Because insulin is a major hormone, it is impossible for the body to balance its minor hormones (estrogen, progesterone and testosterone for example) until insulin metabolism is balanced first.
Being insulin resistant puts a woman at a much greater risk for many other conditions including diabetes, hypertension, heart disease, breast cancer, and PCOS (Polycystic Ovary Syndrome). Our metabolism developed thousands of years ago when our diet included fewer and more complex carbohydrates. Blood sugar imbalances, now rampant in our society, can become chronic and progressively serious, eventually leading to diabetes.
The first step of this progression is the development of insulin resistance, a state in which the muscle and fat cells no longer accept glucose. The body’s demand for fuel varies but the brain requires our blood sugar to remain stable. Getting the cells in the body the energy they need without changing our blood sugar level is a critical function played by insulin as it signals the cells to absorb glucose from the bloodstream. The body monitors what we have ingested, blood sugar level and cell demands, then releases insulin in the correct amounts. This process represents a healthy body that is “insulin sensitive.”
Many women’s diets are low in healthy fats and consist of an excessive amount of refined, processed carbohydrates from sugar and other processed foods, most notably those containing HFCS (high fructose corn syrup). Some of these foods are marketed as “healthy,” such as some breakfast cereals, low fat yogurt, diet soda, white bread, bagels, pasta, etc. Consuming these foods causes a rapid rise in blood sugar. The body manages this high blood sugar with a compensatory rapid rise in insulin. The overproduction of insulin causes a rapid and drastic reduction in blood sugar for a short period of time. (The brain can only last a few minutes without a steady supply of its fuel, glucose.)
This drop in blood sugar levels triggers a compensatory rise in cortisol level (responsible for moving sugar out of storage and into the bloodstream) which generates more of the same cycle including cravings for more carbs and sugar. Extra insulin travels with the new rise in blood sugar to transport the glucose into the cells for storage or energy production. Over time, however, the cells lose their ability to take in large amounts of glucose and this state is called insulin resistance. The cells in the body literally alter the shape of their insulin receptors so the insulin no longer fits the receptor and insulin can no longer transport glucose across the cell membrane. Both the insulin and the glucose are left to circulate in the bloodstream.
The body is not designed for prolonged high levels of insulin.
It disrupts cellular metabolism and spreads inflammation. Insulin disrupts fat metabolism. When the cells can’t absorb the extra glucose any more, the liver converts it into fat. Fat cells are loaded with glucose receptors so this is a vicious cycle. Ironically, while the insulin-resistant woman is gaining weight, her cells are actually “starved” for glucose so she feels exhausted and tends to eat carbohydrate heavy foods in search of energy.
The fat cells are now considered a metabolically active endocrine organ. The extra fat cells are little factories producing estrogen. This contributes to estrogen dominance which causes multiple symptoms in the perimenopausal transition for women.
This cycle of glycemic stress places a great burden on the HPA axis (hypothalamic-pituitary-adrenal axis). Elevated cortisol interferes with the function of estrogen, progesterone, and testosterone, and leads to increased progesterone conversion to cortisol and hence decreased progesterone, resulting in a state of relative estrogen dominance.
Anyone can become insulin resistant – even if they are thin.
The more processed and refined foods we eat, the more insulin we require to metabolize it. The more insulin in our blood, the less responsive our cells become. As we age, this continual exposure wears out our tolerance for refined carbohydrates and reduces our sensitivity to insulin.
Women with the greatest risk for developing insulin resistance and progressing into Metabolic Syndrome are those who suffered from gestational diabetes, have hypertension, are seriously overweight, or have a family history of Type 2 Diabetes.
Women who are apple-shaped, carrying their weight around their abdomen, show less tolerance for insulin. If a woman’s waist/hip measurement is >0.8 (divide waist measurement in inches by hip measurement in inches) she is at risk for developing insulin resistance.
A skin change called acanthosis nigricans, warty-like darkened patches of skin at the neck and armpits also indicates insulin resistance in over 90% of women.
The good news is that glucose metabolism is highly responsive to lifestyle changes and can be supported through dietary modification and supplementation. Weight loss improves insulin resistance. Specifically, losing abdominal fat if key. Also, to sustain weight loss, preserving muscle and lean mass is critical.
Diet and Lifestyle Interventions
Keys to an effective dietary prescription include:
- Eat a balanced breakfast and eat foods with a low glycemic impact. Eat on a regular basis every 3-4 hours to keep blood sugar levels stable.
- Reduce total calories while maintaining regular protein intake – consume some type of protein with each meal and snack throughout the day. Avoid dairy and meat that may have added hormones.
- Shift carbohydrate intake from sweets and wheat and flour containing products to whole foods – primarily organic vegetables, fruits, nuts and seeds such as chia, hemp and quinoa and home cooked cereals (not instant or refined) and less starchy vegetables and grains.
- Select healthy fats and include small fatty fish such as sardines, mackerel, herring and wild caught salmon, flax seed, nuts, olives and cold-pressed extra virgin olive oil, avocado, macadamia and coconut oils. Avoid all oils that are called “vegetable” and all corn, soy, safflower, sunflower and canola oils and foods made with partially hydrogenated and trans fats.
- Avoid all sweetened drinks – soda, fruit juices, sports and energy drinks.
- Avoid all artificial sweeteners, high fructose corn syrup and foods with preservatives and food colorings.
- Eat foods high in fiber to slow the absorption of glucose into the bloodstream. Include hard-shell beans such as kidney beans, navy beans and chickpeas. Adding a half cup of beans to a meal will significantly increase fiber intake or add other fruits, vegetables, nuts and seeds.
- Regular exercise is key but patients need to recognize that exercise without dietary changes is not going to be effective. Resistance exercise and aerobic exercise are both necessary. Exercise improves the sensitivity of the insulin receptors independently from diet.
One last note, never eat carbohydrates in isolation except for fruit. Fruit will not spike your glucose if you are not already insulin resistant. This depends on how insulin sensitive you are – fruit is a complex food that we evolved eating!
