Insulin resistance marks Alzheimer’s disease risk at the earliest stage

An important paper recently published in the Archives of Neurology offers evidence that insulin resistance is a causal factor for Alzheimer’s disease at its earliest stages. The authors observe:

“Insulin resistance is a causal factor in prediabetes (PD) and type 2 diabetes (T2D) and increases the risk of developing Alzheimer disease (AD). Reductions in cerebral glucose metabolic rate (CMRglu) as measured by fludeoxyglucose F 18–positron emission tomography (FDG-PET) in parietotemporal, frontal, and cingulate cortices are associated with increased AD risk and can be observed years before dementia onset.

With this in mind they set out to…

“…examine whether greater homeostasis model assessment insulin resistance (HOMA-IR) is associated with reduced resting CMRglu in areas vulnerable in AD in cognitively normal adults with newly diagnosed PD or T2D (PD/T2D), and to determine whether adults with PD/T2D have abnormal patterns of CMRglu during a memory encoding task.”

In other words, the authors correlated glucose and insulin measurements, brain scans of glucose metabolism and a radioactive emission brain scan (fludeoxyglucose F 18–positron emission tomography)  during a memory encoding task. What did the data show?

Greater insulin resistance was associated with an AD-like pattern of reduced CMRglu in frontal, parietotemporal, and cingulate regions in adults with PD/T2D…During the memory encoding task, healthy adults showed activation in right anterior and inferior prefrontal cortices, right inferior temporal cortex, and medial and posterior cingulate regions. Adults with PD/T2D showed a qualitatively different pattern during the memory encoding task, characterized by more diffuse and extensive activation, and recalled fewer items on the delayed memory test.

The authors’ conclusion adds to the weight of evidence indicating that blood sugar dysregulation and insulin resistance are fundamental causal factors and early risk indicators for Alzheimer’s disease:

Insulin resistance may be a marker of AD risk that is associated with reduced CMRglu and subtle cognitive impairments at the earliest stage of disease, even before the onset of mild cognitive impairment.

Quercitin as effective as resveratrol for inflammation with diabetes and obesity

There has been a lot of interesting science, some of it reported here, documenting the benefits of resveratrol for factors contributing to inflammation, insulin resistance, obesity, diabetes and longevity. A paper just published in the American Journal of Clinical Nutrition offers evidence that the valuable phenolic compound quercitin may be even more effective than resveratrol for reducing the inflammation associated with insulin resistance and diabetes. The authors state:

Quercetin and trans-resveratrol (trans-RSV) are plant polyphenols reported to reduce inflammation or insulin resistance associated with obesity. Recently, we showed that grape powder extract, which contains quercetin and trans-RSV, attenuates markers of inflammation in human adipocytes and macrophages and insulin resistance in human adipocytes…The aim of this study was to examine the extent to which quercetin and trans-RSV prevented inflammation or insulin resistance in primary cultures of human adipocytes [fat cells] treated with tumor necrosis factor-{alpha} (TNF-{alpha})—an inflammatory cytokine elevated in the plasma and adipose tissue of obese, diabetic individuals.”

They stimulated fat cells with TNF-{alpha} to promote inflammation after pretreatment with quercetin and trans-RSV, then measured gene and protein markers of inflammation and insulin resistance. What did the data show?

Quercetin, and to a lesser extent trans-RSV, attenuated the TNF-{alpha}–induced expression of inflammatory genes such as interleukin (IL)-6, IL-1β, IL-8, and monocyte chemoattractant protein-1 (MCP-1) and the secretion of IL-6, IL-8, and MCP-1… Quercetin, but not trans-RSV, decreased TNF-{alpha}–induced nuclear factor-{kappa}B transcriptional activity. Quercetin and trans-RSV attenuated the TNF-{alpha}–mediated suppression of peroxisome proliferator–activated receptor {gamma} (PPAR{gamma}) and PPAR{gamma} target genes and of PPAR{gamma} protein concentrations and transcriptional activity….”

Quercitin is known to be helpful for gut inflammation associated with food allergies, and I have found it to be a surprisingly helpful palliative for airborne allergies. In light of this the authors’ conclusion is not a surprise:

“These data suggest that quercetin is equally or more effective than trans-RSV in attenuating TNF-{alpha}–mediated inflammation and insulin resistance in primary human adipocytes.”

