Insulin resistance: Why and How to Avoid it

Insulin resistance (IR) is related to the body’s blood sugar regulation and can be regarded as essentially an imbalance in a particular individual’s food consumption relative to what is needed. Insulin is a hormone that allows glucose to enter the body’s cells where it is used as energy. More glucose means more insulin is needed. When there’s habitually more sugar provided than can be used up or easily stored, the cells that typically absorb it get full and can’t take more of the glucose that the insulin is presenting to them—they resist it. IR is thus characterized by the body’s inefficient use of insulin due to the repeated presence of excess glucose.

IR can be a transient state, but if the imbalance is perpetuated it eventually becomes more deep-seated and difficult to reverse. IR is widely prevalent among Americans, although it’s considered a “silent” disorder because the signs are not readily apparent. However it’s worthy of awareness because it’s fundamentally integral to a host of other ailments, including type 2 diabetes, non-alcoholic fatty liver disease, high BMI and PCOS. IR can even lower pregnancy implantation rates and is implicated in recurrent miscarriage. The good news is the progression from a pre-diabetic state to full blown diabetes is predictable and largely preventable. 

There are a few different ways to clinically test for IR, including tracking your blood glucose levels at key point throughout the day with a glucometer. Because it’s part of a spectrum disorder, then chances are if enough of the common signs and symptoms are evident, then IR is present. Here are some things to look for:

• sugar/carb cravings
• sleepiness after meals, mid-afternoon energy dip
• being hungry all the time 
• abdominal fat
• acne, especially with large facial pores
• skin tags
• darkened skin at the back of neck, armpits, groin (acanthosis nigricans)
• scalp hair loss on front & sides 
• difficulty losing weight 
• excessive thirst & frequent urination 
• high triglycerides/low LDL cholesterol  

I think of insulin resistance as essentially a condition where the digestive center is overwhelmed with an overabundance, which may be in the form of: too high a proportion of simple carbohydrates or sugar, excess food in general, and/or too much food toxicity (including processed sugar, alcohol, trans fats, GMOs and chemicals). The simplest way to balance this is to scale back on the excess by keeping the good stuff and slashing the junk, and helping it all advance by increasing movement. 

For perspective, consider that between meals the body typically needs less than a teaspoon’s worth of sugar circulating in the bloodstream. Consumption that results in excess of this must either be used up quickly, or put into storage. Excess glucose which is not readily burned is stored in fat cells or in the liver. In order to prioritize glucose metabolism, the presence of insulin signals fat cells to hold onto fat, so fat can’t be metabolized when insulin is busy addressing glucose. This is ok in balance, but ideally there will be times when the body switches gears to allow fat metabolism as well. When insulin can do its job efficiently, there is more opportunity to use up fat. Ideally our body fat status should be one of cycling or rotation, rather than one of constant storage. 

One of the obvious ways to avoid the sugar merry go round is to steer your metabolism more toward nutritious fiber, clean proteins and healthy fats. Remember there is no one-size-fits-all when it comes to diet. Your individual tastes, goals, metabolism, hormonal state and genetic predisposition all factor in. But if you suspect IR is an issue for you, then consider the following guidelines as a basic starting place to help your metabolism shift gears. You may find that structuring your days in supportive ways that includes a good diet and regular movement will go a long way toward helping you avoid heading down the path of insulin resistance.

