Insulin Resistance: An Overlooked Driver of Poor Metabolic Health & Weight Gain
Insulin resistance is a very common contributor to Type 2 Diabetes, weight gain, inflammation and cardiovascular disease. Yet, it’s not commonly screened for or assessed in medicine. And one mistake that people often make is thinking that you need to be drinking a 2L of soda per day in order to develop insulin resistance or pre-diabetes. That is simply not the case. What I see most often is individuals who are consciously trying to make better food choices but are not properly balancing their plates with enough protein and fat and eating too many moderate/high glycemic foods in one sitting.
Currently in the United States today, nearly 1 in 2 adults in the has either pre-diabetes or Type 2 Diabetes (T2D). Meaning almost HALF of the adult population has abnormal blood sugar levels. The saddest part about this condition is that it is entirely preventable! In the last 50 years, this diabetes evolution has been largely driven by increased access to highly processed refined carbohydrates and added sugars; the nature of sedentary lifestyles; stress, which can cause the body to create sugar; and lack of sleep, which is directly associated with poor glycemic control. You know what they say: make time for optimal health now or pay later. This is the perfect example of what paying later looks like.
Most People Don’t Know They Have Pre-Diabetes
While nearly half of the adult population suffers from poor glycemic control, most people aren’t even fully aware that this is an issue for them. It’s reported that approximately 11% of people with pre-diabetes state that they were told by a healthcare practitioner that they had this condition. Literally 11%. In other words, 90% of people with pre-diabetes do not know they have it! Which means they don’t even have the awareness to change their lifestyle, in order to reverse the condition.
Years and Years of Development
This is where you, as the patient needs to be an advocate for your health, your food, your schedule, your sleep and your well-being. News flash: you do not wake up one day and develop diabetes. There is no light switch of going from a healthy functioning endocrine system to diabetic. It’s a gradual progression that builds below the surface years and years, meals and meals before it fully manifests and the person is diagnosed.
What is Insulin Resistance?
More often than not, pre-diabetes begins to develop as a result of chronic consumption of a high glycemic diet high in added sugars and refined grains. This is a primary trigger for a person to become less insulin sensitive, or in other words, insulin resistant. Insulin resistance is often labeled as pre-pre-diabetes. And it goes undiagnosed regularly in medicine. Insulin is a hormone that is produced by the pancreas and carries sugar from your bloodstream, into the cells and tissue. When a person becomes insulin resistant, the cells are not able to respond to insulin efficiently, which leads to a buildup of sugar in the blood. So, the pancreas is prompted to produce more insulin in an attempt to normalize blood sugar levels. That can lead to hyperinsulinemia, which is also described as high levels of insulin.
Associated with Weight Gain
There are many reasons for why high levels of insulin are not desirable. A key reason is that insulin is a fat-storing hormone and can lead to weight gain since it stimulates lipogenesis, which is also known as fat storage. This is especially common around a person’s abdominal area, where you see an accumulation of visceral (or belly) fat.
Associated with Higher Triglycerides
Another reason is that insulin stores free fatty acids in your fat cells. When insulin is doing its job, it helps keep fat in your fat cells until your muscles need it during exercise. But if that system does not work well and a person becomes insulin resistant, fat is removed from fat cells and travels to the liver. This is where free fatty acids are repackaged as triglycerides. This is partly why eating a high glycemic diet filled with sugar (especially fructose) can increase the livers production of triglyceride particles. It also is associated with an increased risk of hypertension and cardiovascular disease. Insulin resistance is also associated with inflammation, type 2 diabetes and cardiovascular disease.
Visceral fat has been shown to increase production of pro-inflammatory cytokines that can disrupt normal insulin action in fat cells and lead to IR in adipose tissue, in addition to contributing to chronic inflammation. So, as a person develops insulin resistance, they will gain more which further contributes to a state of insulin resistance and explains why it can become so difficult to lose weight when you are insulin resistant.
Eating Too Much Rice + Beans Can Contribute to Insulin Resistance
For about 7 years, I was mostly a vegetarian (ate eggs + fish), because of the reported health benefits tied to improved heart health and longevity. What I did not realize is that my meals of rice + beans or oatmeal + strawberries were likely decreasing my insulin sensitivity. Many clients that I work with fall into a similar trap. They aren’t drinking soda or eating a lot of sugar but their meals are whole grain carbohydrates that are moderate to high in the glycemic index, with very little fat and protein. Can you eat a low carbohydrate vegetarian diet? Absolutely. This just takes more planning and intention to see the best results.
Right before we first started the Center for Functional Medicine at the Cleveland Clinic, I completed Dr. Hyman’s 10 Day Detox Diet because I knew that I would be working with many of his patients. For 10 days, a person eliminates gluten, dairy, grains, starchy vegetables, beans, added sugar, and artificial sweeteners.
A few days later, I was at the Ultra Wellness Center to train with Dr. Hyman and his team. I had just completed the 10 Day Detox Diet and noted: “I wanted to eat my arm off during those 10 days!” Knowing that my diet was gluten-free and vegetarian, Dr. Hyman suggested that I might have been hungry because my diet was lacking essential amino acids (amino acids that cannot be made by the body).
Interested in that idea, I had several lab panels done including fasting blood sugar, insulin, NMR lipid panel, thyroid panel, amino acid profile and more. I was shocked to find that my fasting insulin was a 10 and I had several key amino acids deficiencies. And while my insulin levels were technically very much in the normal range, they were not optimal considering my age, physical activity, sleep, and diet.
When I speak to meals that are higher in moderate glycemic carbohydrates and low in protein and fat, here are a few examples:
- Bowl of oatmeal with 1 cup strawberries with almond milk
- Bowl of quinoa with black beans and squash
- Salad with dried cranberries, edamame, kidney beans, diced apple and vinaigrette
- Smoothie with 1 apple, 1 cup spinach, 1 banana, 1 tbsp chia seeds, almond milk
If you are eating a whole foods diet but the glycemic load of each meal is too high, it will increase your blood glucose levels and thus, your insulin levels. This can make it difficult to move the needle in your blood work and your weight. This can lead to weight gain, decreased insulin sensitivity, insulin resistance, pre-diabetes, and eventually even type 2 diabetes.
How to Improve Insulin Sensitivity
- Follow The Optimal Plate Method and avoid eating carbohydrates alone.
- Avoid refined flours and refined grains.
- Reduced added sugar intake to no more than 1-2 tbsp per day.
- Avoid drinking liquid sugar like sodas and sweetened drinks (including ‘diet’ products and juices).
- Include 2 tbsp ground flaxseeds everyday.
- Aim for at least 40+ grams of fiber through whole foods sources.
- Focus on soluble fiber found in nuts, seeds, non-starchy vegetables, low glycemic fruit like berries and legumes
- Add 1-2 Tbsp organic, raw apple cider vinegar 1-2 times per day.
- Exercise regularly and move your body whenever possible
- Cardiovascular exercise for 30-45 minutes (5-6 days/week)
- Strength training 10-30 minutes (3 days/week)