Magnesium, inflammation, insulin resistance and diabetes

Magnesium is important for a multitude of functions and functional deficiencies of magnesium are extremely common. A study just published in the journal Diabetes Care illuminates the role of magnesium in the chronic inflammation associated with insulin resistance and diabetes. The authors set out…

“To investigate the long-term associations of magnesium intake with incidence of diabetes, systemic inflammation and insulin resistance among young American adults.”

They examined 4,497 Americans, aged 18-30 years and without diabetes, for magnesium intake and the subsequent onset of diabetes; along with key inflammatory markers (high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and fibrinogen) and the homeostasis model assessment of insulin resistance (HOMA-IR). What did the data show?

“During 20-year follow-up, 330 incident diabetic cases were identified. Magnesium intake was inversely associated with incidence of diabetes [those with the lowest magnesium had 53% more chance of developing diabetes]…Consistently, magnesium intake was significantly inversely associated with hs-CRP, IL-6, fibrinogen, and HOMA-IR; and serum magnesium levels were inversely correlated with hs-CRP and HOMA-IR.”

The association between magnesium and the inflammation markers hs-CRP, IL-6 and fibrinogen is significant for more than diabetes because chronic inflammation is a hallmark of most chronic diseases including cardiovascular disease and cancer. The same goes for insulin resistance as indicated by HOMA-IR. Serum magnesium is not a sensitive indicator of deficiency. Measuring magnesium concentration in the red blood cells is a more accurate representation. Urinary organic acids can also indicate when key metabolic pathways are impaired due to magnesium deficiency. Muscle cramps at rest are very often associated with magnesium deficiency and clear up when magnesium sufficiency has been restored.

Why not skip breakfast?

Most readers here probably understand that the biological response to skipping breakfast does widespread damage to the body. It provokes a catabolic (‘tearing down’) sympathetic nervous system response as the brain forces the breakdown of muscle tissue with ‘fight or flight’ chemicals (catecholamine neurotransmitters) to satisfy its need for steady glucose (gluconeogenesis). Meanwhile, weight loss is defeated by the suppression of thyroid function as an adaptation to perceived ‘famine’. A study just published in the American Journal of Clinical Nutrition documents the long-term negative cardiovascular effects:

“The objective was to examine longitudinal associations of breakfast skipping in childhood and adulthood with cardiometabolic risk factors in adulthood.”

2184 Australian children were followed over a period of twenty years into young adulthood. Skipping breakfast was defined as not eating between 0600 and 0900. Differences in mean waist circumference and blood glucose, insulin, and lipid concentrations were calculated (after controlling for relevant confounding variables). What did the data show?

“…participants who skipped breakfast in both childhood and adulthood had a larger waist circumference and higher fasting insulin, total cholesterol, and LDL cholesterol concentrations than did those who ate breakfast…”

This certainly makes sense in consideration of the compensatory blood sugar and insulin reaction to the hypoglycemic state imposed by failing to ‘break’ the nighttime ‘fast’ in the morning.

The authors conclude by stating:

Skipping breakfast over a long period may have detrimental effects on cardiometabolic health. Promoting the benefits of eating breakfast could be a simple and important public health message.”

Alzheimer’s disease and insulin resistance

Evidence continues to accumulate for the role of insulin resistance and type 2 diabetes in Alzheimer’s disease. Research just published in Archives of Neurology add more certainty to the association. The authors observe:

Insulin resistance is a causal factor in prediabetes (PD) and type 2 diabetes (T2D) and increases the risk of developing Alzheimer disease (AD). Reductions in cerebral glucose metabolic rate (CMRglu)…in parietotemporal, frontal, and cingulate cortices are associated with increased AD risk and can be observed years before dementia onset.”

They structured their investigation by setting out to…

“…examine whether greater homeostasis model assessment insulin resistance (HOMA-IR) is associated with reduced resting CMRglu in areas vulnerable in AD in cognitively normal adults with newly diagnosed PD or T2D (PD/T2D), and to determine whether adults with PD/T2D have abnormal patterns of CMRglu during a memory encoding task.”

They correlated data on adults with glycemic criteria for pre-diabetes or T2DM (and normal controls) with PET imaging of brain glucose metabolism and memory tests. They also examined the cerebral metabolic glucose rate (CMRglu) during the memory task. What did the data show?

Greater insulin resistance was associated with an AD-like pattern of reduced CMRglu in frontal, parietotemporal, and cingulate regions in adults with PD/T2D. The relationship between CMRglu and HOMA-IR was independent of age, 2-hour OGTT glucose concentration, or apolipoprotein E {varepsilon}4 allele carriage…Adults with PD/T2D showed a qualitatively different pattern during the memory encoding task, characterized by more diffuse and extensive activation, and recalled fewer items on the delayed memory test.”

