Your Hormones in Harmony | Part 3

Insulin: The Keeper of the Metabolic Keys

& Our Sticky Situation with Insulin Resistance


Posted in ,

Dr. Aaron Hartman

February 13, 2024

Hormones-Insulin

    Insulin is one of the three primary hormones in The Hormone Hierarchy that affect all other hormones. Without addressing insulin, cortisol, and thyroid, your secondary hormones will not be balanced regardless of what medications or supplements you take. Unfortunately, most of us are dealing with some form of insulin resistance, a sticky situation as we’ll see.

    What is Insulin?

    Insulin Viewed Under a Microscope

    Insulin plays a critical role in regulating blood sugar.

    Acting like a key, insulin unlocks our cells to allow glucose (sugar) to enter and either be used for fuel or stored as fat. When our body senses a rise in glucose, the pancreas secretes insulin, allowing our muscle cells to take in glucose for fuel and our fat cells to store glucose for the future.

    Without insulin, glucose would continue to accumulate in our blood stream, literally making our blood “sticky” and wreaking havoc throughout the body, all the while depriving our cells of energy.

    Insulin (light orange) binding allows structural changes within the receptor (blue) allowing the transport of glucose (yellow) into the cell through glucose transporter proteins (red).


    Our Sticky Situation

    What is Insulin Resistance?

    Insulin resistance is when our cells begin to ignore insulin and get a little sluggish at allowing glucose to enter. Although the pancreas produces insulin, the cells don’t respond well. Glucose accumulates in the blood, stimulating the pancreas to secrete more and more insulin. Eventually, this can progress to Type 2 Diabetes.

    How Common is Insulin Resistance?

    Insulin resistance is actually incredibly common. We tend to think about diabetes and insulin resistance together, but diabetes is an extreme version of insulin resistance.

    80% of the population in the United States has insulin resistance. Yes, you read that correctly. 15% of our population currently is diabetic, 35% is pre diabetic, and another 30% is insulin resistant.


    80% of the population in the United States has insulin resistance.


    How are Insulin Resistance, Pre-diabetes, and Type 2 Diabetes Diagnosed?

    • Diabetes (Type 2) is defined as an A1C at 6.5 or higher or fasting glucose over 125.
    • Pre-diabetes is defined as an A1C between 5.7 and 6.4 or fasting glucose between 101 and 125.
    • Insulin resistance is when your fasting glucose is between 85 and 100 and your A1C is less than 5.7 – even less than 5.5 in some individuals. Optimal A1C is less than 5.0. To diagnose insulin resistance, ideally we would check fasting insulin as well.

    Is insulin resistance really that important?

    The short answer is: absolutely yes. Insulin resistance affects your physical, mental, and emotional health as well as your risk of death.

    If your fasting glucose (blood sugar) is over 85, your risk for dying of a cardiovascular disease is increased by 40%. Insulin resistance is also linked with a 6-10% decrease in the volume of certain parts of the brain like the hippocampus, which is involved in learning, memory, and emotion. So insulin resistance can affect your memory, emotions, and the regulation of hormones.

    Insulin resistance is a major issue in the health of our population. The standard party line that a fasting glucose of less than 100 is not important is 100% wrong.

    So, why doesn’t our current healthcare system see insulin resistance as a problem? In our current, insurance-based system, we tend to focus on disease, not health and wholeness. Modern, western medicine focuses on the severe ends of the health spectrum and fails to consider the warning signs when people have increased risk but haven’t yet reached the predetermined threshold for disease. Most healthcare providers just don’t worry about that.


    So, why doesn’t our current healthcare system see insulin resistance as a problem? In our current, insurance-based system, we tend to focus on disease, not health and wholeness. Modern, western medicine focuses on the severe ends of the health spectrum and fails to consider the warning signs when people have increased risk but haven’t yet reached the predetermined threshold for disease. Most healthcare providers just don’t worry about that.


    Symptoms of Insulin Resistance

    • Bowel irregularities that cycle from constipation to diarrhea
    • Brain fog
    • Fertility issues
    • Irregular periods
    • Irritability
    • Water retention or edema
    • Weight gain

    Do these sound a little bit like sex hormone issues (e.g. estrogen, testosterone, or progesterone)? Or do they sound similar to adrenal or thyroid issues? That’s because hormones are all interconnected. They’re intended to function in harmony. You can’t just focus on one area and be an “expert” on thyroid or an “expert” on adrenals. We have to address all of these factors to allow the body to heal.

    Causes of Insulin Resistance

    • Chronic stress
    • Excessive alcohol consumption
    • Excessive caloric intake
    • Insufficient sleep (quantity or quality)
    • Nicotine
    • Nutrient deficiency
    • Oral contraceptives
    • Oral hormone replacement therapy
    • Processed foods

    Processed foods are one of the major causes for insulin resistance, as are excessive caloric intake and nutritional status. In fact, 80% of chronic illnesses in our country can be directly attributed to eating processed foods.

