Insulin resistance
What is insulin? Insulin is a hormone secreted by the pancreas in response to the ingestion of a meal. Insulin binds to the cell membrane, causing it to “open the door” and allow the delivery of glucose into the cell. In this way, insulin removes excess glucose from the blood, which otherwise would be toxic. Insulin stops the use of fat as an energy source. In other words, insulin “switches” the cells from fat burning to fat storing mode. Once nutrients are cleared from the blood, the pancreas stops secreting insulin. Under normal conditions, this occurs within three hours.
What is insulin resistance? Insulin resistance (IR) is a condition in which insulin becomes less effective at lowering blood sugar levels. Either the circulating insulin does not bind to the insulin receptors on the cell or it binds but its effects are deficient, so that nutrients cannot be efficiently cleared from the blood. The pancreas then continues to secrete more insulin, leading to higher levels in the blood and for longer periods of time. This exposes the cells to abnormally high levels of insulin, which in turn leads to them becoming less and less responsive to insulin. Insulin resistance is an chronic, self-perpetuating condition. The more insulin resistant the cells become, the more insulin is secreted by the pancreas to deliver the nutrients from the blood into the cell.
What causes IR? Anthropologically humans as a species were designed to live a very different life style than the one we have today. Our bodies were designed to function best on a high protein, high “good” fat, high fiber, very low carbohydrates, mineral rich diet. Our bodies were designed to move, walk and run, over ten miles each day. Much like most living beings on this planet, we were designed to follow a circadian rhythm, which means going to sleep when the sun goes down and waking up with the sunrise. We were designed to deal with stress in the face of danger or an emergency, but to be able to relax and go into a parasympathetic mode (which is required for rest, sleep and proper food digestion) when the danger is over. Most, if not all, of the above factors may be necessary in assisting our body to maintain its health and normal blood sugar regulation. Instead, today many people consume diets high in sugar, carbohydrates and “bad fats” while low in protein and fiber. Their days are largely aberrant of circadian rhythm, including regular or intermittent sleep deprivation, and a sedentary and chronically stressful lifestyle.
Diet is probably the primary factor when it comes to IR. A high sugar/carbohydrates diet leads to abnormally high insulin spikes exposing the cells to constant abnormally elevated levels of insulin, which in turn causes them to become insulin resistant. However, other factors, such as exercise, adequate sleep and stress reduction are shown to be very important when it comes to managing IR as well. Other known contributors to IR include: genetic predisposition, ratio of Omega-3 and Omega-6 fatty acids as well as trans fatty acids in the cell membranes, deficiencies of chromium, magnesium, zinc, B-vitamins and possibly some other trace elements, as well as the use of nicotine.
Manifestations of IR. IR has many different ways of manifesting itself. In blood tests it usually manifests as elevated triglycerides (over 150), depressed HDL cholesterol (less than 40 in males, less than 50 in females). In HbA1C blood tests, results above normal (4% glucose bound to hemoglobin) may indicate insulin resistance, pre-diabetes and diabetes. Other manifestations of IR can include: abdominal obesity (waist to hip ratio greater or equal to 1 inch in males, or waist over 40 inches in circumference; waist to hip ratio greater or equal to 0.8 inches in females, or waist circumference over 35 inches), hypertension, arterial damage, and thick , sticky blood that tends to clot. Advanced IR may manifest in hypoglycemia, abnormal glucose tolerance (or fasting glucose over 100), and gestational or type II diabetes. IR has been linked to a number of serious health conditions, such as: hypertension, type II diabetes, heart attack/heart disease (Stanford University: Obesity, Insulin Resistance, and Cardiovascular Disease, School of Medicine ; Heart surgeon, Dr. Dwight Lundell, speaks out on what really causes heart disease ; The Wall Street Journal: The Questionable Link Between Saturated Fat and Heart Disease), atherosclerosis, stroke, cancers, especially breast, colon and prostate cancers (a couple of links on the subject Obesity, Insulin Resistance, and Cancer Risk by Edward L. Giovannucci, MD, ScD, Professor of Nutrition and Epidemiology, Harvard School of Public Health and CBN News: Starving Cancer: Ketogenic Diet a Key to Recovery), polycystic ovarian syndrome, neurological damage accompanying senility, thrombosis, uterine fibroids and some less serious conditions such as common acne. IR is a major contributor to obesity. Insulin promotes the formation of fat, technically known as lipogenesis. Insulin “switches” the cells from fat burning to fat storing mode. In other words, the more insulin a person secretes, the more likely he or she will gain weight.
Nutrition, Diet, and Lifestyle Factors for Managing Insulin Resistance. Though a serious condition, Insulin Resistance (IR) usually can be successfully managed with a diet and lifestyle modifications.