Their conclusion suggests both the role of insulin resistance in the development of AD as well as its use as an early indicator of risk:

Insulin resistance may be a marker of AD risk that is associated with reduced CMRglu and subtle cognitive impairments at the earliest stage of disease, even before the onset of mild cognitive impairment.

Interestingly, these findings were published along with another study in the same journal that reports on the accuracy of a constellation of blood test indicators for early diagnosis of AD. The authors set out…

“To develop an algorithm that separates patients with Alzheimer disease (AD) from controls.”

They analyzed serum protein–based biomarker data from 197 patients diagnosed with AD and compared it them 203 normal controls. The statistical analyses they used to create a biomarker risk score included a number of analytes that can be linked to insulin resistance and inflammation, including fibrinogen, interleukin-10, and C-reactive protein. When the numbers were crunched their biomarker risk score was highly accurate:

“The biomarker risk score had a sensitivity and specificity of 0.80 and 0.91, respectively, and an area under the curve of 0.91 in detecting AD [identified 80% with AD, excluded 91% without]. When age, sex, education, and APOE status were added to the algorithm, the sensitivity, specificity, and area under the curve were 0.94 [94%}, 0.84 [84%], and 0.95, respectively.”

This is very valuable because other proposed tests involve lumbar puncture for cerebrospinal fluid or expensive neuorimaging, both with obvious drawbacks. The authors’ conclusion also highlights the importance of inflammation (vascular and otherwise, associated with insulin resistance) in the development of AD:

“These initial data suggest that serum protein-based biomarkers can be combined with clinical information to accurately classify AD. A disproportionate number of inflammatory and vascular markers were weighted most heavily in the analyses…suggesting the existence of an inflammatory-related endophenotype of AD that may provide targeted therapeutic opportunities for this subset of patients.”

Magnesium deficiency and death from cardiovascular disease

Magnesium deficiency is so common that it’s hard to find individuals with optimal levels. A study just published in the American Heart Journal adds to the growing body if evidence for the great importance of magnesium in cardiovascular disease. The authors state:

“We hypothesized that serum magnesium (Mg) is associated with increased risk of sudden cardiac death (SCD).”

They assessed risk factors and levels of serum Mg in 14,232 45- to 64-year-old subjects and followed them for an average of 12 years. During that time there were 264 cases of SCD that they used to evaluate the association of serum Mg with risk of SCD. The data made a clear statement:

“Individuals in the highest quartile of serum Mg were at significantly lower risk of SCD in all models. This association persisted after adjustment for potential confounding variables, with an almost 40% reduced risk of SCD in quartile 4 versus 1 of serum Mg observed in the fully adjusted model.”

This is a potent result, summed by the authors’ conclusion:

“This study suggests that low levels of serum Mg may be an important predictor of SCD.”

A whole body of emerging research is illuminating the mechanisms by which suboptimal magnesium levels can have this effect. In a study just published in the journal Diabetes Care the authors set out…

“To investigate the long-term associations of magnesium intake with incidence of diabetes, systemic inflammation and insulin resistance among young American adults.”

The authors followed 4,497 Americans aged 18-30 (who had no diabetes at the beginning) for 20 years. During that time they identified 330 cases of diabetes which they correlated with quintiles of magnesium intake. They also investigated the associations between magnesium intake and inflammatory markers including high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and fibrinogen, and the homeostasis model assessment of insulin resistance (HOMA-IR). What did the data show?

Magnesium intake was inversely associated with incidence of diabetes after adjustment for potential confounders…Consistently, magnesium intake was significantly inversely associated with hs-CRP, IL-6, fibrinogen, and HOMA-IR; and serum magnesium levels were inversely correlated with hs-CRP and HOMA-IR.”

As you know, these are powerful markers for cardiovascular disease risk. As the authors state in their conclusion:

“This inverse association may be explained, at least in part, by the inverse correlations of magnesium intake with systemic inflammation and insulin resistance.”

An earlier paper published in the journal Magnesium Research documents how low magnesium in conjunction with high fructose consumption promotes inflammation associated with metabolic syndrome. The authors begin by observing:

“The metabolic syndrome is a cluster of common pathologies: abdominal obesity linked to an excess of visceral fat, insulin resistance, dyslipidemia and hypertension. This syndrome is occurring at epidemic rates, with dramatic consequences for human health worldwide, and appears to have emerged largely from changes in our diet and reduced physical activity. An important but not well-appreciated dietary change has been the substantial increase in fructose intake, which appears to be an important causative factor in the metabolic syndrome. There is also experimental and clinical evidence that the amount of magnesium in the western diet is insufficient to meet individual needs and that magnesium deficiency may contribute to insulin resistance.”