    “When you realize that 60% of what Americans eat is highly ultra processed. And 80% is processed in general, the question for you is: what are those 8 out of 10 things that you eat on a daily basis that are fake food? This is important because food becomes the primary building blocks for your body.” — Real Food Diaries

    It’s amazing to think that over half of our country is vitamin D deficient, and between 60-80% of our population has B vitamin deficiencies.

    Chronic stress can also drive up cortisol, the King of All Hormones, which can cause insulin resistance. Even oral hormones and oral contraceptives, especially the progesterone in these, can drive insulin resistance. High progesterone during pregnancy can affect sugar levels, which is one of the reasons why the oral glucose challenge test is done at around 28 weeks of pregnancy. Finally, thyroid imbalances, low DHEA, and sleep issues can all promote insulin resistance.

    Ok, so it’s a big deal... What, then, is the current conventional therapy for insulin resistance?

    Actually, there isn’t one. The typical protocol is to wait to intervene until someone is diabetic (when they have an A1C of 6.5 or higher and/or fasting glucose of 126 or higher). Some providers will be a little more aggressive and try to treat pre-diabetes to prevent it from progressing into diabetes. But for those people that have just insulin resistance with “normal” glucose in that 85 – 100 range, there is currently, no conventional therapy.

    Unacceptable. We can do better than that!


    Lifestyle Medicine for Insulin Resistance

    Lifestyle is the foundation for addressing insulin resistance. If you’re not moving, you’re not eating well, and you’re not sleeping, you can’t take enough nutritional supplements or herbs to counteract insulin resistance.

    Get Moving!

    Exercise is a crucial factor in treating and preventing insulin resistance. Exercise trains your muscles to use insulin appropriately. This does not mean that you have to join a gym. Increasing movement is very effective and can include doing yard work, tracking your steps, or going for a walk. Anything that gets your body moving counts! Unfortunately, most Americans are very sedentary due to our current lifestyles and work environments. Just getting up and going for a walk twice a day or going out to do some some yard work can greatly improve your muscles’ ability to use insulin.

    Food Is Medicine, So Eat Well!

    To treat insulin resistance with food, we focus on healthy fats, fiber, adequate protein, and low glycemic index foods. These are the primary dietary ways to address insulin resistance.

    • Healthy Fats: People often forget that healthy fats are incredibly important for sugar control as well as metabolic balance. We want to aim for a balance of 4:1 omega-6’s to omega-3’s and get adequate amounts of saturated fats. Saturated fats account for about 40% of the fat in your cell membranes. So without enough saturated fat, it’s like removing bricks from your house and hoping it will stand when the storm comes. We absolutely need enough of these foundational building blocks.
    • Fiber: Fiber is critical for sugar control. An easy way to make sure that you are getting enough fiber is to consume a plant-based, or plant-forward, diet focused on low-glycemic index foods. A diet rich in whole plant foods is an ideal way to get adequate amounts of fiber for sugar control.
    • Protein: When we remove fats, we also often remove protein. However, protein is essential for glucose control. Actually many amino acids can help with sugar balance during fasts or in-between meals. So getting appropriate amounts of protein and fat can help maintain sugar balance and keep you from getting hungry between meals.
    • Low-Glycemic Foods: Low-glycemic index foods are foods that do not turn into sugar rapidly or in large quantities when we eat them. These tend to be very nutrient-dense foods like broccoli, lentils, chickpeas, cauliflower, etc. Processed foods – for example processed grains, flours, foods with added sugar, and boxed or packaged foods – rapidly turn into sugar. Over-processing and overcooking foods makes them break down faster when you eat them. The overheating and processing also removes nutrients, so they become large calorie sources that turn directly into sugar.


    If you’d like to learn more about what a low-glycemic diet would look like, take a look at the Cardiometabolic Food Plan on our website.

    Get Quality Sleep

    Good quality sleep is absolutely critical for sugar control. Sleeping less than six and a half hours a night is shown to have a direct correlation with increased insulin resistance, risk for type-2 diabetes, and heart disease. Sleep apnea is easily overlooked; I see it often in my clinic.

    If you snore, or you don’t wake up feeling well-rested, please consider getting a sleep evaluation by your primary care provider.

    Weight Loss

    If you are overweight, the strategies above (adding in daily movement, focusing on  quality foods, and getting adequate sleep) will also help you to lose weight, which is itself important for sugar control and insulin sensitivity.


    Nutrients & Botanicals to Improve Insulin Sensitivity

    Once we have implemented the foundational lifestyle medicine of exercise, food, sleep, and stress management, we can begin introducing nutrients and botanicals that are beneficial for insulin resistance.

    Nutrients

    While there are many nutrients that we could use, I’ll focus on the ones with the best science and data behind them, and those that provide the most benefit for the cost.