Diet. Ketogenic diet is a low glycemic (does not cause high blood sugar spikes after a meal), low insulinemic (does not cause high insulin spikes after a meal) diet, and is required in order to control IR. In other words, the diet needs to be high in protein, “good” fats, and fiber, and very low in carbohydrates and sugars. According to Mayo Clinic, ketogenic diet is helpful in reducing seizures in children with epilepsy.
There are a lot of wonderful highly nourishing delicious foods that will keep your insulin and blood sugar levels stable and will help you keep IR under control. Those foods are:
Proteins: meats, organ meat, fish, eggs, seafood, hemp seed, nuts, spirulina, kale. Be sure to only purchase meat which is free of growth hormones and antibiotics. Organic grass-fed and free range meat is the best choice. Wild caught fish is a much healthier choice than farm raised fish.
Beneficial fats: Fish oil, cod liver oil, animal fats, avocado, avocado oil, olive oil, coconut oil, nuts and seeds.
Fiber: green leafy vegetables are high in vitamins and minerals, and are a good source of fiber. Most vegetables contain some amount of good carbohydrates, however not significant enough to cause a problem. Avoid, however, starchy vegetables, such as potatoes and sweet potatoes. In cases of severe insulin resistance minimize other starchy vegetables as well , such as yams, beets and carrots (raw carrots have a lower glycemic index then cooked ones and can be eaten in moderation). In case of severe insulin resistance legumes need to be restricted as well because they contain a fair amount of carbohydrates: beans (green beans are ok), lentils, cashews, etc.
Avoid sugars, grains, breads, pastas. Avoid any soft drinks, including sport drinks or any other sweetened beverages. Avoid fruit juices. Instead drink water, herbal teas, and home-made sugar free lemonade (mix water with freshly squeezed lemon/lime juice, add few drops of stevia drops; you can even carbonate the drink if you wish). Avoid any sweeteners with high fructose content: fructose syrup/high fructose corn syrup (HFCS), agave (agave has even higher fructose content then HFCS), honey. Consumption of sweeteners that are high in free fructose damages the liver, contributing to nonalcoholic fatty liver disease, aggravates insulin resistance and leads to fructose-induced leptin resistance. Leptin is a hormone that signals to your body that it is full after a meal. In other words, leptin causes you to stop eating. Leptin resistance desensitizes your body to leptin, therefore, leading to constant feeling of hunger.
Drinking coffee is a highly controversial subject. From one side, coffee contains chlorogenic acid which is believed to increase insulin sensitivity of the cells. However, levels of the stress hormone cortisol are raised when caffeine is ingested, leading to elevated blood sugar which elevates insulin, aggravating IR. If you enjoy coffee, perhaps switching to organic decaf (non-chemically decaffeinated coffee) would provide the benefit of chlorogenic acid while minimizing the side-effects of caffeine.
Ideally dairy should be excluded from the diet. However, if you decide eliminating dairy completely might be too difficult, limit it to dairy products with high fat content (such as butter, sour cream, half-half, whipping cream, whole milk, cheese, unsweetened whole milk yogurt and kefir). Dairy fat is beneficial and as any fat it slows down digestion, preventing rapid glucose and insulin spikes. Avoid whey; whey is highly insulinemic (causes rapid insulin spikes). Avoid rice milk (rice is too highly insulinemic), or any other sweetened "milks" (soy milk, almond milk, hemp milk, etc.).
Some berries, such as cranberries, blueberries (especially wild blueberries), and blackberries are OK in moderation. Avoid high glycemic fruit, such as bananas, sweet varieties of apples, pears, mangoes, oranges, etc. Occasional grapefruit is ok. Lemons and limes are fine.
Start your day with a large protein loaded breakfast. Try to get as much as 35 grams of protein in (about half a pound of meat or fish; one egg contains approximately 6 grams of protein). Add in some good fats and vegetables for the meal to be more nutritious and satisfying. Make breakfast your main meal. It will help with sweet/carbohydrate cravings during the day and will keep you feeling full and satisfied until lunch time. Make lunch your second biggest meal, loaded with protein, good fats, veggies or greeneries. Try to eat most of your caloric intake before 2 pm. Have a light dinner around 6pm. A large nutritious breakfast and lunch will help you to not be very hungry at dinner time. Do not snack after dinner and try to go to bed around 9pm (before you get hungry for your evening snack).
