Insulin Resistant or Not? - Ask a Nutritionist

Transcript:

Welcome to the “Ask a Nutritionist” podcast, brought to you by Nutritional Weight and Wellness. We are thrilled to have you join us today as we discuss the connection between what you eat and how you feel and share practical real life solutions for healthier living through balanced nutrition. Now, let's get started.

LEAH: Good morning and welcome to Dishing Up Nutrition's new midweek segment called “Ask a Nutritionist”. My name is Leah Kleinschrodt. I'm a Registered and Licensed Dietitian at Nutritional Weight and Wellness. On today's show, I will be answering one nutrition question we've received from our Dishing Up Nutrition listeners.

This listener wrote, “How does one know if they are insulin resistant or not?” Wonderful question. I love this question because it is so applicable to almost everybody who is probably listening or watching, or is even just walking around in the United States, because insulin resistance affects the vast majority of the United States population, whether people know it or not.

What is insulin resistance?

Before we dive into signs or symptoms of insulin resistance, I want to just take a moment and step back and talk about what insulin resistance is and compare that to how a normal metabolism is supposed to work. So if we think about when we eat foods that contain carbohydrates, these carbohydrates are broken down into small bits of sugar in the digestive tract. So mainly glucose. This glucose is absorbed into the bloodstream and it travels to all the various cells in the body. Glucose is one of the big energy currencies of the body. When our body senses that there's glucose in the bloodstream and when this glucose is rising, the body sends a signal to our pancreas to release a hormone called insulin.

So maybe some of these terms are familiar to you like glucose, insulin. So hopefully some of this is ringing a bell. Now, insulin's job is to go around in the body, collect that glucose that's floating around in the bloodstream and kind of carry it or chaperone it into our cells so that our cells can use that glucose for energy. And this is, I mean, when you were talking about energy, this could be our physical energy to go for a walk or to do a workout or to walk from your desk over to a coworker.

But this is also mental energy so that you can respond to your emails at work, so that you can do your crossword puzzle, so that you can do all sorts of things with your brain. And this is also emotional energy. So this energy gives us patience, it gives us focus, it gives us, again, the tools to be there and to have relationships with the people around us. So we need that energy for all sorts of things.

Now, if our cells already have enough energy in them, insulin says, okay, that's fine. We've got some extra storage space in the body that I can put this extra glucose in. And so those storage space areas in the body are the liver, are skeletal muscles, so think like your biceps or your quads or you know all the, all the muscles on your body, and also are adipose tissue. So aka our fat stores.

It is good to have some stores of glucose and stored fat on hand because these things keep us alive in between meals or it keeps us alive when we're sleeping overnight. And in our ancestors' day, those fat stores especially were needed when food would be scarce for months on end. So it is good to have some of these stores in there.

Now the question is how does this process go awry? To keep it simple, when we eat too many carbohydrates and sugar for what our bodies need, we do that time and time again over the course of months, years, and even decades. And we are then releasing too much insulin at the same time. So again, we have too much glucose and now we have too much insulin trying to deal with that glucose. What happens is our cells start to not respond to that insulin as well as they used to.

We have a lot of sugar floating around in the bloodstream. We have a lot of insulin floating around in the bloodstream. And then if we're eating refined oils or crappy fats on top of that, things like a lot of soybean oil, canola oil, corn oil, the vegetable oils, things like that, this kind of fatty sugary insulin type of mixture creates a crust over our cells or kind of this coating over our cells. When insulin comes along then and tries to do its job, it tries to bring more sugar into the cells, it can't now; because there's this crust over the doorway into that cell.

So your body tries harder. Maybe it starts kicking at the door, maybe it starts bringing a battering ram to that door to try to get that glucose in. Your body kicks out even more insulin. But that just exacerbates the problem even more.

