Have you been struggling to lose weight? Have you been told to just eat "healthier" and exercise more? If this sounds like you, know that you are not alone and that it is not your fault. The culture around weight loss is not very supportive. Weight loss, like any other concerns you may have, requires deep investigation. Finding the root cause of your stubborn weight gain can help you achieve sustainable and successful weight loss.
What is Insulin resistance?
Insulin is a building hormone, it is released by your pancreas in response to carbohydrate and protein intake. It signals your cells to uptake said carbs and protein so that they can be used for energy. When there is a surplus of energy, the rest is stored in your fat cells. Insulin is a very important hormone for balancing blood sugar and providing your body with fuel. However, a problem arises when insulin becomes dysregulated and rises disproportionately to blood sugar.
Similar to diabetes, insulin resistance happens when the body needs much more insulin in order to sweep up the extra sugar and protein because the cells have become much less sensitive to its signals. A caveat with insulin resistance is that you do not have to be a diabetic to experience this. You may have perfectly "normal" blood sugar, but your insulin may be sky high. This may happen due to multiple factors.
What are the signs of insulin resistance?
Gaining weight predominately in the abdomen and trunk
Craving sweets and sugar
Struggle with weight loss or gain weight easily
Craving carbohydrates, rice, bread or pasta
Struggle to limit foods at meals or tend to binge eat
Family history of diabetes or have gestational diabetes
Family history or personal history of non-alcoholic fatty liver
Personal history of polycystic ovarian syndrome (PCOS)
Personal history of adult acne
Patches of skin on neck, armpit, groin or other creases that are dark and velvety
History of skin tags
Struggle to keep blood sugar stable ie. feeling hangry, shaky, dizzy or unwell if you go too long without eating
If this sounds like you, you most likely have insulin resistance.
What are the factors that can cause insulin resistance?
Here are some of the factors that can contribute to insulin resistance:
Yo-yo dieting. Yo-yo dieting is the process of restricting your calories below 1400 per day for a period time to lose weight. Once the weight is lost, regular calorie consumption goes back to normal and all the weight is gained back. This causes stress on the body, but also effects gut hormones that regulate insulin. These hormones are called incretins. Incretins such as GLP-1 (glucagon like peptide 1) and GIP (gastric inhibitory peptide), increase insulin sensitivity and increase satiety. Yo-yo dieting can suppress these hormones for up to a year after discontinuing a restrictive diet.
Dysbiosis. The gastrointestinal tract alone contains more microorganisms than human cells in the entire body. There needs to be a balance between the "good" and "bad" bacteria, viruses and fungi that live synergistically in the gut. Dysbiosis is when an imbalance occurs. More specifically, when talking about weight loss there is an imbalance between two families of microorganisms, the firmicutes and bacteriodetes. When the firmicutes are elevated, you can extract more calories from food, which doesn't help when trying to lose weight. Ironically, high fat diets tend to feed the firmicutes which result in inflammation and insulin resistance. So if you have tried a keto style diet to lose weight and it didn't work for you, this may be the reason why.
Poor Sleep. During sleep, the body resets all metabolic hormones including insulin. Research has shown that there is a direct correlation with lack of sleep and obesity. Further, after a couple of nights of sleep restriction, there is a 40% decrease in glucose tolerance and 24% decrease in insulin sensitivity. This means that the ability for your body to regulate blood sugar decreases, resulting in weight gain. Interestingly, one study showed that when people tried to induce sleep with medications, though their sleep improved, blood sugar actually worsened. If sleep is an issue for you and you are trying to lose weight, speak to your naturopathic doctor about how to naturally support sleep.
Meal timing. The time that you eat your meals is also very important in terms of insulin signalling. Your body's release of insulin runs on an internal clock or a circadian rhythm. To put it simply, when it's dark outside your insulin doesn't work to regulate blood sugar as well as it would during day-lit hours. So that means if you tend to eat late dinners, because your metabolism is ready for storing rather than burning, all that insulin and glucose will go straight to your belly.
Grazing & Snacking. You've probably heard the theory about eating 5 small meals a day is good for your metabolism. Unfortunately, it does the complete opposite. In insulin resistance, insulin levels tend to rise and stay high for much longer than someone with proper insulin signalling. If you have insulin resistance and you are eating every couple of hours, your insulin and blood sugar levels will continue to rise and compound.
Chronic Stress. Stress hormones such as cortisol, adrenaline and noradrenaline are responsible for the fight or flight response. Physiologically, when these stress hormones are released, they cause blood flow to move away from our digestive and reproductive systems to the extremities and stimulate the release of glucose and insulin. The fight or flight state is important during certain situations when you need to protect yourself, however, in our current society emails can stimulate this response. Chronic release of glucose and insulin due to stress, will stimulate fat storage as the body perceives a threat such as famine. The body is not looking to shed any fat when it believes it may not be eating for a while.
Eating foods that spike insulin. Certain foods have the ability to spike insulin disproportionately than others. Dairy, beef, fried foods and refined carbohydrates are some of the common foods that will spike your insulin. You can download my weight loss resistance meal plan on my website to ensure a diet that will not spike your insulin levels inappropriately.
Most likely you haven't been tested for insulin resistance.
So what should your next steps be? Unfortunately, insulin testing is not done very often. It is likely that you've had your fasting blood sugar and HbA1c tested, but not your insulin. Again, both of the above tests are great for monitoring blood sugar status, but they may not tell you if you have insulin resistance as insulin can rise disproportionately to blood sugar.
If you check off all the symptoms for insulin resistance, you can ask your health care provider to run fasting insulin. It is no different than any other blood test and is very inexpensive to run. Fasting insulin should be less than 50 pmol/L. Higher than that can be indicative of insulin resistance
In my practice, if I suspect insulin resistance or would like to rule it out, I tend to run a 2 hour fasting insulin-glucose challenge. If you have given birth before, you probably know the drill. After fasting insulin and glucose is tested, you will be given a drink of pure glucose. At 30 minutes, 1 hour and 2 hours your blood sugar and insulin will be tested in response to the glucose drink. This test provides a more accurate representation of where your insulin-glucose response is at.
If you suspect that insulin resistance could be the reason that you aren't losing weight after reading this article, please feel free to book a complimentary meet and greet appointment with myself, Dr. Ann-Marie Regina, ND to learn more about what we can do together.
References
Finally Lose It: A professional woman's guide to stop dieting, fix your hormones and overcome weight loss resistance. Wilson, Sarah. 2018. Amazon.
Holt, S H, et al. “An Insulin Index of Foods: The Insulin Demand Generated by 1000-KJ Portions of Common Foods.” The American Journal of Clinical Nutrition, vol. 66, no. 5, 1997, pp. 1264–1276., doi:10.1093/ajcn/66.5.1264.
Matenchuk, Brittany A., et al. “Sleep, Circadian Rhythm, and Gut Microbiota.” Sleep Medicine Reviews, vol. 53, 2020, p. 101340., doi:10.1016/j.smrv.2020.101340.