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What is Acanthosis Nigricans and why is it important?

Acanthosis is darker or thicker lines in the neck with or without skin tags signifies a metabolic reason for weight gain called insulin resistance.

Acanthosis nigricans is a clear sign of insulin resistance in most people that are either overweight or obese, according to Dr. Prab R. Tumpati, MD, founder of W8MD medical weight loss centers of America.

Belly fat and insulin resistance

Belly fat and insulin resistance

In fact, this thicker or darker area in the neck and or skin tags in the neck, axilla or other places is an early indication of this very common metabolic process called insulin resistance. If left unchecked, insulin resistance can lead to risk of prediabetes, or even diabetes.

I do not eat much, why am I gaining weight?

The reason might be that you are insulin resistant just as about 71% of all adults in the United States leading to their weight gain.

Understanding the anabolic role of insulin resistance is the key to understanding the cause of your weight gain in the middle such as the tummy or in the upper part of the body according to Dr. Prab R. Tumpati, MD, founder of W8MD medical weight loss centers of America.

Can insulin resistance explain why you gain weight especially in the tummy or upper part of the body?

Yes. The traditional thinking used to that you gain weight, and get Acanthosis, and all other metabolic issues associated with it, the new science shows clearly that it could be the opposite. That is, you become insulin resistant first, and this in turn explains not only the weight gain but also the food cravings, especially starchy or salty foods with high glycemic index leading to a vicious cycle of weight gain leading to insulin resistance, and insulin resistance leading to overeating.

Pictures of Acanthosis Nigricans or signs of Insulin Resistance in African Americans – darker lines, patches, dark moles or areas in the neck

acanthosis of the neck African American

Acanthosis of the neck African American 2

 

acanthosis of the neck African American 3

acanthosis of the neck African American 3 

Different stages of insulin resistance

Of the spectrum of insulin resistance, Acanthosis is an early sign and up to about 71% of all adults in USA might have some early signs of insulin resistance.

The middle stage of insulin resistance is prediabetes or metabolic syndrome and about one in three Americans are considered to have metabolic syndrome or prediabetes.

Some examples of necks of people showing signs of insulin resistance. Check to see if you are insulin resistant using this unique W8MD insulin resistance calculator!

  • Does your neck look like this?
  • Do you have darker moles on the neck or face?
  • Do you have excess belly fat?
  • Do you like or crave carbs?
  • Do you tend to get skin tags?

Pictures of insulin resistance or Acanthosis in Caucasians – skin tags, darker or thicker lines on the back or front of the neck.

acanthosis of the neck in whites skin tags

acanthosis of the neck in whites skin tags

 

acanthosis of the neck in whites

acanthosis of the neck in whites

The spectrum of insulin resistance, metabolic syndrome and type 2 diabetes

Imagine an iceberg where the bottom of the iceberg represents (71% of the population) early stages of insulin resistance, metabolic syndrome(35% of the polulation) is the middle of the iceberg and type 2 diabetes is the tip of the iceberg affecting 11% of the population.

 

Ted Talk by Dr. Peter Attia of Johns Hopkins on how insulin resistance can lead to weight gain

The last stage of insulin resistance is type 2 diabetes that affects about 11% of all adult Americans.

No wonder, the incidence of type 2 diabetes has gone up about 500% in the last 50 or so years and is expected to do the same in the next 20-30 years if this epidemic of insulin resistance is not curbed, according to Dr. Prab R. Tumpati, MD – founder of W8MD medical weight loss centers and a leading expert on insulin resistance.

Without changing insulin resistance, losing weight is very difficult as insulin resistance is what causes the cravings, overeating and the unhealthy distribution of body fat.

Related articles on Insulin Resistance and Acanthosis Nigricans

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Did the failed food pyramid contribute to rise in obesity in America?

English: insulin resistance model

English: insulin resistance model (Photo credit: Wikipedia)

 Did the failed food pyramid by USDA contribute to raise in Diabetes in America?