They present present experimental evidence showing that metabolic syndrome, high fructose intake and low magnesium diet may all be linked to the inflammatory response. The data they gathered showed that:

“…a few days of experimental magnesium deficiency produces a clinical inflammatory syndrome characterized by leukocyte and macrophage activation, release of inflammatory cytokines, appearance of the acute phase proteins and excessive production of free radicals. Because magnesium acts as a natural calcium antagonist, the molecular basis for the inflammatory response is probably the result of a modulation of the intracellular calcium concentration.”

These findings remind of the recent research linking calcium supplementation to increased heart attacks.  The authors conclude:

“Since magnesium deficiency has a pro-inflammatory effect, the expected consequence would be an increased risk of developing insulin resistance when magnesium deficiency is combined with a high-fructose diet. Accordingly, magnesium deficiency combined with a high-fructose diet induces insulin resistance, hypertension, dyslipidemia, endothelial activation and prothrombic changes in combination with the upregulation of markers of inflammation and oxidative stress.”

It goes without saying that these are primary inducers of cardiovascular disease. Another paper published last year in the same journal note the association of magnesium deficiency and C-reactive protein:

“Recent findings from epidemiologic studies support that magnesium intake is inversely associated with C-reactive protein concentration, an important marker of inflammation strongly associated with cardiovascular disease risk.”

A fascinating study published in the American Journal of the Medical Sciences investigates magnesium deficiency promotes inflammation and cardiovascular disease through neurogenic pathways:

“This review highlights some key observations that helped formulate the hypothesis that release of substance P (SP) [an inflammatory signalling molecule] during experimental dietary Mg deficiency (MgD) may initiate a cascade of deleterious inflammatory, oxidative, and nitrosative events, which ultimately promote cardiomyopathy, in situ cardiac dysfunction, and myocardial intolerance to secondary stresses.”

The authors further state:

“…SP-mediated events may…facilitate development of in situ cardiac dysfunction, especially with prolonged dietary Mg restriction.”

Additional intriguing research published in the British Journal of Anaesthesia adds even more evidence to the assertion that magnesium helps reduce cardiovascular disease by opposing calcium.  The authors begin by stating:

“Magnesium sulphate (MgSO4) has potent anti-inflammatory capacity. It is a natural calcium antagonist and a potent L-type calcium channel inhibitor. We sought to elucidate the possible role of calcium, the L-type calcium channels, or both in mediating the anti-inflammatory effects of MgSO4.”

And magnesium sulphate is not the most bioavailable form of magnesium supplementation. When the authors induced inflammation by exposure to lipopolysaccharide (LPS) as evidenced by macrophage inflammatory protein-2, tumour necrosis factor-α, interleukin (IL)-1β, IL-6, nitric oxide/inducible nitric oxide synthase, prostaglandin E2/cyclo-oxygenase-2, and NF-κB activation.

MgSO4…significantly inhibited the LPS-induced inflammatory molecules production and NF-κB activation. Moreover, the effects of MgSO4 on inflammatory molecules and NF-κB were reversed by extra-cellular calcium supplement with CaCl2 and L-type calcium channel activator BAY-K8644.”

In other words, in addition to opposing inflammation, magnesium is nature’s calcium channel blocker. The authors conclude:

“MgSO4 significantly inhibited endotoxin-induced up-regulation of inflammatory molecules and NF-κB activation… The effects of MgSO4 on inflammatory molecules and NF-κB may involve antagonizing calcium, inhibiting the L-type calcium channels, or both.”

Blood sugar and the brain in learning and behavioral disorders

The brain needs a steady supply of glucose to work normally. Disorders of blood sugar regulation, whether hypoglycemia or insulin resistance (precursor to type 2 diabetes), deprives the brains cells of the fuel to produce the energy they need to function. Research just published in the journal Diabetologia examines the cognitive impairments present in adolescents when insulin resistance and overweight have progressed to type 2 diabetes.

Central nervous system abnormalities, including cognitive and brain impairments, have been documented in adults with type 2 diabetes…Assessing adolescents with type 2 diabetes will allow the evaluation of whether diabetes per se may adversely affect brain function and structure years before clinically significant vascular disease develops.”

