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How to reverse insulin resistance

How to reverse insulin resistance

Insulin resistance is a condition where insulin signaling—one of your body’s main tools for regulating blood sugar levels— stops working as well as it should. 

The breakdown of insulin signaling severely limits the body’s ability to protect itself against blood sugar spikes and persistently elevated blood sugar levels. 

As a result, insulin resistance often leads to conditions like prediabetes and type 2 diabetes. 

The progression from healthy to insulin resistant isn’t a binary process, where you either have it or you don’t. Instead, insulin resistance develops gradually along a spectrum, which means some people may be more insulin resistant than others. 

Fortunately, with the right resources, you can shift your position on this spectrum and in some cases, you may even be able to reverse insulin resistance altogether. 

Here, we dive into the process of reversing insulin resistance and how various factors such as the gut microbiome, exercise, and diet may help you. 

What is insulin resistance?

“Insulin resistance” is when the cells of the body stop responding to insulin as efficiently as they should. 

Essentially, it’s a communications breakdown that happens within the body between insulin and the cells. 

This breakdown can come about for many reasons, but the end result is all the same: 

The body loses some of its ability to control blood sugar levels. 

For this reason, insulin resistance often leads to the development of type 2 diabetes (more on that below). 

Under normal circumstances, insulin is released into the bloodstream from the pancreas in response to rising sugar levels. There it surges around the body, signaling to skeletal muscle cells, liver cells, and fat cells that sugar is in the blood and free for the taking1

With the help of an insulin sensor (known as Insulin Receptor), these cells begin to harvest sugar from the bloodstream in order to use it as energy, or else store it for later use. As a result, blood sugar levels begin to decrease.

When cells become resistant to insulin, they lose some of their ability to respond to rising insulin levels

That means they don’t get the message that there’s sugar available to use, and blood sugar levels stay higher than they should be. 

 

What causes insulin resistance to develop?

Insulin resistance is caused by a combination of factors that can include: 

  • A decrease or loss in certain types of bacteria in the gut microbiome
  • Having an imbalanced diet that is high in sugar, fat, or sodium
  • Having low levels of physical activity
  • How the body reacts to certain medications 
  • The effects of aging
  • Genetics

     

    Each factor has the potential to alter how cells respond to insulin1.

    High-sugar and high-fat diets, for instance, can lead to high levels of free fatty acids in the blood. 

    Free fatty acids play many important roles in the body, but too many free fatty acids prevent cells from fully responding to rising insulin levels.

    There is strong evidence, too, that suggests the gut microbiome plays a crucial role in insulin resistance. 

    The gut microbiome is an expansive ecosystem that thrives deep in our digestive tract. Home to many different species of bacteria, the gut microbiome has influence over many different aspects of our health, including insulin signaling. 

    Numerous studies have shown people with type 2 diabetes (and by extension, insulin resistance) are missing certain species of bacteria from their gut microbiome. Specifically, species that produce the molecule butyrate.

    Since butyrate plays a critical role in the release of insulin, an out of balance gut microbiome  can lead to high levels of blood sugar—and the development of insulin resistance. 

     

    How does insulin resistance lead to type 2 diabetes?

    Type 2 diabetes develops when the body can no longer control the rise and fall of blood sugar levels, leading blood sugar to be chronically elevated. 

    Insulin resistance leads to type 2 diabetes by taking away one of the body’s best tools for controlling blood sugar levels: 

    Insulin signaling. 

    The loss of insulin signaling can happen in many ways and for many reasons, but the end result is all the same: insulin sensitivity decreases, insulin resistance increases, and blood sugar levels rise. 

    For example, insulin helps to limit the amount of free fatty acids that are in the blood. It does so by slowing down the release of free fatty acids from cells located in fat tissue and encouraging them to take in sugar from the blood. 

    This means that insulin has the immediate effect of both reducing blood sugar levels and free fatty acid levels. 

    That’s important, because high levels of free fatty acids can disrupt sugar metabolism throughout the body. 

    When insulin resistance develops, however, a vicious cycle begins: 

    Cells that are less responsive to insulin may release more free fatty acids into the blood which, in turn, makes the cells even less responsive to insulin1,2

    Taken together, insulin resistance leads to high levels of blood sugar and higher levels of free fatty acids. 

    This has a domino effect that causes inflammation, tissue damage, and excessive fat accumulation. 

    Each of these factors can further harm the body’s ability to regulate blood sugar levels. 

    Ultimately, the effect of these changes can lead to pre-diabetes and type 2 diabetes. 