In May 2011, the USDA released a graphic called “My Plate” to help people choose what foods to eat instead of the “Food Pyramid”. The useless and misleading food pyramid, which has been confusing consumers for over 25 years, has advocated a philosophy of eating more grains and other less “fatty” foods. Food Pyramid failed to differentiate simple versus complex sugars and placed undue importance in promoting grain based products. How can the USDA, a government body set up to promote agriculture and promote sale of agricultural commodities be also charged with health recommendations?

  

Unfortunately, consuming a lot of the grain based “simple carbohydrates” such as breads, potatoes, rice etc. although low in fat, are high in glycemic index and can lead to a phenomenon called “Insulin Resistance”.  Affecting up to one in every three Americans, Insulin Resistance is very common and can lead to difficulty losing weight, pre-diabetes, or type II diabetes, heart disease and other long term health problems associated with obesity.

What is Insulin Resistance?

English: The blue circle is the global symbol ...

English: The blue circle is the global symbol for diabetes, introduced by the International Diabetes Federation with the aim of giving diabetes a common identity, supporting existing efforts to raise awareness of diabetes and placing the diabetes epidemic firmly in the public spotlight. (Photo credit: Wikipedia)

Insulin resistance is a condition in which the body produces insulin but does not use it properly. Insulin, a hormone made by the pancreas, helps the body use glucose for energy. When people are insulin resistant, their muscle, fat, and liver cells do not respond properly to insulin. As a result, their bodies need more insulin to help glucose enter cells. The pancreas tries to keep up with this increased demand for insulin by producing more. Eventually, the pancreas fails to keep up with the body’s need for insulin. Excess glucose builds up in the bloodstream, setting the stage for diabetes. Many people with insulin resistance have high levels of both glucose and insulin circulating in their blood at the same time. Learning about insulin resistance is the first step toward making lifestyle changes that can help prevent diabetes and other health problems. An Obesity medicine physician well versed with medical management of Obesity and Insulin Resistance might be able to help!

 Cause of Insulin Resistance

Scientists have identified specific genes that make people more likely to develop insulin resistance and diabetes. Excess weight and lack of physical activity also contribute to insulin resistance. Many people with insulin resistance and high blood glucose have other conditions that increase the risk of developing type 2 diabetes and damage to the heart and blood vessels, also called cardiovascular disease. These conditions include having excess weight around the waist, high blood pres­sure, and abnormal levels of cholesterol and triglycerides in the blood. Having several of these problems is called metabolic syndrome or insulin resistance syndrome, formerly called syndrome X.

What Are The Effects Of Insulin Resistance

Insulin resistance can lead to many problems including weight gain, especially around the tummy due to the anabolic effects of Isulin. It also leads to metabolic syndrome as defined below, fatty liver, polycystic ovaries, acanthosis nigricans or dark patch around the neck, axilla, groin or other areas, skin tags, prediabetes, risk of elevated blood pressure, cardiovascular disease etc.

What Is Acanthosis Nigricans?

 What Is Metabolic Syndrome?

 Metabolic syndrome is defined as the presence of any three of the following conditions:

  • waist measurement of 40 inches or more for men and 35 inches or more for women
  • triglyceride levels of 150 milligrams per deciliter (mg/dL) or above, or taking medication   for elevated triglyceride levels
  • HDL, or “good,” cholesterol level below 40 mg/dL for men and below 50 mg/dL for women, or taking medication for low HDL levels
  • blood pressure levels of 130/85 or above, or taking medication for elevated blood pressure levels
  • fasting blood glucose levels of 100 mg/dL or above, or taking medication for elevated blood glu­cose levels

What is prediabetes?

 Prediabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. This condition is sometimes called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), depending on the test used to diagnose it. The U.S. Department of Health and Human Services estimates that about one in four U.S. adults aged 20 years or older—or 57 million people—had predia­betes in 2007.

 People with prediabetes are at increased risk of developing type 2 diabetes, formerly called adult-onset diabetes or noninsulin­dependent diabetes. Type 2 diabetes is sometimes defined as the form of diabe­tes that develops when the body does not respond properly to insulin, as opposed to type 1 diabetes, in which the pancreas makes little or no insulin.

