You do everything “right.” Somehow, however, those stubborn extra pounds won’t leave. And worse, they seem to have shifted to your midsection. What happened to your shape?
You can be eating healthy and still struggle with weight. For women, it’s easy to blame slowing weight loss on the hormonal shifts that come with age, but these changes are not necessarily completely due to menopause. Instead, insulin resistance could be at play.
How Does Insulin Affect Your Weight?
Let’s start by looking at the role insulin plays in the body. Insulin is a hormone produced by your pancreas which helps your body to use glucose (sugar) from your food by converting it to energy. A healthy insulin level goes up after a meal and goes down as it helps to drive glucose into the cell. The natural fluctuation of insulin is what keeps your blood sugar in a healthy balance.
When your body’s cells are no longer able to respond to insulin properly, they become “insulin resistant”, your blood sugar levels rise higher than they should even if your pancreas is producing a lot of insulin. This initial phase of impaired insulin and glucose metabolism has been termed hyperinsulinemia.
Excessively high blood sugar has many harmful effects, causing damage throughout the body. So your body has a back-up plan to protect itself: it stores the extra energy by converting it to fat, often around your midsection.
This is why high blood sugar and high insulin levels make it harder to lose weight.
More Than Just a Spare Tire – Insulin’s Many Roles
It’s important to note that insulin plays a role in many body functions, so insulin resistance can affect other facets of your health in addition to giving you a spare tire.
In fact, up to 50 percent of people who are insulin resistant go on to develop life-changing diabetes or prediabetes. Insulin resistance has been linked to the development of several types of cancer, high blood pressure, and high cholesterol.
At the hormone level, insulin is an intricate part of many systems in the body and can affect the performance of your other hormones. For example, high insulin levels can magnify menopausal symptoms. For women who are struggling to manage hot flashes, mood changes or other symptoms, being insulin resistant can make it even harder to regain control of their hormones.
How Do You Know If You’re Insulin Resistant?
Despite its widespread effects, insulin resistance can be difficult to diagnose. In fact, many people don’t experience any symptoms until they develop prediabetes or diabetes. If you are experiencing any of the symptoms below, your best first step should be to talk to your healthcare provider.
- Velvety dark patches of skin in your groin, neck, or armpits (a condition called acanthosis nigricans)
- Abnormal fatigue
- Cravings for sweet or salty food
- Increased hunger and thirst
- High waist-to-hip ratio (if you’re female, measure your waist and hips, then divide the number you measured for your waist by your hip measurement. If the result is higher than 0.8, your ratio is on the higher end. For men, a result greater than 1.0 is concerning.)
The Main Risk Factors (Reasons) For Insulin Resistance
Our bodies need carbohydrates. However, consuming more carbohydrates than your body can manage, can contribute to insulin resistance.
Other risk factors include:
- Excess weight
- Genetics (Some people who develop insulin resistance don’t have other risk factors. For these people, genetics are thought to be the primary factor.)
- Not getting enough sleep
- Medications, including antidepressants and steroids
- Certain medical conditions, including:
- Polycystic ovary syndrome (PCOS)
- A history of gestational diabetes
How Can you Improve Insulin Resistance Naturally?
The good news is that lifestyle changes can dramatically improve the balance of insulin in your body. Lifestyle factors like a healthy well-balanced diet, exercise, stress management and proper sleep hygiene are positively correlated with healthy insulin balance.
One of the dietary practices that is gaining a lot of scientific research on its role for balancing insulin is the concept of intermittent fasting. There are still many skeptics on this practice, and I have to admit for a long time I was one of them. I was conventionally trained in dietetics, and we were taught that people should always eat breakfast and eat six small meals per day.
Believe me, I understand it is a hard concept to wrap your head around. Mark Hyman once said that he believes that if you could bottle the benefits of exercise into a pill, it would be the biggest blockbuster selling drug on the market. I firmly believe that intermittent fasting also has this type of power. In fact, there is not a documentary that you can watch called Fasting – The Most Powerful Drug on Earth.
Intermittent fasting is a practice whereby you restrict the amount of time you are allowed to eat. When done properly, Intermittent Fasting is now considered the gold standard of managing insulin. A common belief is that if you don’t eat enough calories you are going to store weight, and negatively impact your metabolism. In part this is true.