So again, now we have these cells that are covered in a kind of crust and now we can't get nutrients into our cells and we can't get energy into our cells. That is insulin resistance. When we've got this crust over the doorways and we can't use that sugar or use that glucose and use the nutrients that we're getting from our food and get them into our cells effectively. That is insulin resistance.

How do you know if you have insulin resistance?

So how do you know if you have insulin resistance? What do you notice? How do you feel? What are signs that this is potentially an issue for you? So I compiled a a little list of some of the more common things that I look for with clients when we're looking to see if insulin resistance is a problem for them. This is by no means an exhaustive list, but I think it gives you a great starting place.

Lab work to be mindful of

And again, these are some of the more common things that I see in clinic. So some of these main things really may resonate for some of you listeners and viewers out there. Some of the objective measures out there: So if we're looking at lab work, there's different labs that we can look at that might give us some hints that insulin resistance is a problem, one of those being a fasting glucose level that is over a hundred milligrams per deciliter. So if you have some blood work done, usually a fasting glucose number is done either as a standalone lab or it's done as part of a metabolic panel where they're looking at other things in the blood; usually things like your electrolytes like sodium, potassium, magnesium, things like that. Then the glucose, that that fasting glucose number will be in that panel.

So if you're looking at that fasting glucose number and it is 100 milligrams per deciliter or higher, very likely we have some insulin resistance going on at that point because after a period of fasting, which for most labs they say, you know, at least eight to 10, but probably ideally 12 to 14 hours worth of fasting, if we still have too much sugar in our bloodstream after fasting for that long, that means again, we've got, we're not clearing that sugar out of our bloodstream the way that we should be.

And honestly, when I see nineties for fasting glucose, I even start to get concerned there. I don't like to be kind of floating on the high edge of normal. I like to have some buffer room for my clients. So even if you're in the nineties, still start thinking about, you know, insulin resistance, you might be kind of butting up against that. Now, a fasting glucose that's just a snapshot of what's going on in that moment with your blood sugar.

A more comprehensive look or a kind of taking it up to more like a 30,000 foot view would be doing a hemoglobin A1C. This is kind of looking at your average blood sugar over about a three month period. Now this is measured in percentile. So if you're looking at a hemoglobin A1C number, anything that is 5.7% or more, we are definitely looking at insulin resistance.

We are looking at 5.7% to 6.5%, we're in the prediabetes realm. And anything over 6.5%, we're now looking at frank diabetes. And again, you know, 5.5 to 5.6 for a hemoglobin A1C, we're floating on that cusp of having too high a blood sugars. So I'd like to see that number closer to maybe 5.4 or 5.2 or or even five, or some people I've seen even in the fours.

So that hemoglobin A1C, some doctors run that automatically, especially if you have a family history of diabetes. Sometimes you have to request it. It is a very common lab, so most practitioners are willing to run that. You can also look at a fasting insulin level. Now this one could be a little trickier to get from your provider. Some providers are open to it if you ask for it. Again, it's something that you typically have to ask for, but it's the same kind of idea: that fasting glucose after an overnight fast or after a period of fasting, if your insulin level is still running a bit too high, that means that your body, again, is kind of kicking out too much insulin for what is really called for at that time because that's what it's used to. It thinks it needs all that insulin floating around in the bloodstream to do its job.

Now, the cutoffs for what's considered high fasting insulin: I've seen different cutoffs there. I think for the sake of this podcast, I will suffice it to say anything over seven we're probably looking at some insulin resistance. And if you're in the double digits, I would say we're definitely looking at some insulin resistance there.

Now, if you look at your lipid panel, so, or your cholesterol panel, one number that's under that lipid panel is your triglyceride level. That triglyceride level is again, a kind of a measure of how much energy is still floating around in your bloodstream after a fast. So triglyceride level, most labs will say, if you're under 150, then you are good to go.

We like to keep it a little more strict and say we like to see it under a hundred milligrams per deciliter. That's a better number. So more in the double digits instead of the triple digits.So for over a hundred milligrams per deciliter, again, we may be looking at some of that insulin resistance, just more energy floating around in the bloodstream than there should be after a fasting period.