• Cut out added sugars and junky foods: sugary drinks, processed snacks, pastries & white flour-based foods, refined grains, alcohol, trans-fats. 
• Avoid the blood glucose roller-coaster by keeping a modest level of carbs in relation to other healthy macro nutrients. A good rule of thumb is to include some protein and fat in each meal.
• Eat plenty of whole food fiber. Soluble fiber is insulin sensitizing, and insoluble fiber helps maintain healthy gut flora. Colorful fruits & vegetables are high in polyphenols and antioxidants, which help neutralize free radicals in the body that cause harmful inflammation, which in turn correlates with IR.
• Eat foods rich in omega-3 fatty-acids, such as SMASH fish (salmon, mackerel, anchovies, sardines and herring), flax, chia, and walnuts.
• Cook with herbs and spices that can increase insulin sensitivity, including fenugreek, turmeric, ginger, garlic, cinnamon.
• Eat mindfully, in a pleasant and relaxed setting. Digestion is vastly improved when the nervous system is in a receptive mode. No matter what you’re eating, take a moment to bring awareness and appreciation to your meal, welcome your food, chew thoroughly, etc.  
• Make dinner your smallest meal of the day. The body is more efficient at metabolizing glucose in the morning as compared to the evening. Enhance this with a 10-minute walk after dinner, which helps improve digestion, lower blood fats and sugars. 
• Use up your excess glucose with exercise! Depending on the type, movement can increase insulin sensitivity for a couple of hours or even a couple of days. Just 30 minutes of moderate walking every other day is enough to reverse mild IR. More reasons to take breaks from too much sitting and get your daily steps in!
• Sleep well. Inadequate sleep is linked to many health issues, including IR and type 2 diabetes. Studies show that getting less than 7-8 hrs of restful sleep impacts our hormones, making us crave sugar, feel hungrier overall, and reduces insulin sensitivity. Catching up on sleep can help reverse these effects. Maintaining a schedule that supports the body’s natural circadian rhythm is ideal. Countering this too much or too often adds unnecessary stressors that throw our hormones out of whack, including insulin.
• Manage your stress response. The body brings more sugar online in response to stress, so blood sugar goes up. Too much time in a stressful state contributes to IR. In addition, your metabolism is enhanced when your nervous system is in rest/digest mode. Avoid unnecessary emotional and physical stressors where you reasonably can. 
• If you are carrying extra weight, losing 5-10 percent of body weight can significantly improve IR.
• Time off: Giving your metabolism a break from digestion can be an effective way to make space for healing to happen. Intermittent fasting is a popular technique but may not be appropriate for everyone. If you’d like to try it, start with a modest schedule. Most healthy adults can easily handle an overnight stretch of 12-15 hours away from food.

A final few words on carbohydrates:

• Don’t get too caught up in strictly limiting carbs. Keeping a modest amount of healthy carbs such as starchy vegetables and whole grains can help you feel happy and satiated. Moderation is fine for most people, so try small amounts, spread throughout the day (less sugar at eat meal makes insulin’s job easier).
• Which carbs matters. Healthy carbs are generally low glycemic, meaning they release sugars slowly, often because they are one component of a high-fiber food such as whole grains, cereals, legumes, lentils. So go mainly for “slow” carbs.

If you’ve implemented these practices and need additional support, consider acupuncture and Chinese herbal medicine. Talk to your health care advisor about supplements that may be appropriate for your case, such as magnesium, NAC, myo-inositol, milk thistle, omega-3s and alpha-lipoid acid.

References:

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Arora, T., & Taheri, S. (2015). Sleep Optimization and Diabetes Control: A Review of the Literature. Diabetes therapy : research, treatment and education of diabetes and related disorders, 6(4), 425–468. https://doi.org/10.1007/s13300-015-0141-z

Celik, N., Evsen, M. S., Sak, M. E., Soydinc, E., & Gul, T. (2011). Evaluation of the relationship between insulin resistance and recurrent pregnancy loss. Ginekologia polska, 82(4), 272–275.

Chang, E. M., Han, J. E., Seok, H. H., Lee, D. R., Yoon, T. K., & Lee, W. S. (2013). Insulin resistance does not affect early embryo development but lowers implantation rate in in vitro maturation-in vitro fertilization-embryo transfer cycle. Clinical endocrinology, 79(1), 93–99. https://doi.org/10.1111/cen.12099

Edwardson, C. L., Henson, J., Bodicoat, D. H., Bakrania, K., Khunti, K., Davies, M. J., & Yates, T. (2017). Associations of reallocating sitting time into standing or stepping with glucose, insulin and insulin sensitivity: a cross-sectional analysis of adults at risk of type 2 diabetes. BMJ open, 7(1), e014267. https://doi.org/10.1136/bmjopen-2016-01426

Mooren, F. C., Krüger, K., Völker, K., Golf, S. W., Wadepuhl, M., & Kraus, A. (2011). Oral magnesium supplementation reduces insulin resistance in non-diabetic subjects – a double-blind, placebo-controlled, randomized trial. Diabetes, obesity & metabolism, 13(3), 281–284. https://doi.org/10.1111/j.1463-1326.2010.01332.x

Reynolds, A. N., Mann, J. I., Williams, S., Venn, B. J. (2016). Advice to walk after meals is more effective for lowering postprandial glycaemia in type 2 diabetes mellitus than advice that does not specify timing: a randomised crossover study. Diabetologia 59, 2572–2578. https://doi.org/10.1007/s00125-016-4085-2