As Larry explained in his earlier blogs when he first presented to Enara Health he not only had pre-diabetes but also was found to have metabolic syndrome.  Metabolic syndrome is defined as having 3 of 5 risk factors  (abdominal obesity, high triglycerides, low HDL, fasting glucose above 110, and BP>130).

Why should we care about Larry’s metabolic syndrome? 

It is estimated that 47 million Americans have metabolic syndrome. These individuals have vastly elevated risks for cardiovascular disease, type II Diabetes, and cancer (three chronic disease with an economic burden of 717 billion dollars). Studies have found up to a 35-fold increase in type 2 debates risk for individuals with four or more components compared with those with no risk factors at baseline.

The real reason we should care is because metabolic syndrome is closely associated with insulin resistance, something we can definitely reverse with proper treatment.  Insulin resistance is largely driven by visceral fat and you can have too much visceral fat even if your skinny (Are you a Tofi? Thin on the outside, fat on the inside).

The epidemic of insulin resistance is largely driven by processed foods with additive sugars such as your daily granola, cereals, and yogurts to processed grains and rice. This is compounded by our largely sedentary lifestyle.

Why a VLCD to tackle Larry’s metabolic syndrome? 

Screen Shot 2015-08-06 at 7.21.38 PMDuring the first few days of his VLCD, Larry had average glucose of 115-120 with post-prandial glucoses of 135-145. This was his baseline. Even on days he was fasting his glucose stayed high around 120. This is because he needs more glucose to overcome his insulin resistance and his liver adjusts for his low calorie diet by producing more endogenous glucose. Around Day 13 of his journey, Larry’s glucose profile radically changed. Pretty amazing!

Studies of people on VLCD show that within a week our body actually decreases our endogenous glucose production by up to 25%. We additionally get vast drops in our insulin levels and triglyceride levels (over 50%). As a person approaches 5% body weight loss (which Larry reached on day 13), insulin sensitivity improves as well. Interestingly, studies shows that a VLCD, even practiced for 5 days intermittently, leads to better glycemic control independent of weight loss.

Ultimately, the reason for choosing a VLCD in Larry is that by dropping his insulin levels (and addressing insulin resistance first) we are creating a metabolic state that will allow for further fat loss as he continues his journey. Insulin promotes fat accumulation so having a bunch of it around makes weight loss increasingly difficult.