Insulin resistance and Spleen deficiency: two readings of the same reality

If you are gaining fat despite eating reasonably, feeling fatigued after meals and experiencing persistent sugar cravings, it is likely that two mechanisms are overlapping in your case: insulin resistance as described by modern endocrinology, and Spleen Qi deficiency (Pi Qi Xu 脾气虚) as described by traditional Chinese medicine. These two concepts are not in competition with each other. They describe the same physiological phenomenon using two different vocabularies.

Insulin: the key that no longer opens the door

The mechanism of resistance

Insulin is the hormone produced by the pancreatic beta cells to usher glucose into cells. In a healthy individual, blood glucose rises moderately after a meal, the pancreas releases insulin in proportion, glucose enters the muscle and liver cells, and insulin levels return to baseline. Lipolysis - the breakdown of stored fat - can then occur between meals.

The problem arises when this system is chronically and excessively solicited. The modern diet, rich in added sugars, refined flour and ultra-processed products, provokes repeated glycaemic spikes that compel the pancreas to produce massive quantities of insulin several times a day.

Over time, the insulin receptors on cell membranes become less responsive to the signal. This is insulin resistance, first described by Gerald Reaven in 1988 under the name ‘Syndrome X’ (Reaven, 1988, Diabetes). The molecular mechanism involves abnormal phosphorylation of insulin receptor substrates (IRS-1 and IRS-2), which disrupts the intracellular signalling cascade.

Faced with this resistance, the pancreas responds by producing yet more insulin - this is compensatory hyperinsulinaemia. And as long as insulin remains elevated, hormone-sensitive lipase (HSL), the enzyme responsible for mobilising stored fat, is inhibited. The body is biochemically incapable of burning fat whilst insulin remains high, regardless of caloric restriction.

The five downstream consequences

Insulin resistance triggers a cascade of disruptions:

• Hepatic lipogenesis: excess glucose is converted into triglycerides in the liver, giving rise to non-alcoholic fatty liver disease (NAFLD), which affects 25% of the world’s population.
• Leptin resistance: the satiety hormone ceases to be recognised by the brain, maintaining artificial hunger despite considerable reserves.
• Chronic inflammation: hyperinsulinaemia stimulates the production of pro-inflammatory cytokines (TNF-alpha, IL-6, CRP), which in turn worsen insulin resistance.
• Cortisol disruption: the hypothalamic-pituitary-adrenal axis is activated, promoting the storage of visceral abdominal fat.
• Intestinal dysbiosis: the composition of the microbiome shifts in favour of pro-inflammatory bacteria.

The Spleen in TCM: the pivot of transformation

The Spleen-Pancreas, source of acquired Qi

In traditional Chinese medicine, the Spleen (Pí 脾) is the central organ of metabolism. Associated with the Earth Element and paired with the Stomach, it governs transformation (Yun Hua 运化) and transport (Yun Shu 运输) of nutrients. Its primary function is to transform ingested foods and fluids into food Qi (Gu Qi 谷气) and Body Fluids (Jin Ye 津液), then distribute these throughout the organism.

「

The Spleen is the source of Qi and Blood acquired after birth. When the Spleen is strong, the ten thousand diseases cannot arise. When the Spleen is weak, the hundred diseases are born.

」

Spleen Qi deficiency (Pi Qi Xu 脾气虚) is, in literal terms, a deficit in the capacity to extract energy from food. This inability to transform generates accumulation: untransformed fluids stagnate and form Dampness (Shi 湿), a pathological substance that manifests as heaviness, swelling and progressive weight gain.

The causes of Spleen deficiency

The Su Wen identifies the factors that progressively weaken the Spleen:

• Excess Sweet flavour: refined sugar and white flour overload the Spleen beyond its transforming capacity. This is the precise TCM equivalent of insulin resistance.
• Excess raw and cold foods: these extinguish the digestive fire of the Spleen, whose Yang nature requires warmth to function. Research confirms that digestive enzymes operate optimally at 37°C.
• Intellectual overwork: the Su Wen specifies that ‘excessive thinking knots the Spleen Qi’. Chronic stress elevates cortisol, which inhibits insulin secretion and promotes abdominal fat storage.
• Irregular meal times: constant snacking disrupts the Spleen’s natural rhythm. TCM advocates regular meals at fixed times - a principle that modern chrononutrition fully validates.

The correspondence table: insulin and Spleen side by side

Aliment	Nature	Saveur	Méridiens	Actions	Précautions
Normal insulin secretion	Strong Spleen Qi - efficient transformation	Balanced diet with moderate glycaemic index
Insulin resistance	Spleen Qi deficiency - diminished transforming capacity	Reduce refined carbohydrates
Compensatory hyperinsulinaemia	Spleen straining without result - ineffective overcompensation	Space out meals to allow insulin to fall
De novo hepatic lipogenesis	Production of Dampness (Shi) - untransformed substances	Bitter and pungent foods to drain
Non-alcoholic fatty liver disease (NAFLD)	Dampness obstructing the Liver	Berberine, artichoke, milk thistle
Leptin resistance	Phlegm obstructing the orifices of the Heart	Progressive, non-restrictive weight loss
Adipose tissue inflammation	Dampness-Heat (Shi Re)	Turmeric, omega-3, green tea

An integrative strategy to restore transformation

What works within both systems simultaneously

• Reduce refined sugars: lowers insulin spikes (science) and reduces the burden on the Spleen (TCM).
• Eat warm, cooked foods: optimises digestive enzyme activity (science) and preserves Spleen Yang (TCM).
• Space out meals (3 meals, no snacking): creates lipolytic windows by reducing basal insulin (science) and allows the Spleen to rest between transformations (TCM).
• Moderate physical activity: improves insulin sensitivity via GLUT4 (science) and mobilises Qi to resolve Dampness (TCM).
• Stress management: lowers cortisol (science) and unties Spleen Qi (TCM).

Key foods to tonify the Spleen and improve insulin sensitivity

Low-glycaemic-index foods with a Spleen tropism in TCM:

• Lentils (Hong Xiao Dou 红小豆): GI 32, neutral, tropism for Spleen and Heart
• Millet (Xiao Mi 小米): GI 71 but low glycaemic load, warm, tonifies Spleen and Kidney
• Sweet potato (cooked) (Shu Yu 薯蓣): GI 63, neutral, tonifies Spleen and Kidney
• Rolled oats: GI 55, warm, tropism for Spleen and Stomach
• Cinnamon (Rou Gui 肉桂): improves insulin sensitivity (science) and warms Spleen Yang (TCM)

FAQ

Can insulin resistance be reversed?

Yes, insulin resistance develops progressively and can be reversed. The three principal levers are: reducing overall glycaemic load, spacing out meals to allow insulin to fall, and increasing insulin sensitivity through physical activity and certain nutrients (chromium, magnesium, berberine).

How can one measure insulin resistance?

The most accessible marker is the HOMA-IR index (fasting blood glucose in mmol/L x fasting insulin in µIU/mL / 22.5). A HOMA-IR above 2.5 suggests significant insulin resistance. Ask your GP for a fasting insulin level in addition to the routine blood glucose test.

What TCM signs indicate Spleen deficiency?

The characteristic signs are: fatigue after meals, slow digestion, bloating, loose stools, a slightly sallow complexion, mental fog and a tendency to retain fluid. The classic Spleen deficiency tongue is pale, swollen with tooth marks on the edges, and covered with a slightly greasy white coating.

Back to the main guide: Metabolism and Weight Loss - Complete TCM and Science Guide