A new and convenient biomarker for early insulin resistance

Elevated 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.