    Vitamin D

    There is a direct correlation between low vitamin D levels and the risk of developing insulin resistance and diabetes. Think about this statistic: Metformin helps improve insulin sensitivity by about 13%, yet giving vitamin D supplements to people who are deficient improves insulin sensitivity 60%! Vitamin D deficiency is very prevalent in the U.S, with 42% of the general population (up to 82% of minority ethnic groups) having a vitamin D deficiency. You read that correctly: If your vitamin D level is low – which includes most of the patients I see – raising your vitamin D level alone will work better for you than a prescribed medication. So you can see how simply improving vitamin D levels can be more powerful than the number one recommended medication for diabetes in the country.

    Chromium

    Chromium is an important trace mineral required for carbohydrate and lipid metabolism. Chromium levels can affect insulin sensitivity, and chromium supplementation can have medicinal properties for improving insulin sensitivity. There’s a proprietary product called chromium GTF that’s been studied for its effect of improving insulin sensitivity. This is a go-to product for me.

    Magnesium

    Magnesium is another mineral that is essential for insulin control. Magnesium helps blood sugar to cross the cell membrane; a deficiency is directly associated with insulin resistance, cardiovascular disease, and neurological issues. Unfortunately, 30 – 40% of Americans are magnesium-deficient or insufficient. A simple dose of 400 milligrams a day is a good starting place for this nutrient. I tend to use magnesium glycinate as it’s better absorbed by mouth and tends to have the fewest side effects.

    Omega-3 Fatty Acids

    The next nutrient to consider is omega-3 fatty acids. EPA and DHA are critical omega-3s for sugar control, cell membrane balance, inflammation control, and more. A dosage of 1,000–2,000 milligrams a day is a good starting point. An important caveat: If you take more than 4,000 milligrams a day of omega-3s, you should balance it with vitamin E because excessive omega-3’s can actually induce insulin resistance.

    Botanicals

    Botanicals are plant-based nutrients that can be used to help regulate metabolism and your body’s other systems. Many drugs we currently use actually originated in the plant and animal kingdom.

    Berberine

    Berberine, a naturally occurring plant compound, is basically nature’s Metformin. It has been used to help control sugar and cholesterol levels at the Vanderbilt Hypertension Clinic. Berberine can have a profound impact on insulin resistance. It can also improve digestion, support the growth of good bacteria in the gut, and has a host of different functions. Usually, 500 milligrams twice a day is the starting dose. There can be some GI upset from Berberine (similar to Metformin), but overall it is well-tolerated.

    Cinnamon

    Cinnamon is a spice that has insulin-like or insulin-activating properties. It’s commonly used and has been studied throughout the world. A proprietary product called CinSulin has been studied for insulin resistance and that’s my go-to when using cinnamon as a supplement to support insulin sensitivity.

    Green Tea

    The active ingredient in green tea, EGCG, has profound metabolic effects. EGCG has antiviral and anti-inflammatory properties, helps improve insulin sensitivity, and also helps with controlling the inflammasome, which is the part of our cellular metabolism that regulates inflammation. Green tea also has positive effects on the immune system. It helps protect your B-cells from cytokine-induced damage. Cytokines are the part of your immune system that you see elevated with inflammation. So – almost by definition – if you have insulin resistance, you therefore have inflammation. EGCG can help protect your your immune system from damage from inflammation. A typical dose of EGCG is about 500 milligrams 1–2 times per day. If you prefer to get it from drinking green tea, the therapeutic dose of green tea is about four to six cups per day.

    Pycnogenol

    Pycnogenol is a standardized extract from maritime pine bark. Pycnogenol has been used throughout the cardiometabolic world for reducing cholesterol and inflammation, as well as a support for patients with chronic fatigue and fibromyalgia. Through its anti-inflammatory effects and its basic plant structure, it actually helps lower insulin resistance as well. Pycnogenol contains certain plant chemicals called polyphenols that help modulate inflammation and has been shown to lower A1C, blood pressure, and cholesterol. I tend to actually use Pycnogenol more for in my cholesterol patients than in my diabetic patients. But because it’s such a versatile product that also helps with joint aches and pains from inflammation, it can be great adjunct in this arena.

    Summary

    Insulin resistance is not just a precursor to diabetes; it’s a pervasive health concern that affects our physical and mental well-being. By understanding the critical role of insulin in The Hormone Hierarchy and recognizing the symptoms and causes of insulin resistance, we are empowered to take action.

    Embracing a holistic approach through lifestyle medicine—incorporating regular exercise, a low-glycemic diet rich in nutrients, quality sleep, and stress management—we can significantly improve our insulin sensitivity. Furthermore, targeted supplementation with vitamin D, chromium, magnesium, omega-3 fatty acids, and beneficial botanicals like berberine and green tea can offer additional support.

    I urge you to reflect on your daily habits and consider the steps outlined in this article. Take charge of your health by implementing these strategies to combat insulin resistance and pave the way to a harmonious hormonal balance and a vibrant, healthier life.