Addressing Insulin Resistance to Prevent Disease and Improve Health

Excess insulin and chronic inflammation are underlying factors connected to most chronic diseases, including Alzheimer’s disease. Patients who take steps to address insulin resistance see rapid improvements in risk factors.

Dr. Ronesh Sinha, an internal medicine physician at Palo Alto Medical Foundation, discussed insulin resistance in an interview on the Broken Brain podcast. When we consume carbohydrate, the body converts it into glucose. In a healthy body about 80% of glucose will go to muscles after a meal. However, in an insulin-resistant body, the muscle becomes less responsive, causing a glucose overflow that makes the pancreas create more insulin. While this keeps the body in balance in the short term, over time the mechanism wears out and stops producing adequate insulin. Dr. Sinha states that by the time someone develops a blood sugar abnormality, this mechanism is already reduced to about 40–50% of capacity. In order for muscles to convert glucose to energy, we need a good working system; inflammation and inadequate aerobic capacity damage the mechanisms that create energy in the body.

In order to assess risk of chronic diseases, Dr. Sinha recommends looking at the key elements of insulin resistance: body metrics such as waist circumference and blood panel data such as lipids and inflammation markers, as well as blood pressure and glucose levels. It is important to look at triglyceride levels as well as the ratio of HDL and LDL.

If we convince our bodies that we’re active, then everything will fall into place metabolically.

Dietary and lifestyle changes can rapidly improve risk factors. Dr. Sinha’s analysis of metabolic syndrome studies showed that lowering dietary carbohydrates lowers triglycerides. He says, “Change that one macro, and within weeks the numbers drop by half.” He recommends patients eat a more plant-based diet, including a variety of different vegetables that aren’t overcooked; reduce or eliminate highly processed packaged foods, most of which are high in starches; choose vegetables instead of starchy carbs; and combine carbs with protein and fat in order to lower the glycemic spike of the meal. Avoiding frequent blood-sugar spikes and allowing time for the system to rest between meals can improve metabolic health, he says.

Finding ways to be more active throughout the day can help regulate blood sugar, Dr. Sinha says. If we convince our bodies that we’re active, then everything will fall into place metabolically. An intense daily workout is good, but it’s even more important to stay lightly active throughout the day with basic exercises such as squatting and walking.

Sleep is also a critical component to metabolic health. Dr. Sinha says going to bed earlier improves blood sugar, as does eating an earlier dinner. He suggests allowing a metabolic rest of at least 12 hours between dinner and breakfast the next day. For those who have transitioned to a lower-carb diet, fasting for longer periods may be another powerful tool for reversing insulin resistance.

Dr. Sinha was motivated to create new resources when he realized just how pervasive insulin resistance is in all populations, especially Asian and Indian populations. Although traditionally these populations ate vegetarian diets and had active lifestyles, many have adopted a westernized lifestyle which is high in carbs and low in physical activity. These populations tend to have a higher proportion of visceral fat compared to Western populations, which also contributes to a higher incidence of insulin resistance.