Are you suffering from obesity? Is your weight increasing suddenly? Tired of trying every diet plan and exercise and still getting no results?
Here's why you are gaining weight and not able to lose it even after all possible measures. You might have insulin resistance.
Insulin resistance can cause obesity, type 2 diabetes mellitus, hypertension, dyslipidemia and cardiovascular disease which most people these days are affected by. Many people have more than one and sometimes all of these conditions.
Let's discuss how insulin resistance causes these problems.
OBESITY: Insulin resistance causes hormone leptin resistance which inhibits hunger and diminishes fat storage in adipocytes. Now, since there is leptin resistance, you continue to feel hungry even when you are full. This leads to overeating and hence obesity.
HYPERLIPIDEMIA: Insulin resistance causes high FFA (free fatty acid) flux and TG (triglycerides) synthesis in the liver. There is also decreased HDL (high-density lipoprotein) cholesterol levels (a significant risk factor for heart disease), increased serum VLDL (very low-density lipoprotein), cholesterol and TG levels which leads to hyperlipidemia.
HEART DISEASE: In the liver, fat accumulation causes oxidative stress and lipid peroxidation occurs in an insulin-resistant person. The consequence of this physiological dysfunction increases the risk for the development of diabetes and atherosclerosis and increased the risk for coronary artery disease.
DIABETES: Insulin resistance also leads to the development of Type 2 Diabetes Mellitus. In an insulin-resistant state, your pancreas makes extra insulin. For a while, this will work, and your blood sugar levels will stay normal. But over time, your pancreas won’t be able to keep up. This will exhaust your pancreatic beta cells and eventually it will stop producing insulin. This will raise your blood sugar levels until you have prediabetes or diabetes.
HYPERTENSION: Insulin resistance can lead to hypertension through compensatory hyperinsulinemia. It stimulates the sympathetic nervous system, increases renal sodium retention, modulates cation transport, and induces hypertrophy of vascular smooth muscle.
METABOLIC SYNDROME: Insulin resistance can also lead to Metabolic Syndrome (MetS). Metabolic syndrome is a complex interrelated but specific risk factor for CVD (cardiovascular disease) and T2DM (Type 2 Diabetes Mellitus) like hypertension, high fasting blood glucose levels, high TG levels, low HDL levels which we already understood.
Prevalence of IR
Worldwide, the prevalence of insulin resistance varies from 15.5 to 46.5%, among adults.
Why is the risk of IR is higher in Indians?
Indians have a high percentage of body fat, more visceral fat and less lean muscle mass. This is called the 'thin-fat' phenotype which increases the risk of insulin resistance syndrome in Indians. This could be influenced by the parental size, maternal food intake, physical activity and circulating concentration of nutrients and metabolites at an early stage of life. It can be improved by improving aspects of fetal growth, reducing overnutrition in later life, and controlling environmental factors. Prevention of T2DM must begin in utero and continue throughout life.
Now that you know why insulin resistance is bad news, let's understand what it is, how it can be diagnosed, and treated.
To understand insulin resistance let's first understand what insulin itself is.
Insulin is a hormone necessary for uptake, storage and use of carbohydrates, fats and protein (our body fuels).
It acts like a key that helps unlock cells to let glucose inside the cell to make energy. When we eat a meal, the absorbed glucose in the blood triggers the secretion of insulin secretion which helps uptake, storage and use of glucose.
But when a person is insulin resistant, their body becomes resistant to the hormone insulin. In this condition, your body can produce the hormone insulin but is unable to use it for glucose uptake, storage and use. Initially, there is a compensatory increase in the release of insulin secretion causing hyperinsulinemia which maintains blood glucose concentration in the normal range. But eventually, your beta cells get exhausted and stop producing insulin. This leads to glucose buildup in your bloodstream. This is seen in Type 2 Diabetes Mellitus, Prediabetes and Gestational Diabetes Mellitus.
What are the causes and risk factors for Insulin Resistance?
Bad diet: A bad diet will directly influence your health. Eating foods containing excessive amounts of fructose (sugar), branch chain amino acid (BCAA) (protein), ethanol (alcohol), and trans fat in the form of soda beverages, desserts, alcohol, whey protein shakes, bakery items, etc. can cause IR by causing inflammation in the liver and subsequent fatty liver. The liver then exports this fat to other organs including muscle tissue and pancreas turning them into insulin resistance. These four items are usually present in all processed and packaged foods.