 Studies have shown that most people with prediabetes develop type 2 diabetes within 10 years, unless they lose 5 to 7 percent of their body weight—about 10 to 15 pounds for someone who weighs 200 pounds—by making changes in their diet and level of physical activity. People with prediabetes also are at increased risk of developing car­diovascular disease.

How do you diagnose Insulin Resistance?

Health care providers use blood tests to determine whether a person has prediabetes but do not usually test for insulin resistance. Insulin resistance can be assessed by measur­ing the level of insulin in the blood. How­ever, the test that most accurately measures insulin resistance, called the euglycemic clamp, is too costly and complicated to be used in most doctors’ offices. The clamp is a research tool used by scientists to learn more about glucose metabolism. If tests indicate prediabetes or metabolic syndrome, insulin resistance most likely is present.

Diabetes and prediabetes can be detected with one of the following tests:

                        Fasting glucose test. This test measures blood glucose in people who have not eaten anything for at least 8 hours. This test is most reliable when done in the morning. Fasting glucose levels of 100 to 125 mg/dL are above normal but not high enough to be called diabetes. This condition is called prediabetes or IFG. People with IFG often have had insulin resistance for some time. They are much more likely to develop diabetes than people with normal blood glucose levels.

                        Glucose tolerance test. This test mea­sures blood glucose after people fast for at least 8 hours and 2 hours after they drink a sweet liquid provided by a doc­tor or laboratory. A blood glucose level between 140 and 199 mg/dL means glu­cose tolerance is not normal but is not high enough for a diagnosis of diabetes. This form of prediabetes is called IGT and, like IFG, it points toward a his­tory of insulin resistance and a risk for developing diabetes.

People whose test results indicate they have prediabetes should have their blood glucose levels checked again in 1 to 2 years.

 Why is it important to look at glycemic index of foods?

 Glycemic Index of foods is important because it determines how much insulin your body is going to need after the meal. The higher the Glycemic Load, the higher the Insulin Requirements. It is believed that eating high glycemic foods such as Bagels, Doughnuts, white breads, white rice, sweetened beverages etc., the body starts to go into Insulin Resistance. The Insulin Resistance, in turn will lead to higher levels of Insulin circulating in the blood stream at baseline setting the stage for insulin resistance. Since insulin is an anabolic(body building hormone), this can not only lead to weight gain, but also lead to central distribution of weight. Research has shown that central distribution of weight leads to increased risk of cardiovascular disease, diabetes and other health problems.

http://youtu.be/TjK8kR6ggbY

Tips for Avoiding Insulin Resistance

According to the American Diabetes Association, nearly two million new cases of diabetes were diagnosed in people aged 20 years and older in 2010. Since the grossly misleading food pyramid was introduced, the incidence of type 2 diabetes has gone up as much as 400 percent in the United States. Pre-diabetes, also called insulin resistance syndrome or metabolic syndrome, affects about a third of all Americans. If you have some extra weight especially around your waist, you might be insulin resistant! An obesity medicine physician specializing in the medical management of obesity and insulin resistance might be able to help. 

W8MD physicians have specialized obesity medicine training and are well versed with  managing insulin resistance and other metabolic effects of weight. W8MD physicians can help you lose weight safely, effectively using proven non surgical methods. Call (800)W8MD-007 for more information.

§    Get enough protein. If the body gets carbohydrates without enough protein, it goes into insulin resistance. Most people need about 30 grams of protein at each meal. One egg is about 7 grams. As we evolved as hunters and gatherers, we are designed to eat a non-grain based diet rich in protein, fruits, nuts and vegetables.

§    Try to work more physical activity into your day. Both exercise and resistance training can help reduce your risk of diabetes, and also helps to control it once you have it.

§    Eat more fiber. Fiber helps reduce your risk of diabetes by improving your blood sugar control. Try more fruits, vegetables, beans, whole grains, nuts, and seeds.

§    Choose whole grains. When you do eat grains, look for the word “whole” in the ingredient list. Whole wheat, stone-ground whole wheat, brown rice, and oats are all whole-grain ingredients.