     

    What are the signs and symptoms of insulin resistance?

    There are no unique symptoms of insulin resistance. 

    However, there are a wide variety of related symptoms that can suggest a person has insulin resistance. 

    These symptoms vary depending on a person’s age, how long they’ve had insulin resistance, what medications they are taking, and a number of other factors1

    Most often, these symptoms include:

    • Obesity in combination with hypertension or hyperlipidemia (high-levels of fat particles in the body)
    • A diagnosis of metabolic syndrome
    • A diagnosis of prediabetes or type 2 diabetes mellitus
    • Symptoms of microvascular disease (retinopathy, neuropathy, or nephropathy)
    • Those with macrovascular disease (stroke, PAD, and CAD)
    • Diagnosis of polycystic ovarian syndrome
    • Elevated blood pressure
    • Increased waist circumference beyond what is expected based on age, sex, and ethnicity

      None of these symptoms guarantee that a person has developed insulin resistance. 

      However, people with these symptoms are more likely to develop insulin resistance compared to people without them.

        

      How is insulin resistance diagnosed?

      While there are some insulin resistance tests that can be used to study this condition in a laboratory setting, there is currently no widely used insulin resistance test in the clinical setting1,3.

      Instead, physicians can look to see if you have multiple symptoms that, together, suggest potential insulin resistance. 

      This type of analysis can include an examination of various biomarker levels in your blood, such as insulin, glucose, triglyceride, and cholesterol levels. 

      Individuals who have at least 3 of these symptoms can be diagnosed as having metabolic syndrome, which often is a sign of insulin resistance1:

      • A waist circumference of 32” to 40” based on gender and race
      • Elevated triglycerides greater than or equal to 150 mg/dL
      • Reduced HDL less than 40 mg/ dL in men, less than 50 mg/ dL in women
      • Elevated blood pressure greater than or equal to 130 mmHg systolic and/or greater than or equal to 85 mmHg diastolic
      • Elevated fasting glucose greater than or equal to 100 mg/ dL

         

        Physicians may also suspect insulin resistance when they see signs of elevated fasting glucose levels in combination with any of the following1:

        • Body mass index (BMI) greater than or equal to 25 kg/m2
        • Diagnosis of cardiovascular disease, polycystic ovarian syndrome, non-alcoholic fatty liver disease
        • A family history of type 2 diabetes, hypertension, or cardiovascular disease
        • A sedentary lifestyle
        • Non-Caucasian ethnicity
        • Age greater than 40 years

           

          Can insulin resistance be reversed?

          In many cases, insulin resistance can be treated and reversed through some combination of lifestyle changes, medication, or surgery. 

          Most of the research on this topic has focused less on insulin resistance and more on reversing conditions that involve insulin resistance, such as prediabetes and type 2 diabetes4

          From these studies, it is clear that reversal of insulin resistance is possible, though it may not be permanent.  

           

          How the gut microbiome can help reverse insulin resistance

          Researchers have found that the gut microbiome—a complex ecosystem in our gut that is home to bacteria, viruses, and fungi—may be a significant factor in reversing insulin resistance4,12,13

          The gut microbiome is a dynamic environment. As a person’s diet or lifestyle changes, so too does their gut microbiome. Depending on the circumstances, some species of bacteria may flourish while others perish. 

          The specific species of bacteria that are surviving in your gut matters, especially when it comes to reversing insulin resistance.

          Several studies have found that people who have developed insulin resistance tend to be missing certain species of bacteria from their gut microbiome, such as Roseburia, Faecalibacterium prausnitzii, and Akkermansia muciniphilia14

          The species of bacteria that are often missing in people with insulin resistance generally contribute to prevention of “leaky gut” or help in the production of butyrate. 

          The “leaky gut” is a term used to describe situations where it is easier than normal for bacteria and other molecules to slide past the gut barrier and enter the body. This can lead to higher than usual levels of inflammation which is known to be a major contributing factor to insulin resistance14

          Loss of bacteria species that produce butyrate is also a significant issue. Butyrate is a molecule produced by bacteria who help breakdown fiber. 

          Generally speaking, people who have high amounts of fiber in their diet tend to have higher amounts of butyrate production in their gut14. That’s good because butyrate helps maintain the gut barrier and promotes the release of hormones that increase insulin sensitivity15

          Several lines of evidence suggest that restoring the missing bacteria in a person’s gut can help to reverse insulin resistance15. Studies have shown that transplanting these bacteria into obese mice helped prevent both weight gain and insulin resistance15,16

          Similarly, studies in humans have shown that the return of these bacteria tend to track well against improving sugar regulation15

              

          Can losing weight reverse insulin resistance?

