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Q
Can Carbs Make You Sick?

What is hyperinsulimia? How is it controlled? What are the tests? What is Glucophage?

A
Answer (Published 9/3/2002)

Hyperinsulimia is a correlate of insulin resistance, which is, itself, the main problem in metabolic syndrome, an inherited condition that affects many people in our society. This problem causes cells to lose their sensitivity to insulin, the hormone needed to allow blood sugar to enter cells for use as fuel. This prompts the pancreas to overcompensate and crank out even more insulin, which can promote weight gain and cardiovascular disease. It can also lead to adult-onset diabetes.

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People with the genetic tendency to develop metabolic syndrome can avoid it by getting regular exercise and by minimizing consumption of high-glycemic index carbohydrate foods - i.e., those that digest rapidly into glucose (blood sugar). High consumption of refined starches and sugars combined with lack of physical activity are probably responsible for the epidemic of obesity in this country.

My colleague Kathleen Johnson, a nutritionist here at the Arizona Center for Integrative Medicine, estimates that a great many people, perhaps 50% of the population or more, are genetically predisposed to insulin resistance. This condition can be diagnosed with an insulin level test done after a period of fasting, but you also can presume that it exists among those who have weight problems and also have high serum triglycerides and low HDL ("good" cholesterol).

The best way to control insulin resistance is by getting regular exercise, reducing total carbohydrate consumption (to 50 percent of calories or less) and by choosing carbohydrate foods - like beans, sweet potatoes, winter squash, and whole grains - that are lower on the glycemic index (GI) scale. Foods ranked above 60 on that scale are all considered "high" glycemic index foods.

You can find a list of common foods and their GI values through www.diabetesnet.com.

In short, your best bet is to cut back on sugars and starches (other than beans); eat lots of vegetables and reasonable portions of lean meat and fish and a little fruit. Ms. Johnson advises eating frequently so you don't get hungry.

Glucophage (Metformin) is a drug that lowers blood sugar and that also seems to help lower cholesterol and triglycerides and decrease appetite. It is often prescribed to people with adult-onset diabetes. Its side effects (often temporary) include nausea, stomach pain, bloating and diarrhea. A more serious side effect, lactic acidosis, can affect those with kidney or liver disease, severe heart failure or a history of alcohol abuse. (Lactic acidosis is rare but dangerous - half the cases are fatal.) If you take Glucophage, your physician should also monitor your liver function regularly and check blood counts and vitamin B12 levels, as anemia can occur in those susceptible to B12 deficiency.

Andrew Weil, M.D.

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