The authors compared two groups of overweight adolescents, one with and the other without type 2 diabetes. The depredations of insulin resistance on the brain were stunning:

Adolescents with type 2 diabetes performed consistently worse in all cognitive domains assessed, with the difference reaching statistical significance for estimated intellectual functioning, verbal memory and psychomotor efficiency…[and] executive function, reading and spelling. MRI-based automated brain structural analyses revealed both reduced white matter volume and enlarged cerebrospinal fluid space in the whole brain and the frontal lobe in particular… In addition, assessments using diffusion tensor imaging revealed reduced white and grey matter microstructural integrity.”

The authors conclusion places both clinicians and parents on the alert:

“These abnormalities are not likely to result from education or socioeconomic bias and may result from a combination of subtle vascular changes, glucose and lipid metabolism abnormalities and subtle differences in adiposity in the absence of clinically significant vascular disease.”

On the hypoglycemic pole of glucose regulation we can appreciate earlier fascinating research published Pediatric Research documenting an impaired neurotransmitter response to falling blood sugar in children with ADD (the catecholamines epinephrine and norepinephrine attenuate the drop in blood sugar).

“Eating simple sugars has been suggested as having adverse behavioral and cognitive effects in children with attention deficit disorder (ADD)…metabolic, hormonal, and cognitive responses to a standard oral glucose load (1.75 g/kg) were compared in 17 children with ADD and 11 control children.”

Their data showed a significant difference between ADD and control children:

“The late glucose fall stimulated a rise in plasma epinephrine that was nearly 50% lower in ADD than in control children. Plasma norepinephrine levels were also lower in ADD than in control children…”

The authors’ conclusion indicates the need for conscientious blood sugar management through dietary and other measures:

“These data suggest that children with ADD have a general impairment of sympathetic activation involving adrenomedullary as well as well as central catecholamine regulation [of blood sugar].”

Similar phenomena are presented in a paper published in the Journal of the American Academy of Child & Adolescent Psychiatry describing abnormalities of brain metabolism in girls with ADHD:

“This study assesses the effect of attention-deficit hyperactivity disorder (ADHD) and gender on cerebral glucose metabolism (CMRglu), using positron emission tomography and 18F-fluorodeoxyglucose.”

An interesting gender difference emerged from the data:

“However, the global CMRglu in ADHD girls was 15.0% lower than in normal girls, while global CMRglu in ADHD boys was not different than in normal boys. Furthermore, global CMRglu in ADHD girls was 19.6% lower than in ADHD boys and was not different between normal girls and normal boys.”

Gender differences that must be respected are pronounced here and throughout medicine and biology:

“The greater brain metabolism abnormalities in females than males strongly stress that more attention be given to the study of girls with ADHD.”

Addressing the dysfunctions in blood sugar dysregulation associated with disorders of learning and behavior requires understanding that deleterious eating conducts can manifest as a form of self-medication. A paper recently published in Current Psychiatry Reports brings attention to this:

“In the past decade, we have become increasingly aware of strong associations between overweight/obesity and symptoms of attention-deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults.”

The need to satisfy imperious physiological urges on a cellular level when an individuals genetic needs are not being met can overwhelm all advice and intention to acquire more wholesome and sustainable habits:

“It is also proposed—based on the compelling evidence that foods high in fat, sugar, and salt are as addictive as some drugs of abuse—that excessive food consumption could be a form of self-medication. This view conforms with the well-established evidence that drug use and abuse are substantially higher among those with ADHD than among the general population.”

True remediation demands a functional medicine approach to resolve the underlying cellular and metabolic needs that are not being met so they can be supported in a physiological and sustainable manner to restore normal function.

A paper published in the Journal of Nutrition, Health & Aging brings us back to the fundamental importance of glucose regulation for the brain.

The regulation of glycaemia (thanks to the ingestion of food with a low glycaemic index ensuring a low insulin level) improves the quality and duration of intellectual performance, if only because at rest the brain consumes more than 50% of dietary carbohydrates, approximately 80% of which are used only for energy purpose. In infants, adults and aged, as well as in diabetes, poorer glycaemic control is associated with lower performances, for instance on tests of memory. At all ages, and more specifically in aged people, some cognitive functions appear sensitive to short term variations in glucose availability.