Exercise. The ideal exercise routine to reduce IR would include:
- Walking at a brisk but comfortable pace for 30-60 minutes most days (walking broken up into multiple short segments rather than one long one);
- Intermittent burst-type maximal exercise, such as a sprint, bike sprint, or a short bout with weights. The burst exercises may be from 30 seconds to 5minutes, and may be integrated into a walking session;
- A short session of burst exercise two hours after the evening meal will clear nutrients from the blood and prepare the body for fat burning during sleep.
Without regular physical activity (which burns glucose and lowers insulin levels), insulin keeps increasing the ratio of fat cells to muscle cells. With more fat cells and fewer muscle cells, the body loses still more of its ability to efficiently burn up glucose. Ultimately, both glucose and insulin levels remain elevated.
Supplementation. Supplementation with chromium, magnesium, zinc, B-vitamins, trace minerals and Omega 3 containing oils (fish or cod liver oil) may be necessary.
Sleep. An average person requires at least 8 hours of sleep. People with insulin resistance may require as much as 9-10 hours of sleep a day. There is a direct correlation between lack of sleep and elevated blood sugar/ insulin resistance. The best way to get a good quality night sleep is to follow a circadian rhythm: go to bed when the sun goes down and wake up with the sunrise. Sleep deprivation is associated with reduced leptin, elevated ghrelin (hunger hormone), and increased body mass index. While leptin tells the body to stop eating, ghrelin is known as a hunger hormone or appetite enhancing hormone. Ghrelin has been linked to inducing appetite and feeding behaviors. As the hours of sleep increase, ghrelin concentrations lower, thereby potentially reducing appetite and avoiding potential obesity.
Stress. Stress hormones, such as cortisol and adrenalin, elevate blood sugar which in response elevates insulin. Individuals with pre-diabetic insulin resistance may flip into full blown diabetes under the influence of cortisol. Furthermore, cortisol increases the appetite for carbohydrates, which further aggravates IR.
Therefore, reducing overall stress levels in one’s lifestyle as far as possible, as well as finding good stress managing techniques, may be an important aspect to dealing with IR.
Herbs. Some herbs are thought to increase insulin sensitivity of the cells: sunflower seeds, vaccinium (leaf), fenugreek, cinnamon, maitake mushroom, basil and milk thistle seed. Incorporating these herbs into your daily diet and herbal teas might have a beneficial effect on IR.
Caution. It is very important to remember that a low carbohydrate diet can bring blood sugar levels and blood pressure within a normal range very rapidly, as well as rapidly improve type II diabetes. Therefore, if you take medication for insulin resistance-related symptoms, such as, for example, insulin or hypertension meds, you need to inform your doctor about starting on a low carbohydrate diet right away, so the dosage of your medication can be closely monitored and adjusted if needed.
What is insulin resistance? Insulin resistance (IR) is a condition in which insulin becomes less effective at lowering blood sugar levels. Either the circulating insulin does not bind to the insulin receptors on the cell or it binds but its effects are deficient, so that nutrients cannot be efficiently cleared from the blood. The pancreas then continues to secrete more insulin, leading to higher levels in the blood and for longer periods of time. This exposes the cells to abnormally high levels of insulin, which in turn leads to them becoming less and less responsive to insulin. Insulin resistance is an chronic, self-perpetuating condition. The more insulin resistant the cells become, the more insulin is secreted by the pancreas to deliver the nutrients from the blood into the cell.
What causes IR? Anthropologically humans as a species were designed to live a very different life style than the one we have today. Our bodies were designed to function best on a high protein, high “good” fat, high fiber, very low carbohydrates, mineral rich diet. Our bodies were designed to move, walk and run, over ten miles each day. Much like most living beings on this planet, we were designed to follow a circadian rhythm, which means going to sleep when the sun goes down and waking up with the sunrise. We were designed to deal with stress in the face of danger or an emergency, but to be able to relax and go into a parasympathetic mode (which is required for rest, sleep and proper food digestion) when the danger is over. Most, if not all, of the above factors may be necessary in assisting our body to maintain its health and normal blood sugar regulation. Instead, today many people consume diets high in sugar, carbohydrates and “bad fats” while low in protein and fiber. Their days are largely aberrant of circadian rhythm, including regular or intermittent sleep deprivation, and a sedentary and chronically stressful lifestyle.
Diet is probably the primary factor when it comes to IR. A high sugar/carbohydrates diet leads to abnormally high insulin spikes exposing the cells to constant abnormally elevated levels of insulin, which in turn causes them to become insulin resistant. However, other factors, such as exercise, adequate sleep and stress reduction are shown to be very important when it comes to managing IR as well. Other known contributors to IR include: genetic predisposition, ratio of Omega-3 and Omega-6 fatty acids as well as trans fatty acids in the cell membranes, deficiencies of chromium, magnesium, zinc, B-vitamins and possibly some other trace elements, as well as the use of nicotine.