Now, high blood pressure can also be a signal of insulin resistance, not for everybody, but the nice thing about blood pressure, if you are kind of running in that hypertensive state, high blood pressure, just actually by controlling your blood sugar and balancing your blood sugars throughout the day, that can make a huge difference in your blood pressure. Also, when we have too high of insulin, again, that will typically drive that blood pressure up. So when we can lower insulin and lower blood sugar, it's a nice side effect, that blood pressure actually comes along for the ride.

Weight gain: common sign of insulin resistance

Another side of insulin resistance is weight gain; very common here. So weight gain in general, or if you gain weight pretty easily on a higher carbohydrate diet, or if you're having difficulty losing weight. Again, that's very general, very broad I know, but it's, it can be a signal like, hey, we've got some of this insulin resistance going on.

And especially when we're looking at that weight gain, if that weight gain tends to be a lot in the mid-section area, in that belly area, that belly fat, that is a big indicator that we've got insulin resistance going on just because that, that those sites specifically right in the abdomen, that is where our body likes to store a lot of that, that extra glucose, a lot of those extra carbohydrates floating around is right there in the belly.

Now for us women, if you've had a personal history of gestational diabetes, so again, that just means you had high blood sugar numbers and high blood sugars when you were pregnant, that's gestational diabetes. If that was you during pregnancy, even if it went away after pregnancy, you do have a higher risk for developing diabetes again later on in life.

Gestational diabetes and diabetes connection

And so we just know that women who have had gestational diabetes are more predisposed to having more of that insulin resistance and to potentially have more blood sugar problems later on. And for some of my clients, I ask too, did your mom have gestational diabetes when she was pregnant with you? Because we do know that higher blood sugars or uncontrolled blood sugars during pregnancy can actually have metabolic ramifications on the baby later on in life. We're talking even decades later in life. It kind of just sets up some of those genetic factors to line up to be more insulin resistance. So some people know that. Some people don't. Testing for gestational diabetes didn't get really great until somewhere around the 1950s, I believe. So again, some, some people may know that. Some people may not.

PCOS: commonly correlated with insulin resistance

Another one for us, women polycystic ovarian syndrome, PCOS. that is a, with that type of condition where you may have cysts on your ovaries. You may have high testosterone levels. You have some hormonal imbalances. High insulin levels and high blood sugars: that tends to come along for the ride also. So for women who deal with polycystic ovarian syndrome, that is typically we are addressing blood sugars and insulin resistance with that group of women.

Poor sleep: commonly correlated with insulin resistance

If I have a client who struggles with poor sleep or struggles with insomnia, that is a sign that we're probably butting up against some insulin resistance. When we don't sleep well and we don't allow our bodies or our bodies just can't clean house during that sleeping period, then our liver responds by kicking out more glucose. We tend to crave more sugar and more carbohydrates as an energy source, and over time that we'll build up more of that insulin resistance.

I mentioned sugars and carbs, like we tend to crave that when we are sleep deprived. But if we crave sugar in carbs and we're, even if we're sleeping well, that can be a sign of some of that insulin resistance also, that we're just not getting the energy or getting the nutrients into our cells. So we are craving some of those higher carbohydrate foods.

One indication of insulin resistance can be if you get sleepy or tired or feel like you kind of crash after a meal with lots of carbs, especially if they're more the refined carbohydrates. I actually had a client just earlier this week who said, if I eat a breakfast that is more like cereal or an English muffin or a bagel or toast, I crash so badly after an hour or two that I want to go back to bed and I feel like I am better off if I just don't eat anything at all. I feel like I actually have better energy if I don't eat at all versus if I eat a breakfast that has have those kind of carbohydrates.