Inflammation and insulin resistance genes are activated by surgery

Journal of Clinical Endocrinology & MetabolismThis interesting paper recently published in the Journal of Clinical Endocrinology & Metabolism describes one of the reasons why support when undergoing a surgical procedure is so important (and links to the risks for delirium and accelerated dementia after surgery in the elderly). The authors set out to investigate the…

“…mechanisms behind postoperative insulin resistance and impaired glucose utilization…”

They shrewdly analyzed the expression of 21 target genes in abdominal adipose (fat) tissue from samples taken at the beginning and end of patients undergoing abdominal surgery. What did the data show?

“After surgery, both sc [subcutaneous] and omental adipose tissue mRNA levels of genes involved in the IL6 and nicotinamide phosphoribosyltransferase pathways were increased, whereas mRNA levels of insulin receptor substrate 1 and adiponectin were reduced. TNF pathway genes were differently regulated between sc and omental adipose tissue, and glucose transporter 4 mRNA levels were decreased only in omental adipose tissue.”

In other words, surgery elicits a shift in genetic expression that favors insulin resistance and inflammation. The authors conclude:

“The transcriptional output of pivotal inflammatory and insulin signaling pathway genes is altered after surgery…This could be of importance for the metabolic aberrations associated to postsurgical complications…”

This helps to understand why patients who are lucky enough to receive adjunctive support for the insulin and inflammatory signaling pathways and receptors recover faster and with less complications.

A new and convenient biomarker for early insulin resistance

PLoS OneElevated levels of insulin due to insulin resistance can do so much damage throughout the body long before the onset of type 2 diabetes that better tools for making the diagnosis early enough for lifestyle changes to have their maximum benefit are always welcome. This research article just published in PLoS One (Public Library of Science) validates the use of an ‘old friend’, α-hydroxybutyrate (α–HB, α = alpha), as a valuable warning sign in the non-diabetic population. The authors first note that…

“Current diagnostic tests, such as glycemic indicators, have limitations in the early detection of insulin resistant individuals. We searched for novel biomarkers identifying these at-risk subjects.”

The authors use of ‘random forest statistical analysis’ of 399 nondiabetic subjects (representing a broad spectrum of insulin sensitivity and glucose tolerance) selected α-hydroxybutyrate (α–HB) as the most accurate biochemical for detecting insulin resistance.

“α–HB also separated subjects with normal glucose tolerance from those with impaired fasting glycemia or impaired glucose tolerance independently of, and in an additive fashion to, insulin resistance. These associations were also independent of sex, age and BMI.”

Thus the authors conclude:

α–hydroxybutyrate is an early marker for both insulin resistance and impaired glucose regulation.

I have been testing α–HB for years as part of an organic acids panel because it is also an indicator of toxin-stimulated upregulation of detoxification pathways and glutathione demand. So it makes sense that the authors would also add:

The underlying biochemical mechanisms may involve increased lipid oxidation and oxidative stress.”

I’m looking at an organic acids report from the file of a patient with other signs of insulin resistance plus a recurrence of breast cancer and, sure enough, α–hydroxybutyrate is abnormally elevated.

Diet induced weight loss can rapidly improve sexual function for men

International Journal of ObesityReaders of these posts know about the profound impact of insulin resistance on glandular and metabolic function; as the authors of this study just published in the International Journal of Obesity note…

Abdominal obesity and type 2 diabetes mellitus are associated with erectile and urinary dysfunction in men.”

The investigators set out to determine the extent to which weight loss would impact overall sexual function and lower urinary tract symptoms by measuring the effects of an 8 week low-calorie diet using meal replacements* on insulin sensitivity, testosterone, erectile function, sexual desire, prostate symptoms, abdominal obesity and waist circumference. What did their data show?

“Weight loss of ~10% was significantly associated with increased insulin sensitivity, plasma testosterone levels, IIEF-5 (erectile function) and SDI (sexual desire) scores, as well as reduced WC (waist circumference) and IPSS (prostate) scores, in diabetic as well as nondiabetic men.”

They further observed that…

“The degree of weight loss was significantly associated with improvements in plasma testosterone levels, erectile function and LUTS. Reduction in LUTS was significantly associated with increased plasma testosterone, erectile function and sexual desire.”

Hence their clear-cut conclusion:

Diet-induced weight loss significantly and rapidly improves sexual function, and reduces LUTS, in obese middle-aged men with or without diabetes.”

This is a compelling illustration of the link between insulin resistance and male sexual function.

* Although effective in this study (at 800 calories per day) there are better meal replacement products available for weight loss than this one loaded with fructose, milk protein, and low grade minerals and fish oil.