Also, another important factor is a low fiber diet. A diet low in fiber is considered a bad diet. This is because fiber helps in cutting down the effects of fructose, BCAA, ethanol and trans fat. All processed foods contain very low or negligible amounts of fiber. Another important factor is the high intake of saturated fatty acids in the form of red meat, dairy, vanaspati etc.
Behavioural factors: Some bad behavioural habits like late sleeping time, late wakeup time, inappropriate meal timings, no physical activity are also important risk factors for insulin resistance. Having meals throughout the day, especially late evening. Not having a proper sleep schedule which can lead to stress. No involvement in physical activity as it helps increase insulin sensitivity. Also deficiency of Vitamin D because of poor sunlight exposure can cause insulin resistance.
Liver fat: Liver fat is one of the causes of insulin resistance. It is liver fat that dictates the insulin dynamic problems. When you have excess liver fat, non-systemic fatty acid synthesis occurs which is de novo lipogenesis which exhausts lipid export machinery which in turn causes intrahepatic lipid deposition and hence insulin resistance.
High BMI (body mass index): It can occur because of high BMI i.e. obesity especially abdominal fat. Adipose tissue produces inflammatory cytokines such as TNF alpha which causes inflammation and hence insulin resistance in the liver. This IR in the liver causes high compensatory insulin production by the pancreas. High insulin levels in blood turn acute IR into chronic IR. This same effect is also caused by insulinogenic Diabetes medications such as exogenous insulin and Sulfonylureas. If you have a BMI of more than or equal to 25 kg/m² you are at risk. Also, an Inactive or sedentary lifestyle is a risk factor as it can cause the buildup of fat in your body.
Chemicals: Some endocrine-disrupting chemicals like BPA (found in plastics), DDT, polybrominated diphenyl ether (PBDE) found in items such as sofas, carpets, and electronics, are believed to cause insulin resistance too.
Gestational diabetes: Next is gestational diabetes since pregnancy is related to hyperinsulinemia that may cause some women to develop diabetes. During pregnancy, your body makes more hormones and goes through different changes, such as weight gain. These changes cause your body's cells to use insulin ineffectively, leading to insulin resistance.
Genetics: A family history of diabetes, obesity or insulin resistance can be a risk factor. Even your ethnicity, if your ancestors are from Africa, Latino, or Native American, southeast Asia you are at risk of developing insulin resistance.
Smoking: Smoking directly increases the risk for insulin resistance due to its effects on abdominal obesity. Nicotine can also trigger your body to make more triglycerides, a type of fat that can lead to insulin resistance. It also raises levels of hormones that fight insulin.
Ageing: Ageing is another risk factor for developing insulin resistance. As you age your risk increases.
Other: Some health conditions like NAFLD (non-alcoholic fatty liver disease) and PCOS (polycystic ovary syndrome) can also lead to insulin resistance. Other causes and risk factors include hormonal disorders like Cushing’s syndrome or acromegaly, medicines like steroids, antipsychotics, HIV medications and sleep problems like sleep apnea.
Signs and symptoms of insulin resistance?
Acanthosis nigricans: Patches of dark, velvety skin like the groin, armpit and especially on the neck region.
Fatigue
Frequent thirst and urination
Tingling of hands and feet
A waist circumference of more than 35 inches (90 cm) for men and more than 32 inches (80 cm) for women.
Blood pressure readings of 130/80 or higher
A fasting glucose level over 100 mg/dL
A fasting triglyceride level over 150 mg/dL
An HDL cholesterol level under 40 mg/dL in men and 50 mg/dL in women
Diagnosis of Insulin Resistance?
HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) is a test used to determine if a person has insulin resistance. The blood sugar levels may be normal, but if the insulin levels are high, the body may be struggling to maintain blood sugar levels in balance. HOMA-IR tells how much insulin the pancreas needs to make to control the blood glucose levels.
Other blood tests are:
Fasting plasma glucose test measures your blood sugar after you haven’t eaten for at least 8 hours.
Oral glucose tolerance test where you'll take the fasting glucose test, then have a sugary drink solution. Two hours after that, take another blood test.
Hemoglobin A1C (HbA1c), blood test shows your average blood sugar level for the past 2 to 3 months. Doctors use it to diagnose prediabetes or diabetes.