          When it can be done in a healthy way, losing weight is an important part of reversing type 2 diabetes and insulin resistance4,17

          Excess body fat can promote insulin resistance through various different mechanisms (hormones, free fatty acid release, inflammation)11

          Removing excess fat has primary and secondary benefits. 

          The primary benefits include a decrease in fat tissue which is a source of specific hormones and inflammatory signals that suppress insulin signaling. Removing this will help reverse insulin resistance. 

          The secondary effects come from the process of losing the weight. 

          For instance, if weight loss is gained through diet and exercise, both of these activities have their own ways of helping to reverse insulin resistance. 

          Surgical weight loss is also a very effective method for reversing insulin resistance. It is believed that gastric bypass surgery helps to reduce total calorie intake, alter hormone signaling in the gut, and to have other unknown effects that result in rapid reversal of insulin resistance10

          Regardless of the method used, it is important then that you work with your doctor or a nutritionist to create a plan that is healthy, effective, and sustainable.  

           

          Can exercise reverse insulin resistance?

          Exercise can help in reversing insulin resistance by encouraging your body to burn excess energy (in the form of sugar and free fatty acids), contributing to weight loss, and, overtime, promoting a healthy microbiome6,7,8

          Without much exercise, excess sugar and fat can build up in the body. This excess fuels the development of insulin resistance. 

          As our muscles contract and strain during exercise, they break down sugars and fats to create energy. 

          Because the muscle cells pull in sugar and free fatty acids from the blood when the energy demand is high, exercise is a great way to start lowering your blood sugar and free fatty acid levels. 

          This has the added benefit of helping you lose weight as well. 

          Exercise also boosts the release of certain hormones that support insulin signaling and may help improve the body’s ability to release insulin, both of which help restore insulin sensitivity6,7,8.

          This is borne out in several large-scale studies in which participants were divided into groups that received different treatments for pre-diabetes or diabetes. 

          The groups that were assigned exercise or a combination of exercise and diet modification often showed significant improvements in blood sugar regulation relative to the control groups4,5,6,7,8

          Additionally, exercise has been shown to alter the gut microbiome18

          When we exercise, our bodies change in several small ways, such as temporary increase in blood pressure, hormones, and the speed at which food moves through the digestive tract. 

          If these changes occur frequently, it may affect which bacteria are able to survive in the gut and favor a microbiome that is better able to help the reverse insulin resistance. 

          Taking all of this together, it seems as though exercise does help with reversing insulin resistance. 

          However, exercise alone is not enough to fully reverse insulin resistance and this reversal may be temporary if sustainable, long-term habits aren’t formed. 

          Exercise

           

          Can the right food & diet reverse insulin resistance?

          Generally speaking, the first-line treatment for insulin resistance includes a close examination of a person’s diet.

          Insulin resistance is fueled, in part, by excess sugar and free-fatty acids that overwhelm the system and prevent insulin from doing what it’s supposed to do.

          Because the system is being overwhelmed, eating foods that are high in sugar, sodium, or fat can make things worse1

          Therefore a big step towards treating insulin resistance is to shift your diet away from these types of foods, choosing instead foods that are high in fiber. 

          Many species of bacteria in your gut get their nutrients from the food you eat. If you primarily eat foods that are high in sugar or fats, then it will favor the bacteria that thrive on those food sources.

          However, if you eat meals that are high in fiber or resistant starches, different kinds of bacteria are likely to survive and grow. 

          These bacteria are known to produce butyrate which helps to increase insulin sensitivity, thereby reducing insulin resistance. 

          Multiple large-scale studies support the idea that dietary changes can help treat insulin resistance4,5

          For example, in the Diabetes Prevention Study, a group of study participants were treated with intensive lifestyle intervention which included a shift towards a low-calorie, low-fat diet. 

          These participants were found to be 58% less likely to develop type 2 diabetes and to have lower levels of insulin resistance relative to control groups5

          Food

           

          Can intermittent fasting reverse insulin resistance?

          There is conflicting evidence on whether intermittent fasting can help to reverse insulin resistance. 

          Some studies have shown that over a short period of time (a few months) intermittent fasting can help decrease insulin resistance in certain populations. 

          However, there have also been studies that reported no effect from intermittent fasting19

          This conflict doesn’t mean that intermittent fasting is ineffective, it just means there is more work to be done before we fully understand if it is helpful and in what context it is most effective (if at all). 

