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Life is an injury-repair-injury cycle. Repair of damage caused by ongoing cellular injury expands cellular energy requirements – need for more adenosine triphosphate (ATP) generation in mitochondria, ATP being the unit of energetic currency of the body. To produce more ATP energy rapidly, mitochondria need fuel that is readilymetabolized. Glucose serves this role better than any other source of energy in the body. Enter insulin. It is the primary mover of glucose across cell membranes into the cell innards. Insulin, viewed in this light, is the principal energy-regulating hormone in the body. Therefore, the designation of minister of energy and metabolism is appropriate.
Hyperinsulinism, viewed in this broader context, may then be visualized as an enhanced energy response of the body to meet the increased energy demands of injured cellular populations in the repair process. The broader and deeper the cellular injury, the larger the energy-for-repair need, and greater the insulin production in the pancreas to meet that demand. This is the author's "energetic response-to-cellular-injury" view of hyperinsulinism. This is also the simple explanation of the beginning of hyperinsulinism, which the author has observed in patients with diverse chronic inflammatory diathesis – from psoriasis to pustular acne, from rheumatoid arthritis to systemic lupus erythematous, from hepatic steatosis to cirrhosis, from Crohn's colitis to recurrent diverticulitis, from polycystic ovarian syndrome to ovarian endometriosis. Indeed, more indolent the inflammatory process, the greater the degree of hyperinsulinism as documented with numerous insulin and glucose profiles in the author's Darwin and Dysox Trilogy, the 10th, 11th, and 12th volume of The Principles and Practice of Integrative Medicine.20-22
Assessing Insulin Homeostasis in Integrative Medicine
For health preservation and reversal of chronic diseases in the general population, the author heavily relies on the assessment of insulin homeostasis with three-hour insulin and glucose profiles. Wide variations in insulin responses to a glucose challenge among profiles of an individual are the rule, not an exception – as is the case in diagnostic histopathology. In the context of cancer therapeutics, this core point reaches beyond the prevailing notions of metabolic syndromes related to hyperinsulinism. Two case studies of prostate cancer (Tables 2 and 3) are especially illuminating in the context of cancer co-morbidities of severe and persistent stress (Table 2) and Type 2 diabetes (Table 3). As an aside, Table 2 shows a "flat" post-glucose-challenge tolerance pattern (here the fasting blood glucose level of 82 mg/mL is followed by post-glucose load levels of 75, 63, and 60). This is usually dismissed as an error produced by the patient not taking the glucose load. In reality, the "flat" glucose tolerance pattern is produced by a brisk initial insulin spike which masks the expected initial glucose spike. This can be readily proved by measuring glucose and insulin levels at the half-hour mark.
Co-Morbidities of Cancer and Insulin Dysregulation
Co-morbidities of all chronic disorders worsen the degrees of the primary disease processes. Severe and persistent stress is usually a notable co-morbidity of both cancer and insulin dysregulation, but its clinical manifestations have a wide range.
The author made his main points concerning insulin dysregulation encountered in women with breast cancer in his comments e-published by Nature and excerpted earlier in this paper. Simply stated, several factors associated with the diagnosis and chemotherapy for breast cancer lead to hyperinsulinism which, in turn, set the stage for further growth and spread of cancer. Insulin profiles of three women with breast cancer (Table 1) show patterns of insulin responses to surgery and chemotherapy.
The author's main point: It can be reasonably argued that: (a) hyperinsulinism evoked by cancer diagnosis and treatment favors tumor growth and spread; (b) the faster growth and wider spread of the tumor deepens the degrees of hyperinsulnism; (c) the cancer-hyperinsulinism cycles continue to fan their own fires; and (d) good patient care demands that all relevant safe and effective integrative therapies be implemented in treating cancer. I address these critical issues at length in writings on the subject.12,13
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Majid Ali, MD, is author of the 12-volume series The Principles and Practice of Integrative Medicine. He is also the founder of the YouTube Science, Health, and Healing Encyclopedia, and producer and host of the program "Science, Health, and Healing" on MNN TV and WBAI radio (New York). In addition, Dr. Ali is president of the Institute of Integrative Medicine and was formerly associate professor of pathology at Columbia University.