What You Need to Know About Insulin Resistance & Pre-Diabetes

Do you carry extra fat around your middle (apple-shaped)? Do you have frequent cravings for sweet or salty snack foods or the feeling you are addicted to carbohydrates? Do you often experience afternoon fatigue?

Do you suffer from high blood pressure, high cholesterol or high triglyceride levels? Do you have trouble losing weight?

If so, you may have insulin resistance (IR), a condition associated with pre-diabetes. It's estimated that up to 75% of Americans may be insulin resistant, and most are unaware of the condition. Because of the link between insulin resistance and diabetes, heart disease, stroke, obesity and fertility problems, it's now recognized as one of our leading health epidemics. In June 2008, a new study showed insulin resistance was linked to Peripheral Arterial Disease (PAD), which leads to a 40% to 50% increased risk of heart attack and stoke.

The relationship between food, blood sugar, insulin and fat is a complex one. If you keep gaining weight despite following a low-fat diet, insulin resistance may be your problem.

What is Insulin Resistance? Pre-Diabetes?

Insulin is a hormone, just like estrogen, testosterone, cortisone and thyroid hormone. Insulin is secreted into your bloodstream by the pancreas to regulate the amount of glucose (your body's main source of energy) in your blood.

People with insulin resistance have a diminished ability to respond to insulin. Normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. In order to compensate, the pancreas produces more insulin.

As an example, if you have insulin resistance and eat carbohydrates, up to five times the amount of insulin is necessary to bring your blood glucose back down to healthy levels. And some people with insulin resistance produce so much insulin that their blood sugar levels dip way below normal, forcing them into hypoglycemia. When you experience intense cravings for sugary or starchy foods, there's a good chance it's due to hypoglycemia.

When insulin levels spike due to high glucose levels, it creates fat. And the more obese you are, the more insulin resistant you become, because the fat causes a spike in another hormone (cortisol) that prevents the insulin from working properly.

Lowering insulin levels will help you lose weight and make you thinner. As you lose body fat, insulin resistance will improve.

According to the American Diabetes Association, before people develop Type 2 diabetes, they almost always have pre-diabetes - higher than normal blood glucose levels. These levels are not yet high enough to be diagnosed as diabetes, but may already be causing long-term damage, especially to the heart and circulatory system. They estimate about 54 million people in the U.S. have pre-diabetes.

Symptoms of Insulin Resistance

Some of the common symptoms of insulin resistance include:

• Fatigue
• Brain (mental) fogginess
• Sleepiness and/or intestinal bloating (gas), especially after a meal containing more than one-third carbohydrates
• Increased blood triglyceride levels
• Weight gain, especially in the abdominal area, including a high body fat ratio and difficulty losing weight
• Brief periods of low blood sugar. Agitation, mood swings, nausea or headaches are commonly due to low blood sugar, and are often rapidly relieved once food is eaten.
• Depression

What Causes Insulin Resistance?

The culture and lifestyle of developed countries, especially in the U.S., are probably the leading cause of insulin resistance. Diets have become heavier in fructose (high fructose corn syrup, also known as HFCS), which causes changes in blood lipid profiles. Ordinary table sugar, sucrose (one-half fructose), is also a culprit. Accompanied by an abundance of high-fat, high-sodium convenience foods and a decline in exercise, the typical U.S. lifestyle is ripe for the development of insulin resistance. A diet high in sodas and fast food, loaded with carbohydrates, is a recipe almost certain to cause insulin resistance and pre-diabetes.

Insulin resistance has been linked to Polycystic Ovarian Syndrome (PCOS or Stein-Leventhal syndrome), although it is still unclear whether it causes, or is being caused by it. However, recent studies have linked the insulin sensitivity present in PCOS to a gene mutation.

Metabolic Syndrome, also referred to as Syndrome X, is another condition associated with insulin resistance. Dr. Charles Reaven of Stanford University was the first to recognize that many seemingly unrelated heath problems were caused by insulin resistance (1988). He created the CHAOS acronym to describe the complications resulting from insulin resistance:



• C - Coronary Artery Disease
• H - Hypertension
• A - Adult Onset Diabetes (Type 2)
• O - Obesity
• S - Stroke

Some studies have also linked glucosamine, often prescribed for joint and bone conditions, as a possible cause of insulin resistance. Other things known to aggravate insulin resistance include: caffeine, artificial sweeteners, nicotine, high stress levels and some medications, especially steroids.


Insulin Resistance & Pre-Diabetes Treatment

The primary treatment for insulin resistance is exercise and weight loss. Following a low-glycemic index diet or a low-carbohydrate diet to promote weight loss is usually recommended.

In some cases, Metformin and other diabetes medications are used to improve insulin resistance. Metformin is sometimes prescribed to promote weight loss in people with diabetes or insulin resistance. However, it's important to remember that these are not approved therapies. The "Diabetes Prevention Program" demonstrated that exercise and diet were nearly twice as effective as Metformin at reducing the risk of progressing to Type 2 diabetes.


The Insulin Resistance Diet

Written by Cheryle R. Hart, M.D. and Mary Kay Grossman, R.D., the book "The Insulin Resistant Diet" uses a link and balance eating method to stabilize insulin levels.

Because protein foods do not cause insulin levels to spike, they are ideal foods to eat when managing weight problems due to insulin resistance. The link and balance method in "The Insulin Resistance Diet" recommends eating one protein serving for each serving of a carbohydrate.

Examples of proteins recommended by "The Insulin Resistance Diet":



• Lean meats, fish, poultry and eggs
• Legumes, such as dried beans, lentils, peas and soy products
• Low fat or fat-free dairy products, like low-fat or fat-free milks and cheeses, including cottage cheese or yogurt with no sugar added
• Nuts and seeds, although you should limit your servings because they tend to be high in fat

Examples of meals using the link and balance method:



• Apple with a slice of low-fat cheese
• Potatoes with lean meat
• Crackers with low-fat lunch meat or deli meat
• Bread with no-sugar added peanut butter with the oil poured off

In addition, some supplements can help to reduce or eliminate insulin resistance. For example, chromium is often used to reduce carbohydrate cravings. In addition, magnesium and potassium are often deficient in a person with insulin resistance. However, these and other supplements should never be taken without consulting your physician. Adding a multi-vitamin is also recommended.

Controlling your insulin resistance now is important, because it can prevent pre-diabetes and eventually, diabetes and other health complications that accompany the disease. You'll also look and feel happier and healthier.

Learn more about diabetes and obesity or how to monitor your blood sugar levels from Diabetic Care Services.

References:
The Insulin Resistance Diet - www.irdiet.com
Washington Post - www.washingtonpost.com
American Diabetes Association - www.diabetes.org





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