§    Eat fewer simple carbohydrates. These foods, with high glycemic index, break down quickly in the body, and can lead to rapid fluctuations in blood sugar levels. Go easy on foods like white rice, white bread, white pasta, refined flours, candy, fruit juice, soda pop, and baked goods made with white flour. The key is to understand glycemic Index of foods and focus on low glycemic foods.

§    Get enough sleep. When you’re sleep deprived, your body drives you to eat more simple carbohydrates. Get at least 7-8 hours a night.

§    Get help from Obesity Medicine physicians. You probably tried them all and still cannot lose weight! You might want to get help from physicians trained in Obesity Medicine that can help deal with the complex issues leading to weight gain.

The role of the failed food pyramid in causing obesity, insulin resistance and diabetes

Hawaiian woman

Hawaiian woman (Photo credit: Wikipedia)

Fast Facts On Obesity„„

rate-of-rise-of-obesity-in-usa

Since the early 1960s, the prevalence of obesity among adults more than doubled, increasing from 13.4 to 35.7 percent in U.S. adults age 20 and older. Currently, 68.8% of all adults in the United States are either overweight or obese!

The rate of rise of obesity, unfortunately, correlates with the misguided recommendations from the USDA in the form of the now withdrawn and failed food pyramid. Although the intention of the food pyramid was to promote healthy eating and weight loss, it in fact, did the opposite of what it intended to do by contributing to a new problem – insulin resistance or metabolic syndrome.  Before we look at how this happened, let’s take a look at the staggering Obesity Numbers.

Alarming Statistics Of Obesity

More than 2 in 3 adults are considered to be overweight or
obese.

    „„More than 1 in 3 adults are considered to be obese„„
    More than 1 in 20 adults are considered to have extreme obesity
    „„About one-third of children and adolescents ages 6 to 19 are considered to be overweight or obese„„
    More than 1 in 6 children and adolescents ages 6 to 19 are considered to be obese.
    More than two-thirds (68.8 percent) of adults are considered to be overweight or obese.„„
    More than one-third (35.7 percent) of adults are considered to be obese.„„
    More than 1 in 20 (6.3 percent) have extreme obesity.„„Almost 3 in 4 men (74 percent) are considered to be overweight or obese.„„
    The prevalence of obesity is similar for both men and women (about 36 percent)   „„
    About 8 percent of women are considered to have extreme obesity.
    Source: Data from the National Health and Nutrition Examination Survey, 2009–2010 2,3

adult-obesity-stats-2010

What really caused this enormous rise of Obesity?

While the Government might want to make you believe it is your fault you are overweight or obese, as a physician trained in Obesity Medicine, I will show you the contribution by the Government to this problem. Obviously, there are multiple reasons for Obesity but here are the most important in my opinion.

In 1992, The USDA made a nice looking food Pyramid. old-and-failed-food-pyramid-from-usda

In May 2011, the USDA released a graphic called “My Plate” to help people choose what foods to eat. This new guideline is meant to replace the old “Food Pyramid” that many people grew up with. Remember the triangle shape with the bread, cereal, and rice at the bottom and the fats and oils to be “used sparingly” at the top? This useless and misleading food pyramid, which has been confusing consumers for over 25 years, has advocated a philosophy of eating more grains and other less “fatty” foods.

What the Food Pyramid failed to do was to differentiate simple versus complex sugars. It also placed undue importance on grain-based products. Grain-based “simple carbohydrates” such as breads, potatoes, rice, cereal and pasta, although often low in fat, also rate high on the glycemic index. That means that they break down quickly in the body, overwhelming the blood with sugars and potentially leading to a phenomenon called “insulin resistance.” 

Affecting up to one in every three Americans, insulin resistance is very common and can lead to difficulty losing weight, pre-diabetes, or type II diabetes, heart disease and other long-term health problems associated with obesity. With the new “My Plate” guidelines and some other tips, more Americans may be able to avoid these unhealthy complications.