So that's a perfect example of what I was just saying. If you spike those blood sugars and then they drop back down very quickly, you get that sleepy, tired, almost exhausted type of feeling, or you feel like you want to crawl under your desk and take a nap, that can be a sign of some of that insulin resistance, and probably more so again, like we've just got some blood sugar instability there.

Feeling hungry all the time: another potential sign of insulin resistance

Now, if you also feel hungry all the time, even after you've eaten a balanced meal that has some carbs, some good fats and some protein, that can be a sign of insulin resistance. Again, it just means that even after a good meal, your cells are not able to get some of those nutrients into them as they should. So even after a well-rounded balanced meal, you still are feeling hungry.

Some medications can cause insulin resistance

Some medications can cause insulin resistance. One class specifically, and there are more, but one class that I think about are steroid medications. And so steroid medications a lot of times are being used to control inflammation and sometimes it's just a short burst of those steroids to get some inflammation under control.

But some people are on steroid medications at a low dose for weeks, months, or even years. They're on it long term. So steroid medications are just one example that can cause high blood sugar numbers and more of that insulin resistance.

Stress can contribute to insulin resistance

And last but not least in the list that I created is stress. And not like you're stressed for an hour, you get over it, you move on with your day. We're talking about long-term chronic stress. Maybe you are caring, maybe your caregiver for a loved one or for a friend.

Maybe you have some turmoil going on in your life. Maybe you're moving houses. Maybe you have a new baby, or just like a shift in family dynamics. There can be those good stresses. There can be those negative stresses, but long-term chronic stress causes your cortisol levels to go up. So that's your big stress hormone. And when cortisol goes up and stays up, especially for a long time, that can increase insulin levels, increase blood sugar levels and increase then that insulin resistance.

So I hope some of that was helpful. Those were just some of the signs of insulin resistance; some of the things that I look for with my clients. There are certainly more of them out there. I'm sure we talked about some other ones on our Dishing Up Nutrition shows or on our blog posts. So if you're interested, you can go search out or just put in the search bar the term insulin resistance and you'll come up with more information.

Strategies to heal insulin resistance

But if you were going through this list with me and you're saying, yep, yep, or checking the boxes there, and if, if you suspect that this explains some of your health concerns, then I encourage you to think that now is the time to start working on eating real food, balancing your blood sugars so that your cells can start to heal and start to chip away at some of that insulin resistance crust that's on your cells.

And this is exactly what we help our clients with day in and day out in eating real whole foods in a combination: that protein, carbohydrate, healthy fat combination every three to four hours is going to be the most important thing that you do to control your blood sugars and control that insulin response.

Some people can reverse their insulin resistance pretty quickly, especially if they catch it a little earlier on. But others, it may take longer. It may take years to fully heal that insulin resistance. A lot of my clients, even if it does take a long time, usually they're seeing progress along the way, but it really may take some time to fully heal that insulin resistance.

And for some people, insulin resistance, they're just more predisposed to that. So it does, it does mean going forward, they need to be very mindful about their blood sugars, the types of carbohydrates that they're eating, that combination and eating regularly throughout the day. And that just needs to be their regular practice.

Supplement support for insulin resistance

Now, there's some supplements out there like omega-3 fatty acids that can help speed up that healing process. There are others out there, but I would also say it would be helpful to work with one of us, one, a dietitian or nutritionist, just to make sure that you are using the targeted supplements that are the most important for you. Because there are a lot out there, it can get overwhelming. And so it's important to kind of be able to sift through things with a professional.

Schedule Nutrition Counseling

And if you're feeling overwhelmed or if you just don't know where to start, then give us a call or get on the Dishing of Nutrition Facebook page, start asking more questions, read our blog posts, listen to some more podcasts, and maybe you're at the point where you're ready to dive in and sign up for an appointment with one of us counselors. Or maybe you're ready to jump into one of our programs like the Nutrition for Weight Loss Foundation series. We talk a lot about insulin resistance in that series and we really hit that very hard. Again, just because it's so common for our clients.

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