          Intermittent fasting

           

          Can bariatric surgery reverse insulin resistance?

          In some cases, bariatric surgery can be used to reduce total energy intake, leading to rapid weight loss and improved insulin signaling4,10

          Fat tissue has many important roles to play in keeping us healthy. It pads our organs to prevent physical damage and provides us with energy when our sugar levels are low. But in excess, fat tissue can do some harm, particularly with respect to insulin resistance. 

          Researchers have found that stores of excess body fat produce hormones, free fatty acids, and other factors that have the potential to cause inflammation and suppress insulin signaling11. As body fat grows, the production of these factors helps to overwhelm insulin signaling and contributes to the development of insulin resistance. 

          Multiple studies have found that removal of excess body fat, either by lifestyle intervention or surgery, can help to improve insulin signaling4,10. Some reports even suggest that insulin resistance is decreased within days of gastric bypass surgery, suggesting that the benefits of surgery go beyond weight loss. It is not yet clear how surgery may have such fast acting benefits, though. 

           

          Are there supplements that can help reverse insulin resistance?

          There are several supplements that may help with lowering blood sugar levels and, by extension, helping to reverse insulin resistance. 

          No supplement on its own is likely to be enough to reverse insulin resistance. However, they may help in small ways. 

          A good example of this is Pendulum’s Glucose Control. 

          This medical probiotic helps to boost the presence of several beneficial species of bacteria in the gut, specifically a set of bacteria that are known to help blood sugar regulation. 

          In support of this, a clinical study using Pendulum’s Glucose Control found that participants with type 2 diabetes experienced a reduction in their blood A1C levels while taking this probiotic20

          Lower long term blood sugar levels may help to reduce insulin resistance. 

           

          How long does it take to reverse insulin resistance?

          In some cases, reversing insulin resistance can be very quick. Bariatric surgery, for example, has been reported to improve insulin sensitivity in a matter of days4

          However, reversing insulin resistance is a bit of a loose term, there is no good definition for what it means to partially or fully reverse insulin resistance. If reversing means an improvement in insulin sensitivity, then you can reverse insulin resistance quickly through exercise and diet changes. 

          If you are looking to reverse insulin resistance to the point where your insulin signaling is considered within a healthy range, then it may take a longer, more sustained effort. 

          One of the largest hurdles in reversing insulin resistance (and this is true for pre-diabetes and type 2 diabetes as well) is maintaining a reversal4. The large-scale studies showing a beneficial effect from dieting and exercise have also found that the benefits decrease overtime as people relapse into old habits. 

          For this reason, it is best to work with your healthcare professional to find ways to build a sustainable treatment plan that will enable you to reverse insulin resistance and keep it down. 

           

          Final Thoughts

          Insulin resistance is a condition where the body loses some of its ability to regulate blood sugar levels. There are several ways for it to happen, but in general insulin resistance develops when insulin signaling is no longer effective. 

          If left untreated, insulin resistance can progress to type 2 diabetes, metabolic disorder, and other similar conditions. 

          Fortunately, insulin resistance is a reversible condition. 

          Through some combination of exercise, diet, and medication, insulin resistance can be managed and in some cases undone. 

          As with pre-diabetes and type 2 diabetes, reversal of insulin resistance is not guaranteed to be permanent. But with the right set of tools and support from professionals, insulin resistance need not be a lifelong condition.

           

           

           

          References

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          2. Sears, Barry, and Mary Perry. “The role of fatty acids in insulin resistance.” Lipids in health and disease vol. 14 121. 29 Sep. 2015, doi:10.1186/s12944-015-01231 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4587882/ 
          3. Wallace, Tara M., et al. “Use and Abuse of HOMA Modeling.” Diabetes Care, American Diabetes Association, 1 June 2004, care.diabetesjournals.org/content/27/6/1487. https://pubmed.ncbi.nlm.nih.gov/15161807/ 
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          16. Vrieze A;Van Nood E;Holleman F;Salojärvi J;Kootte RS;Bartelsman JF;Dallinga-Thie GM;Ackermans MT;Serlie MJ;Oozeer R;Derrien M;Druesne A;Van Hylckama Vlieg JE;Bloks VW;Groen AK;Heilig HG;Zoetendal EG;Stroes ES;de Vos WM;Hoekstra JB;Nieuwdorp M; “Transfer of Intestinal Microbiota from Lean Donors Increases Insulin Sensitivity in Individuals with Metabolic Syndrome.” Gastroenterology, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/22728514/. https://pubmed.ncbi.nlm.nih.gov/22728514/ 
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