What is Insulin Resistance? adam

Insulin resistance is a condition in which the body produces insulin, but does not use it properly. Insulin, a hormone made by the pancreas, helps the body use glucose (natural sugar) for energy. When people are insulin resistant, their muscle, fat, and liver cells do not respond properly to insulin. As a result, their bodies need more insulin to help glucose enter cells.

The pancreas tries to keep up with this increased demand for insulin by producing more. Eventually, it becomes overworked and may no longer be able to meet that demand. Excess glucose builds up in the bloodstream, setting the stage for diabetes.

Many people with insulin resistance have high levels of both glucose and insulin circulating in their blood at the same time. Learning about insulin resistance is the first step toward making lifestyle changes that can help prevent diabetes and other health problems.

Read this related and well written article on why the new MyPlate from the USDA is a ‘”Lipstick On A Pig

By advocating a grain based, low fatty diet, over a protein based hunter gatherer diet that we evolved on, the USDA’s food pyramid contributed to insulin resistance. Unfortunately, up to 71 percent of the population has insulin resistance that leads to compensatory increase in the production of this hormone in order to keep the blood sugars under control.

This compensation is what makes you gain weight especially in the belly and upper part of the body as insulin is an “anabolic” or body building hormone. It also leads to a new problem called metabolic syndrome that one in three adults have. Thanks to USDA, all our understanding about healthy foods was skewed as we look at fat as unhealthy although there are many people groups such as those in the polar regions that eat up to 80 percent of their diet as fat and they do not get the cardiovascular diseases we do. This is because, although fat can make you gain weight, it would not lead to insulin resistance or metabolic syndrome.

Why I think the food pyramid contributed to your increased weight gain? obesity graph bySex

By advocating foods high in carbohydrates in the name of “low fat” foods, it directly contributed to our misguided views about fat which does not cause the problems they accuse it does. For example, our views about cholesterol and fat were heavily influenced by this food pyramid but the truth is that up to 70 percent of the body’s cholesterol is made in the liver and only 30 percent comes from the diet. By going “low fat”, low cholesterol in the diet, we were steered to a more grain based diets that cause insulin resistance over time. Since insulin resistance means we compensate by increasing the production of this hormone called insulin, we not only gain weight due to the anabolic effects of insulin, but it can also make our cholesterol profiles worse.

Why high insulin levels leads to cholesterol problems?

Insulin is an inducer of the enzyme in the liver called HMG coA reductase, which is a key enzyme in the production of cholesterol in the liver. Since up to 70 percent of the body’s cholesterol is manufactured in the liver while only about 30 percent comes from the diet, high levels of insulin induce this key enzyme called HMG CoA reductase leading to worsening of the cholesterols – this happens despite the patient eating a low fat, low cholesterol, so called “healthy diet”. (The popular cholesterol medications such as Lipitor inhibit this enzyme HMG C0A Reductase.)

How we evolved as Hunters and Gatherers

We were hunter and gatherers used to a diet rich in lean meats, eggs, vegetables, nuts, fruits, roots, and other naturally grown foods without the grain based agriculture products.  Agriculture is only about 5,000-10,000 years old it is a relatively short period for us to adapt to this type of diet that is poor in nutritional quality and has many deficiencies.

Read this excellent paper titled “Cereal Grains: Humanity’s Double-Edged Sword” by Loren Cordain, PhD

In this paper, the author points out that cereal grains lack a number of nutrients which are essential for human health and well-being; additionally they contain numerous vitamins and minerals with low biological availability. Furthermore, the inability of humans to physiologically overcome cereal grain antinutrients (phytates, alkylresorcinols, protease inhibitors, lectins, etc.) is indicative of the evolutionary novelty of this food for our species. This genetic maladaptation between human nutrient quirements and those nutrients found in cereal grains manifests itself as vitamin and mineral deficiencies and other nutritionally related disorders, particularly when cereal grains are consumed in excessive quantity.