Medications
Some medications used for controlling blood glucose levels can also cause insulin resistance like Insulin and Sulfonylureas. Because of insulin resistance, there's also leptin resistance and hence overeating and weight gain too. However, some good medications help improve insulin resistance like Metformin, Alpha-glucosidase inhibitors (acarbose), thiazolidinediones and GLP1 receptor antagonists.
Treatment of Insulin Resistance?
Insulin resistance can be managed and treated by lifestyle modifications such as improving your diet, including physical activities in your day to day life, improving quality of sleep, managing stress, and mental health.
Diet: Excess of fructose, BCAA, alcohol and trans fat should be avoided in the diet. These foods are found in sugary drinks, processed foods, beverages, soda, bakery items. A healthy diet, which includes more complex carbohydrates in the form of whole grains and pulses is recommended. Whole grains are also a good source of fiber both soluble and insoluble. Dietary fiber increases insulin sensitivity by inducing the synthesis of glucagon-like peptide 1 which delay gastric emptying, increase insulin-dependent glucose uptake, inhibit glucagon secretion, stimulate insulin secretion and reduce hepatic glucose production.
Examples of soluble fibers are legumes, beans, apples, citrus fruits, and insoluble fibers are the bran, seeds, fruits with skin, vegetables.
Good quality protein from vegetable sources like pulses, legumes, nuts and seeds, low-fat milk and milk products; non-vegetarian sources like egg, fish, lean cuts of meat and poultry. To improve the quality of protein from vegetarian sources, a cereal pulses combination can be used.
Good quality fat, mainly unsaturated fats like MUFA (monounsaturated fatty acid), PUFA (polyunsaturated fatty acid) and omega 3 fatty acids is recommended. Some good sources of fats are nuts and oilseeds like avocado, pumpkin seeds, flaxseeds, chia seeds, sunflower seeds, olive oil, seed butter like tahini. Canola oil and fish oils are also good sources.
Sodium in the diet should be monitored. The general recommendation is 2300 mg/day. To increase the palatability of the foods sodium adjuncts can be used like vinegar and lemon. Some of the examples are kokum and jeera chutney, peas chutney, tomato chutney, etc.
Micronutrients deficiency (magnesium, chromium, selenium, zinc, vitamin A, folate, biotin, thiamin, vitamin C, D, E) plays an important role in insulin resistance. Therefore, it is important to include these micronutrients in the diet. A good way to include all important micronutrients in the diet is by having whole grains, nuts, 4-5 servings of vegetables, 1 - 2 servings of fruits, and 1 - 2 servings of low-fat dairy or dairy products daily.
Chromium picolinate has been shown to reduce insulin resistance and to help reduce the risk of CVD and T2DM. Dietary chromium is poorly absorbed, and it decreases with age. Supplements containing 200-1,000 mcg chromium as chromium picolinate a day have been found to improve blood glucose control.
Avoid:
Processed foods and beverages as they contain higher portions of sugars mainly fructose and trans fat which causes insulin resistance.
Red meats should be avoided as they contain saturated fat.
Saturated fatty acids like butter, ghee, coconut oil, palm oil and Trans Fats like vanaspati ghee, margarine, oil containing processed foods should be completely avoided.
Alcohol should also be restricted in the diet as it contains ethanol which is again a cause for insulin resistance.
Smoking as it causes oxidative stress which causes insulin resistance.
Behavioural Factors: Some factors like sleeping schedule, eating schedule, stress management, the inclusion of physical activity improve your insulin resistance. Having meals in an 8-10 hour window is also important. Late night meals should be avoided. Getting out to get enough sunlight exposure to get vitamin D as its deficiency leads to insulin resistance is important. Also having a proper sleep schedule and getting enough sleep is important for improving insulin sensitivity.
Exercise: Individuals with insulin resistance can reverse it by involving themselves in daily physical activity since it helps to improve insulin sensitivity, glucose utilization, lipid profile, blood pressure, as well as weight loss and maintenance. Since abdominal fat contributes to insulin resistance, regular exercise helps in reducing this fat and thus increases insulin sensitivity. According to World Health Organization, one should do at least 150–300 minutes of moderate-intensity aerobic physical activity per week.
