Hypothalamic Role in the Insulin Resistance Syndrome
At the outset I must logically concede that in the span of a single chapter, it is not possible to aptly review the existing common fund of knowledge relating to hypothalamic control of insulin resistance. I have therefore chosen to discuss a few choice groups of “neuronal circuits” within the hypothalamus that have profound inﬂuences on peripheral metabolism, are generally poorly recognized, and are not primarily focused on feeding behavior per se. Even within the self-imposed conﬁnes of this outline, the complexity of the brain and the complications of the insulin resistance syndrome prevent the composition of a ﬁnished story. Nonetheless, the presented material offers new insights and perspectives into the pathophysiology of the insulin resistance syndrome that hopefully will trigger new approaches to scientiﬁc endeavor by investigators in this ﬁeld. A primary tenet of this chapter is that the insulin resistance syndrome need not be the result solely of genetic “defects” but contrariwise evolved as a survival strategy in an environment of (annual) cyclic food availability and quality. Evolution selected for neuronal plasticity within the central nervous system (CNS), particularly within the hypothalamus, that allows for both the natural development and reversal of the syndrome.