Manifestations of IR. IR has many different ways of manifesting itself. In blood tests it usually manifests as elevated triglycerides (over 150), depressed HDL cholesterol (less than 40 in males, less than 50 in females). In HbA1C blood tests, results above normal (4% glucose bound to hemoglobin) may indicate insulin resistance, pre-diabetes and diabetes. Other manifestations of IR can include: abdominal obesity (waist to hip ratio greater or equal to 1 inch in males, or waist over 40 inches in circumference; waist to hip ratio greater or equal to 0.8 inches in females, or waist circumference over 35 inches), hypertension, arterial damage, and thick , sticky blood that tends to clot. Advanced IR may manifest in hypoglycemia, abnormal glucose tolerance (or fasting glucose over 100), and gestational or type II diabetes. IR has been linked to a number of serious health conditions, such as: hypertension, type II diabetes, heart attack/heart disease (Stanford University: Obesity, Insulin Resistance, and Cardiovascular Disease, School of Medicine ; Heart surgeon, Dr. Dwight Lundell, speaks out on what really causes heart disease ; The Wall Street Journal: The Questionable Link Between Saturated Fat and Heart Disease), atherosclerosis, stroke, cancers, especially breast, colon and prostate cancers (a couple of links on the subject Obesity, Insulin Resistance, and Cancer Risk by Edward L. Giovannucci, MD, ScD, Professor of Nutrition and Epidemiology, Harvard School of Public Health and CBN News: Starving Cancer: Ketogenic Diet a Key to Recovery), polycystic ovarian syndrome, neurological damage accompanying senility, thrombosis, uterine fibroids and some less serious conditions such as common acne. IR is a major contributor to obesity. Insulin promotes the formation of fat, technically known as lipogenesis. Insulin “switches” the cells from fat burning to fat storing mode. In other words, the more insulin a person secretes, the more likely he or she will gain weight.
Nutrition, Diet, and Lifestyle Factors for Managing Insulin Resistance. Though a serious condition, Insulin Resistance (IR) usually can be successfully managed with a diet and lifestyle modifications.
Diet. Ketogenic diet is a low glycemic (does not cause high blood sugar spikes after a meal), low insulinemic (does not cause high insulin spikes after a meal) diet, and is required in order to control IR. In other words, the diet needs to be high in protein, “good” fats, and fiber, and very low in carbohydrates and sugars. According to Mayo Clinic, ketogenic diet is helpful in reducing seizures in children with epilepsy.
There are a lot of wonderful highly nourishing delicious foods that will keep your insulin and blood sugar levels stable and will help you keep IR under control. Those foods are:
Proteins: meats, organ meat, fish, eggs, seafood, hemp seed, nuts, spirulina, kale. Be sure to only purchase meat which is free of growth hormones and antibiotics. Organic grass-fed and free range meat is the best choice. Wild caught fish is a much healthier choice than farm raised fish.
Beneficial fats: Fish oil, cod liver oil, animal fats, avocado, avocado oil, olive oil, coconut oil, nuts and seeds.
Fiber: green leafy vegetables are high in vitamins and minerals, and are a good source of fiber. Most vegetables contain some amount of good carbohydrates, however not significant enough to cause a problem. Avoid, however, starchy vegetables, such as potatoes and sweet potatoes. In cases of severe insulin resistance minimize other starchy vegetables as well , such as yams, beets and carrots (raw carrots have a lower glycemic index then cooked ones and can be eaten in moderation). In case of severe insulin resistance legumes need to be restricted as well because they contain a fair amount of carbohydrates: beans (green beans are ok), lentils, cashews, etc.
Avoid sugars, grains, breads, pastas. Avoid any soft drinks, including sport drinks or any other sweetened beverages. Avoid fruit juices. Instead drink water, herbal teas, and home-made sugar free lemonade (mix water with freshly squeezed lemon/lime juice, add few drops of stevia drops; you can even carbonate the drink if you wish). Avoid any sweeteners with high fructose content: fructose syrup/high fructose corn syrup (HFCS), agave (agave has even higher fructose content then HFCS), honey. Consumption of sweeteners that are high in free fructose damages the liver, contributing to nonalcoholic fatty liver disease, aggravates insulin resistance and leads to fructose-induced leptin resistance. Leptin is a hormone that signals to your body that it is full after a meal. In other words, leptin causes you to stop eating. Leptin resistance desensitizes your body to leptin, therefore, leading to constant feeling of hunger.
