BENEFITS OF GROWTH HORMONE

IN RELATION TO METABOLIC SYNDROME AND INSULIN RESISTANCE

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As species we are in the middle of an epidemic with regards to metabolic syndrome and

diabetes. Diabetes, which only used to be a disease of young adults due to autoimmune destruction of the beta cells of the pancreas. The only known diabetes type was type 1 diabetes whereas type 2 diabetes is a fairly new phenomenon. According to American Diabetes Association (ADA), the prevalence of diabetes in the United States in 2015 was reported as 30.3 million Americans, 9.4% of the population, and 7.2 million patients were undiagnosed. Furthermore, another scary statistic is that there are 1.5 million new cases diagnosed every year and prediabetes was diagnosed in 84.1 million Americans aged 18 and older. In 2015 alone 79,535 death were attributed to underlying diabetes and its complications. The treatment of diabetes and its related complications have overburdened the United States healthcare system, and $327 billion spent in the total cost of diabetic management in 2017, out of which $237 billion were the direct medical cause and $90 billion was in reduced productivity cost (ADA, 2017).

The treatment of diabetes consists of multiple medications including insulin. It is extremely rare to find patients’ curing their diabetes and living without taking any medications. We have long been excited about the advent of insulin as a mainstay treatment of uncontrolled diabetes, however, this treatment has only led to worsening of diabetes and patients requiring more and more insulin in order to keep blood glucose within normal levels. Furthermore, it is extremely difficult for patients to adhere to their treatment regimen, and most patients just end up not complying with the proper treatment guidelines. The question then arises, is Diabetes curable? For this, we must understand the hormonal imbalance and the physiological effects of these hormones during hyperglycemic events.

Type 2 diabetes starts with insulin resistance. How does one become insulin resistant? To answer this, we must understand the physiology of the hormone insulin and its interaction with the cellular framework. Insulin is a hormone that can also be called a fat-storage hormone. Insulin takes the glucose that is generated from the meals we consume, and it essentially opens the door required for the glucose to enter the cells. After the cells have been saturated with glucose, the remaining excessive amount of glucose is then stored as fat with the help of insulin. In the modern American diet, we have large amounts of carbohydrates being consumed without corresponding physical activity. Response to large amounts of carbohydrates in the body is to produce large amounts of insulin which subsequently leads to increased visceral fat. Eventually, the receptors that insulin binds to in order to open the Flood Gates for glucose become resistant to insulin itself due to overuse. We can take an example of a lock and key mechanism, where the key has been severely overused, and the lock has been eroded where the key does not fit. The high insulin state is what leads to Metabolic Syndrome and subsequently full-blown diabetes.

Now that we understand the mechanism of insulin and the mechanism of diabetes, how do we treat diabetes? That is right, with insulin. This treatment does not seem logical, because it only exacerbates the problem at hand. High levels of insulin lead to an increased amount of visceral fat via lipogenesis, non-alcoholic steatohepatitis or NASH, increased intra-cellular fat, worsening mitochondrial function that hinders energy formation.

We have a natural mechanism in place that is opposing the effects of insulin by the virtue of growth hormone. High levels of insulin in the body inhibit the production of growth hormone leading to growth hormone deficiency. Growth hormone deficiency can be categorized by multiple metabolic abnormalities including visceral obesity, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, development of metabolic syndrome, and diabetes among others. All these metabolic abnormalities are exactly what an excessive amount of insulin causes as well.

FIGURE 1

Figure 1 graphically represents the function and benefits of having an adequate amount of growth hormone. A study published in Annals of Pediatric Endocrinology Metabolism in 2017 titled, “Effects of growth hormone glucose metabolism and insulin resistance and human”, presents findings of growth hormone therapy to patients with growth hormone deficiency. They concluded that growth hormone therapy antagonizes insulin’s action on the tissue such as skeletal muscle, liver, and adipose tissue and increases glucose production from skeletal muscle and liver, thereby decreasing the uptake of glucose in adipose tissue. Due to growth hormone-induced lipolysis and increased free fatty acids in circulation, the insulin signaling pathway is inhibited.

Taking this relationship into consideration we can treat diabetes with a new approach, which includes increasing natural growth hormone as opposed to exogenous therapy. We can potentially achieve this by just altering diet and significantly decreasing our carbohydrate intake while becoming more active in our lives. The challenge is to motivate our patient population to undergo a strict diet plan that includes long fasting periods so that there is a lot less insulin circulating leading to increased production of growth hormone. Success in the treatment of diabetes and metabolic syndrome is highly contingent upon the motivation and the drive of patients. Medications can be used in conjunction with a new kind of diet plan that can kick start the production of growth hormone. Diets such as the ketogenic diet can be extremely beneficial in achieving this goal. A ketogenic diet when combined with intermittent fasting can really expedite the process. We must understand and make our patient population understand the alternatives to carbohydrates and how to utilize them in a moderate amount so that we get the most benefit. It must be said that there is no magic bullet, but our understanding of these hormones and their physiological effects can certainly create new treatment therapies, which can significantly improve the quality of life of our patient population.

References

1. American Diabetes Association. Statistics About Diabetes. https://www.diabetes.org/resources/statistics/statistics-about-diabetes. Retrieved on September 25, 2019.

2. Kim, S. H., & Park, M. J. (2017). Effects of growth hormone on glucose metabolism and insulin resistance in human. Annals of pediatric endocrinology & metabolism, 22(3), 145–152. doi:10.6065/apem.2017.22.3.145