A typical belief that any skin problem is merely a matter of aesthetics, a localised issue that affects our look, is far from the truth. Many conventional doctors address skin problems, treating the skin as an absolutely isolated organ without addressing an actual cause that could be coming from an underlying medical issue, wrongly perceived as “unrelated to skin”. One such cause is insulin resistance.
Many visible skin issues and disorders are actual indicators of our metabolic dysfunctions and often undiagnosed serious conditions such as insulin resistance.
Excessive weight and skin health
Abdominal obesity or excessive weight in the midsection of our body (represented by a high waist-to-hip ratio, and not necessarily high BMI) is one of the well-recognised signs of insulin resistance. Yet patients are still seeking quick methods to remove this fat aesthetically without addressing true underlying cause-an insulin resistance. Similarly, the same individuals suffering from insulin resistance would have various skin issues, lacking proper education and assessment pointing out the actual cause. It looks like our bodies intend to give us clues (by making us “fat and ugly”) that something serious is happening inside our bodies. And insulin resistance is a serious condition that can progress into: type 2 diabetes, dyslipidemia (high cholesterol) and CMS (heart attack, hypertension, PCOS, non-alcoholic fatty liver disease, Alzheimer’s, and various cancers. The Functional Medicine approach is dedicated to treating patients understanding these connections and not undermining skin issues related to insulin resistance.
What are the skin issues related to high insulin and excessive weight?
-Acanthosis nigricans (increased pigmentation)
-Accelerated skin aging
Acanthosis nigricans (dark patches)
This condition is characterized by increased pigmentation and skin thickening and has a velvety texture. Often is accompanied by an odor. These dark patches usually appear on skin folds in the armpits, back of the neck, underneath female breasts, elbows, knees, knuckles etc. Patents often ask for aesthetic procedures such as chemical peels, lasers, etc. to remove these patches as it often negatively impacts their self-esteem and quality of life. However, this seemingly “skin condition” is a true sign of chronically high insulin as it is considered as a clinical sign of insulin resistance. According to a study, constant exposure to high levels of insulin and IGF-1(insulin growth factors) causes skin cells (keratinocytes and fibroblasts) to grow and replicate, resembling that thick, dark velvety patches. Instead of trying to remove it with an aesthetic procedure, patients suffering from this condition should be screened for insulin resistance and type 2 diabetes, and the underlying cause of Insulin resistance must be addressed vigorously with Functional Medicine tools.
What is excessive consumption of carbohydrates and processed food packed with artificial trans fats is to do with acne? These foods, gut issues (gut endotoxemia), heavy metal toxicity, genetic predisposition, excessive stress, nutritional depletion (magnesium, chromium, vitamin D), and sleep deprivation could all be root causes of insulin resistance. In one study, compared to women without acne, women with acne showed higher fasting insulin levels, abdominal fat, and PCOS. Typically acne appears in the lower third of the face and neck.
High insulin and midsection obesity may contribute to acne in men, too. Post-adolescent men with acne more commonly have insulin resistance and may develop hyperinsulinemia or type 2 diabetes in the future. These patients should not be treated only with aesthetic procedures but should be followed up for a prolonged time to determine whether they develop conditions associated with insulin resistance.
Potential mechanisms by which high insulin causes acne may be related to the increase in Insulin growth factors (IGF-1) and a decrease in binding proteins, which may affect the functioning of the body’s natural retinoids. Furthermore, elevated androgens, as we see in PCOS patients, may stimulate sebum production, a necessary step in developing acne.
Skin tags are small, soft growths on the skin, non-contagious but often mistaken for warts. They can vary in color and size, hanging off the skin. Skin tags usually grow on the neck, armpits, under the breasts, around the groin, eyelids, etc. They do not usually cause pain or discomfort. However, they can have a psychological impact on a self -esteem. Patients typically seek aesthetic intervention for skin tag removal, and although it is successful, one must not forget the real cause of their appearance. Insulin resistance with excessive abdominal fat is found in most cases. The functional medicine approach used for Insulin resistance will reverse insulin resistance and eliminate skin tags too!
Accelerated skin aging
It is evident that patients suffering from insulin resistance and type 2 diabetes look older and have more wrinkled skin. A lot is to do with advanced glycation end products(AGEs).
Some AGEs are formed internally via a non-enzymatic reaction of proteins with carbohydrates and accumulate in many tissues during aging. They are responsible for many age and diabetes-related diseases. On the other hand, AGEs are also formed by the heating of the food – think about that crispy chicken skin that is packed with AGEs, and that increases overall aging, including skin aging. High carbohydrate intake increases AGEs too, and causes persistent insulin elevation and potentially high blood sugar (hyperglycemia). Over time, even modest hyperglycemia can result in a significant accumulation of AGEs.
Advanced glycation end products (AGEs) increase oxidative stress and contribute to wrinkles formation. These adverse effects of both internally and externally derived AGEs skin have been implicated in the formation of diabetic complications and changes associated with aging. In a very simplified way, we need to decrease carbohydrate and well-done fatty meat intake for our flawless skin.
Other skin conditions
Hidradenitis suppurativa and psoriasis are additional conditions that may be consequences of insulin resistance.
There is growing evidence supporting the link between psoriasis and cardiovascular problems associated with insulin resistance and abdominal fat. Studies showed that psoriasis patients had a higher occurrence of metabolic syndrome and insulin resistance compared with the general population, and patients with more severe psoriasis had greater chances of insulin resistance with complications than those with milder psoriasis.
Metabolic disorders, including obesity and insulin resistance syndrome, are the most common associated conditions observed in patients with hidradenitis suppurativa. Hidradenitis suppurativa (HS) is a painful, long-term skin condition characterized by boil-like lumps, cysts, scarring, and channels in the skin that leak pus. It usually occurs near sweat glands, around the groin, bottom, breasts, and armpits. It can tremendously affect the psychological well-being of a patient suffering from it.
While aesthetic procedures and certain medications may be helpful, if insulin resistance or metabolic syndrome are primary contributors to these skin conditions, it may be more effective for the long term improvement and reversal to target that underlying metabolic dysfunction using Functional Medicine.
All references are available on request.Tags: Abdominal Obesity, Alzheimer’s, Excessive weight, High Insulin, high insulin and excessive weight, Insulin Resistance, Non-alcoholic Fatty Liver Disease, PCOS, Skin Health, Weight Issue