Continuous caloric restriction can result in lowered thyroid function and long term can impact metabolism and cause individuals to gain more weight. This is the whole concept of yoyo dieting. Severe and continuous caloric restriction, followed by those individuals running out of “willpower” and gaining all of their weight back and more. It is an exhausting cycle not only for people emotionally but physiologically as well.
Intermittent fasting, however, is not continuous caloric restriction. In fact, it has been shown to kick-start and sparks metabolism as well as brain function.
It is important before starting a fasting protocol that you speak with your healthcare provider, or someone knowledgeable in the area. Fasting protocols are not appropriate for pregnant or breastfeeding women, underweight individuals, kids, teens, elderly or those with a history of an eating disorder.
The three most studied intermittent fasting styles are the alternate day fast, the 5:2 approach or time-restricted eating. We will explore these in greater detail.
Alternate Day Fasting (ADF)
This pattern is considered a true intermittent fast, as food is restricted for 24-36 hours every other day. On the feast days, the person would consume a normal caloric intake, followed by fast days where they would consume liquids only. These liquids can include tea, coffee, sparkling water, herbal tea, bone broth, pickle juice, and salted water.
A study performed at the University of Illinois by head researcher Krista Varady found that people who fasted every other day could lose 1-2 pounds per week while reducing their cholesterol and blood pressure levels. If that process sounds daunting, preliminary research is suggesting that similar benefits can be achieved by fasting for 12-16 hours per day.
Animal studies on ADF have found lower rates of diabetes and lower fasting glucose and insulin concentrations compared to those that practice daily caloric restriction.
This model suggests that you eat normally for five days of the week and then cut calories to 25% of normal intake on two consecutive days per week. It is suggested that during the five days, there is no calorie cap and during the fasting days, calories should be spent following a low carbohydrate plan. Some patients like this model because they feel less restricted and they only have to focus on what they are eating (or not eating) two days per week. While there is some positive scientific data on this model I tend to use it less than the other two.
This model suggests that you consume all of your food in a 6-8 hour window and “fast” for the rest of the day. The timing of the window can be flexible, however, I find it easier for patients to delay their first meal. I find people are most successful when eating between 10 am-6 pm, 11 am-7 pm or 12 noon-8 pm. I tend to implement this model with a low carb high fat/ketogenic plan for optimal results. I also find it to be a great tool for weight maintenance.
Studies have shown that this type of model has positive health benefits in prediabetic men with respect to lowering blood pressure and improving insulin sensitivity.
Extended Day Fasting
There are very exciting scientific advances coming from researchers like Dr. Joseph Antoun, Valter Longo and Jason Fung on the metabolic, immune, brain and longevity benefits of extended day fasting. This is a practice whereby food is restricted for over 42 consecutive hours and must be supervised by a medical professional.
Intermittent fasting is not for everyone, but it has been a very important and consistent tool in my practice. I find that it gives patients more freedom than traditional caloric restriction because they are not continually focused on and planning everything that goes into their mouths. They also tend to feel great with heightened energy, focus and concentration on there fasting days. For my busy clientele, what is easier or cheaper than just not eating for a day!!
I believe it is important for these protocols to be supervised by a health care professional. Please reach out to your health care provider before starting a fasting protocol.
Arnason TG et al. Effects of intermittent fasting on health markers in those with type 2 diabetes: A pilot study. World J Diabetes. 2017;8:154-164
Carter S et al. Effect of intermittent compared with continuous energy-restricted diet on glycemic control patients with type 2 diabetes. JAMA. 2018;1:e180756
Hoddy KK et al. Effects of different degrees of insulin resistance on endothelial function in obese adults undergoing alternate day fasting. Nutr Healthy Aging. 2016;4:63-71.
Sutton EF et al. Early time-restricted feeding improves insulin sensitivity, blood pressure and oxidative stress even without weight loss in men with prediabetes. Cell Metab. 2018;27:1212-1221
Varady, K et al. Effects of 8 hours of time-restricted feeding on body weight and metabolic disease risk factors in obese adults: A pilot study. Nutr and Healthy Aging. 2018; 4(4): 345;353
Varady K et al. Alternate-day fasting and chronic disease prevention: a review of human and animal trials. Am J Clin Nutr. 2007:86:7-13
From the Editors, Recommended Reads:
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