Drinking coffee is a highly controversial subject. From one side, coffee contains chlorogenic acid which is believed to increase insulin sensitivity of the cells. However, levels of the stress hormone cortisol are raised when caffeine is ingested, leading to elevated blood sugar which elevates insulin, aggravating IR. If you enjoy coffee, perhaps switching to organic decaf (non-chemically decaffeinated coffee) would provide the benefit of chlorogenic acid while minimizing the side-effects of caffeine.
Ideally dairy should be excluded from the diet. However, if you decide eliminating dairy completely might be too difficult, limit it to dairy products with high fat content (such as butter, sour cream, half-half, whipping cream, whole milk, cheese, unsweetened whole milk yogurt and kefir). Dairy fat is beneficial and as any fat it slows down digestion, preventing rapid glucose and insulin spikes. Avoid whey; whey is highly insulinemic (causes rapid insulin spikes). Avoid rice milk (rice is too highly insulinemic), or any other sweetened "milks" (soy milk, almond milk, hemp milk, etc.).
Some berries, such as cranberries, blueberries (especially wild blueberries), and blackberries are OK in moderation. Avoid high glycemic fruit, such as bananas, sweet varieties of apples, pears, mangoes, oranges, etc. Occasional grapefruit is ok. Lemons and limes are fine.
Start your day with a large protein loaded breakfast. Try to get as much as 35 grams of protein in (about half a pound of meat or fish; one egg contains approximately 6 grams of protein). Add in some good fats and vegetables for the meal to be more nutritious and satisfying. Make breakfast your main meal. It will help with sweet/carbohydrate cravings during the day and will keep you feeling full and satisfied until lunch time. Make lunch your second biggest meal, loaded with protein, good fats, veggies or greeneries. Try to eat most of your caloric intake before 2 pm. Have a light dinner around 6pm. A large nutritious breakfast and lunch will help you to not be very hungry at dinner time. Do not snack after dinner and try to go to bed around 9pm (before you get hungry for your evening snack).
Exercise. The ideal exercise routine to reduce IR would include:
- Walking at a brisk but comfortable pace for 30-60 minutes most days (walking broken up into multiple short segments rather than one long one);
- Intermittent burst-type maximal exercise, such as a sprint, bike sprint, or a short bout with weights. The burst exercises may be from 30 seconds to 5minutes, and may be integrated into a walking session;
- A short session of burst exercise two hours after the evening meal will clear nutrients from the blood and prepare the body for fat burning during sleep.
Without regular physical activity (which burns glucose and lowers insulin levels), insulin keeps increasing the ratio of fat cells to muscle cells. With more fat cells and fewer muscle cells, the body loses still more of its ability to efficiently burn up glucose. Ultimately, both glucose and insulin levels remain elevated.
Supplementation. Supplementation with chromium, magnesium, zinc, B-vitamins, trace minerals and Omega 3 containing oils (fish or cod liver oil) may be necessary.
Sleep. An average person requires at least 8 hours of sleep. People with insulin resistance may require as much as 9-10 hours of sleep a day. There is a direct correlation between lack of sleep and elevated blood sugar/ insulin resistance. The best way to get a good quality night sleep is to follow a circadian rhythm: go to bed when the sun goes down and wake up with the sunrise. Sleep deprivation is associated with reduced leptin, elevated ghrelin (hunger hormone), and increased body mass index. While leptin tells the body to stop eating, ghrelin is known as a hunger hormone or appetite enhancing hormone. Ghrelin has been linked to inducing appetite and feeding behaviors. As the hours of sleep increase, ghrelin concentrations lower, thereby potentially reducing appetite and avoiding potential obesity.
Stress. Stress hormones, such as cortisol and adrenalin, elevate blood sugar which in response elevates insulin. Individuals with pre-diabetic insulin resistance may flip into full blown diabetes under the influence of cortisol. Furthermore, cortisol increases the appetite for carbohydrates, which further aggravates IR.
Therefore, reducing overall stress levels in one’s lifestyle as far as possible, as well as finding good stress managing techniques, may be an important aspect to dealing with IR.
Herbs. Some herbs are thought to increase insulin sensitivity of the cells: sunflower seeds, vaccinium (leaf), fenugreek, cinnamon, maitake mushroom, basil and milk thistle seed. Incorporating these herbs into your daily diet and herbal teas might have a beneficial effect on IR.
Caution. It is very important to remember that a low carbohydrate diet can bring blood sugar levels and blood pressure within a normal range very rapidly, as well as rapidly improve type II diabetes. Therefore, if you take medication for insulin resistance-related symptoms, such as, for example, insulin or hypertension meds, you need to inform your doctor about starting on a low carbohydrate diet right away, so the dosage of your medication can be closely monitored and adjusted if needed.
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