If you are diabetic 15 min of easy to moderate exercise after each meal helps curb risky blood sugar spikes all day. Evening post-meal walk is the most effective in lowering blood glucose levels for a full 24 hours. If you have hypertension, fractionized exercise (10 mins 3 times a day) is more effective than a continuous 30 min exercise.
Stress: Stress management is another important factor for a healthy lifestyle. If you're stressed, your body will produce the hormones cortisol and adrenaline which makes it difficult for insulin to work properly leading to IR. So check with your doctor if you're stressed and ways you can deal with it.
Sleep: Have a good sleeping schedule where you sleep for at least 8 hours. Since partial sleep deprivation over even one night increases insulin resistance.
Water intake: Inadequate water intake causes the conversion of glucose to fructose in the liver which in turn causes fatty liver and hence insulin resistance. Hence, 6 - 8 glasses or 2.5 litres of water should be consumed daily.
Success stories of our members:
Mr Aditya, came to TGHC with his HOMA IR values very high, weighing 124kg. Our Registered Dietitian and health coaches guided him through his meal plans, exercise, stress management, sleeping pattern and appropriate fluid intake to manage his insulin resistance. In just about 3 months, he lost 20 kgs and his Insulin resistance was significantly improved.
Sign up for a free consultation with our Health Coach to further understand the topic and take quick tips to change your life positively
References:
https://www.sleepfoundation.org/physical-health/sleep-and-blood-glucose-levels Ekpenyong CE. Micronutrient deficiency, a novel nutritional risk factor for insulin resistance and Syndrome X. Arch Food Nutr Sci. 2018; 2: 016-030. DOI: 10.29328/journal.afns.1001013
Fahed, M., Abou Jaoudeh, M.G., Merhi, S. et al. Evaluation of risk factors for insulin resistance: a cross-sectional study among employees at a private university in Lebanon. BMC Endocr Disord 20, 85 (2020).
https://doi.org/10.1186/s12902-020-00558-9 Gestational diabetes mellitus, Eman M. Alfadhli, MD, FRCP Saudi Med J. 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404472/
Cigarette Smoking: An Accessory to the Development of Insulin Resistance Ashley Artese, MS, Bryant A. Stamford, PhD, and Robert J. Moffatt, PhD, Am J Lifestyle Med. 2019 Nov-Dec; 13(6): 602–605.Published online 2017 Aug 23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6796230/
https://www.webmd.com/diabetes/nicotine-blood-sugar: Raygor V, Abbasi F, Lazzeroni LC, Kim S, Ingelsson E, Reaven GM, Knowles JW. Impact of race/ethnicity on insulin resistance and hypertriglyceridaemia. Diab Vasc Dis Res. 2019 Mar;16(2):153-159. doi: 10.1177/1479164118813890. PMID: 31014093; PMCID: PMC6713231.
Ageing and Insulin Resistance: Just Say iNOS, Joseph L. Evans and Ira D. Goldfine. American diabetes association 2013 Feb; 62(2): 346-348. https://doi.org/10.2337/db12-1239
Insulin resistance syndrome, GOUTHAM RAO, M.D., University of Pittsburgh Medical Center–St. Margaret, Pittsburgh, Pennsylvania, Am Fam Physician. 2001 Mar 15;63(6):1159-1164
https://www.researchgate.net/figure/Link-between-insulin-resistance-and-metabol ic-dyslipidemia-Insulin-resistance-is_fig4_236691925
https://www.apollo247.com/lab-tests/homa-ir-insulin-resistance-index IDF Global Fact Sheet 2019, 9th edition.
YouTube video by Prof. Lustig on Towards a unifying hypothesis of metabolic syndrome.
A Short Walk After Meals Is All It Takes to Lower Blood Sugar, Written by Sandy Calhoun Rice — Updated on October 7, 2018
Early Life Origins of Insulin Resistance and Type 2 Diabetes in India and Other Asian Countries, C. S. Yajnik, Diabetes Unit, King Edward Memorial Hospital and Research Center, Rasta Peth, Pune 411011, India
The 10-Minute Workout, Times Three. By Gretchen Reynolds July 25, 2012
Three 15-min Bouts of Moderate Postmeal Walking Significantly Improves 24-h Glycemic Control in Older People at Risk for Impaired Glucose Tolerance by LORETTA DIPIETRO, ANDREI GRIBOK, MICHELLE S. STEVENS, LARRY F. HAMM, PHD, WILLIAM RUMPLER.