More disturbing is the ability of cereal grain proteins (protease inhibitors, lectins, opioids and storage peptides) to interact with and alter human physiology. These interactions likely occur because of physiological similarities (resultant from phylogenetic commonalities) shared between humans and many herbivores which have traditionally preyed upon the gramineae family.

http://www.youtube.com/watch?v=GlOfySWrC5w

W8MD’s Three Things That Caused Obesity, Inflammation and Disease

More insulin resistant you are, more insulin the pancreas has to produce to keep the blood sugars under control. Most people are able to compensate well to insulin resistance by increasing the production of insulin so that their blood sugars are kept under control.  Unfortunately, Insulin is an anabolic(body building) hormone. Therefore, more insulin resistant one is, the more body building happens.

Insulin also builds the body in the wrong areas such as intra-abdominal fat and upper body fat, two areas of fat accumulation that are associated with metabolic syndrome. Studies have shown that belly fat leads to increased inflammation in the body thereby increasing the risk of cardiovascular disease, diabetes and other conditions. In fact, waist circumference of over 40 inches in men and 36 inches in women(lower in Asian Populations), is one of the five criteria for metabolic syndrome. As the metabolic syndrome increases production of harmful chemicals such as cytokines thereby increasing the body’s inflammation levels increasing the risk of disease.

Lack of Antioxidants

Second thing that happened to our diet that increases inflammation is lack of polyphenols and other antioxidants in the diet. Before the modern food processing era, our diet used to have more than 50 percent unprocessed and uncooked food items such as colored fruits, vegetables, and other natural ingredients that are high in antioxidants such as polyphenols. Studies have shown that lack of polyphenols leads to increased inflammation in the body. Read this article on an overview of oxidative stress to gain an insight in this important paradigm.

Omega 3 to Omega 6 Ratio

Third thing that leads to increased inflammation is the ratio of Omega 3 to Omega 6 fatty acids used to be 1:1 but is now at 1:16 which also increases inflammation. Learn more. With the above 3 factors, the inflammation levels rise significantly thereby increasing the risk of many health problems including cardiovascular diseases, diabetes and even increased risk of certain types of cancers! in this context, it is important to remember that most human diseases start with inflammation.

Tips for Reducing Insulin Resistance

  • Get enough protein. If the body gets carbohydrates without enough protein, it goes into insulin resistance. Most people need about 30 grams of protein at each meal. One egg is about 7 grams. As we evolved as hunters and gatherers, we are designed to eat a non-grain based diet rich in protein, fruits, nuts and vegetables.
  • Try to work more physical activity into your day. Both exercise and resistance training can help reduce your risk of diabetes, and also helps to control it once you have it.
  • Eat more fiber. Fiber helps reduce your risk of diabetes by improving your blood sugar control. Try more fruits, vegetables, beans, whole grains, nuts, and seeds.
  • Choose whole grains. When you do eat grains, look for the word “whole” in the ingredient list. Whole wheat, stone-ground whole wheat, brown rice, and oats are all whole-grain ingredients.
  • Eat fewer simple carbohydrates. These foods, with high glycemic index, break down quickly in the body, and can lead to rapid fluctuations in blood sugar levels. Go easy on foods like white rice, white bread, white pasta, refined flours, candy, fruit juice, soda pop, and baked goods made with white flour. The key is to understand glycemic Index of foods and focus on low glycemic foods.
  • Get enough sleep. When you’re sleep deprived, your body drives you to eat more simple carbohydrates. Get at least 7-8 hours a night.
  • Get help from Obesity Medicine physicians. You probably tried them all and still cannot lose weight! You might want to get help from physicians trained in Obesity Medicine that can help deal with the complex issues leading to weight gain.

prab-r-tumpati-3An obesity medicine physician specializing in the medical management of obesity and insulin resistance might be able to help. Call Prab R. Tumpati, M.D., an obesity medicine physician with specialized training in managing insulin resistance and medical weight loss and founder of W8MD Medical Weight Loss Centers of America can help.

Dr. Tumpati serves as the medical director at Sleep Medical Associates and W8MD Medical Weight Loss Center located at 2003, Bath Avenue, Brooklyn, NY 11214. 718-946-5500 or 1(800)W8MD-007. Dr. Tumpati also has offices in Greater Philadelphia Area in North East Philadelphia and King Of Prussia and is the founder of W8MD Medical Weight Loss Centers Of America.

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