. That energy has the potential to travel to storage (glucose stored as glycogen in liver or muscle; fat or glucose stored as fat in adipose tissue) or to be utilized as fuel by the cell (oxidation via the mitochondria).
Remember, as blood glucose levels rise, insulin is released to signal to the body to take care of the rising glucose levels. The result is a pro-storage signal resulting in this energy being driven towards storage. Meanwhile, the mitochondria are working hard to burn off glucose, which means that fatty acid oxidation comes to a halt. Furthermore, the liver is busy taking in glucose and fat and exporting both of these in VLDL particles (particles that ship fat around to other parts of the body).
Notice a few key points here:
1. Fat enters a system with elevated insulin.
2. This happens because, in the case of these modern meals, fat enters the body alongside refined carbohydrate.
3. For the internal state of the body, this means: a state of elevated blood glucose + elevated insulin + elevated blood lipids
Which we know drives the insulin resistance progressive loop when done consistently.

That was a lot of information at once, so let me recap: the modern meal almost always consists of a mix of refined carbohydrate (e.g. refined grain) and refined fat (e.g. vegetable oil). When this food enters the body, it is quickly metabolized and sent into circulation causing elevated blood glucose (which in turn causes elevated insulin) and elevated blood lipids. This combination (elevated blood sugar + insulin + elevated blood lipids) drives insulin resistance.
This pathway is key, so let’s look at it one more time from a slightly simplified view:
When this is done consistently (e.g. with 3-5+ meals/snacks each and every day), that adipose tissue starts to reach capacity, at which point fat begins to leak back out into the bloodstream. Bonus: remember the mechanism here?
The result is an overflow of lipid in the bloodstream, which as we know, ends up as excess lipid being exposed to other tissues such as the muscle and liver, which can then drive insulin resistance in these tissues.
Thus, we have one clear take away from this brief walkthrough: when we consume modern, industrial meals – meals which are high in refined carbohydrate and contain fair quantities of fat – the body is flooded with elevated blood lipids and elevated blood sugar (and thus, elevated insulin), which forces cells to “choose” between taking care of fat or carbohydrate first. When done consistently, this behavior drives the progression of insulin resistance.
One important detail worth understanding, yet one that I am going to skip over for now – Is it necessarily one macronutrient or another that is at fault here? Or, is it the combination of refined carbohydrate alongside excess fat?
For today’s purposes – that is, the purpose of getting you introduced to addressing insulin resistance in your own life – I recommend focusing on the well-established facts: it is the combination of elevated lipids and insulin/glucose that drives this pathophysiologic loop. More detailed explanations of dietary implications for insulin resistance can be found over on the Reprogram Your Diet Page. For now, let’s continue examining external inputs by switching gears to other types of environmental inputs.
From our diagram above, we see food entering the bloodstream from where it can go to storage (adipose or glycogen), liver (conversion to fat or glycogen storage), or oxidation (mitochondria). We began by discussing how incoming food can drive insulin resistance, but what about the other components involved in the pathway of that energy?
Below I will introduce you to three other components and their relative factors that play strong roles in this insulin resistance progressive loop. You will find short descriptions of how these link into the above pathways along with links to more information on each topic.
The mitochondria: oxidative capacity
The basic idea: A body that has a stronger ability to oxidize fats will be better at maintaining metabolic homeostasis. If a particular tissue (e.g. muscle) is good at burning fat, then it will be less likely to store that fat or release it into circulation.
Unfortunately, our sedentary lifestyles and toxic environments lead to cells with impaired mitochondrial capacity, leading to fat build-up in tissue, particularly skeletal muscle.
Learn more about building strong mitochondria here.
The Liver
Above, the liver is shown as a downstream tissue affected by insulin resistance in adipose tissue. However, it is not the case that insulin resistance always begins in adipose tissue and makes its way to the liver. Often, insulin resistance begins elsewhere and insulin resistant adipose tissue is a downstream effect. That “elsewhere ” is often in the liver, which can be caused directly due to some all-too-common industrial factors.
One incredibly prevalent factor driving insulin resistance directly in the liver is none other than sugar.
When speaking of sugar, there is one particular type that is especially problematic: fructose. Fructose makes up around half of the majority of sugar consumed (e.g. the white grainy sugar that typically comes to mind or high fructose corn syrup). Fructose is a special type of carbohydrate – what makes it special is:
1) It activates pleasure and reward centers in the brain, leading individuals to seek out sugar like no other food component. The food industry knows this, which is a large reason why sugar is in all packaged food on the grocery store shelf.
2) Any excess fructose can only be dealt with only by the liver.
The result of an over-abundant substance of which individuals seek out to an absurd degree – a substance of which can only be dealt with by one organ: that organ gets overloaded with energy, leading to malfunction.
Visceral Fat
This last factor has been left out of this conversation thus far, yet it is a primary pathway in the Reprogrammed Systems Model of Modern Disease.
Subcutaneous adipose tissue is a necessary component of a well-functioning body. This tissue is tightly regulated such that it is constantly communicating its needs with the rest of the body, playing a safe and necessary role in a healthy metabolism.
However, dysregulation in the body’s metabolism can lead to fat stored in alternative areas, such as in and around our organs. This form of fat is dangerous because:
- It is particularly leaky, leaking fat and pro-inflammatory molecules into the bloodstream.
- Its location in close proximity to organs makes this leaky behavior particularly dangerous, as this lipid and pro-inflammatory overflow can head straight to organs to cause dysfunction.
The Reprogrammed Systems Model shows visceral fat as the product of an overstressed individual. The basic mechanism is shown below:
Chronic stress –> chronic elevation of cortisol
Cortisol + Insulin –> Visceral Fat Storage
For now, just understand that our over stressful environment leads to visceral fat deposits, which create one more pathway for lipids and pro-inflammatory molecules to leak into the bloodstream.
Adding sugar and chronic stress to the established pathways:
Sugar –> an overloaded (fatty) liver – a liver that is inflamed and pumping out excess fat
Stress –> elevated cortisol –> visceral fat storage –> hyperlipdemia and inflammation
Combining these four environmental inputs:
Chronically elevated insulin levels combined with elevated lipids combine to drive the insulin resistance progressive loop. When an individual is consistently consuming refined carbohydrate, insulin becomes chronically elevated. Adding high quantities of fat to this results in elevated blood lipid.
To make matters even worse, consuming sugar regularly and living overly stressful lives add in two additional pathways for elevated lipids and pro-inflammatory signals.
Conclusions on external factors driving insulin resistance
Insulin resistance is caused by modern, industrialized lifestyles.
The consumption of refined foods consistently elevates insulin while delivering excess energy – energy that just goes to storage due to that elevated insulin – resulting in excess storage of fat.
If this isn’t enough, we add large quantities of sugar to this system in a pro-storage, hyperenergetic state, forcing the liver to work in overdrive to convert this sugar to fat. This excess fat gets shipped out into circulation or is even stored right there in the liver where it can cause liver dysfunction.
Adding in chronic stress to this system drives much of this fat into visceral fat storage deposits, from which a pro-inflammatory state arises along with even more leakage of lipids into the bloodstream.
Combined, we have a system (a body) with hyperlipidemia, hyperinsulinemia, on its path down the insulin resistance progressive loop, a path leading directly to Type II Diabetes and all other forms of modern disease.
The question for us now, is how do we get these driving factors out of our lives so that we can avoid these pathways and the path to modern disease.
To find out how, check out the following pages: