A brief look at insulin resistance and abdominal weight gain.
Spare tire, muffin top, belly fat…just a couple of the slang options to describe abdominal fat. No matter what you call it, one thing is true of abdominal fat. It creeps up on you, and no matter how little you eat, or how much you exercise it can really get stuck there.
There are a number of reasons that fat accumulates around the abdomen, especially in the peri-menopause or andropause years. A reduction in muscle mass can change the way we metabolise fats, changes in oestrogen can change the way fat is distributed, and in men changes in cholesterol metabolism can impact distribution.
One area that isn’t discussed much is the impact of a little hormone Insulin! Insulin is a hormone made by the pancreas that helps glucose in your blood enter cells in your muscle, fat, and liver, where it’s used for energy. When blood glucose, also called blood sugar, levels rise after you eat, your pancreas releases insulin into the blood. Insulin then lowers blood glucose to keep it in the normal range. Unfortunately this process isn’t always clean cut and insulin can accumulate in the blood stream, leading to insulin resistance.
Insulin resistance can be a major driver behind PCOS, weight gain and also heavy periods and due to its inflammatory nature can have long term impact on neuro degenerative conditions, cardiovascular disease and bone health. Yikes!
So what is Insulin Resistance and how do we get it?
There is a metabolic chain – eat food, it gets turned into energy and enters cell to get used. Simple right? When this cycle goes haywire (normally from eating too many carbohydrates). The outcome is less energy, and an increased tendency to put on weight, or the so called spare tire. It can also increase inflammation, increasing production of adipocytes, which secrete more inflammatory cells (nasty cycle).
How do you know if you have it?
When I studied it wasn’t popular to test for insulin resistance you could assume from the following physical signs: large waist circumference, skin tags, darkening of skin under the arms, combined with blood pathology of high cholesterol, high trigylcerides, elevated liver enzymes (ALT) and CRP-( c-reactive protein). However, now days if you’re GP will test, you might like to ask for a fasting insulin test. A healthy fasting insulin should be less than 10 mIU/L or 60 pmol/L.
What to do if you have it?
There are so many things you can do to improve insulin sensitivity and reverse the negative effect of insulin resistance. I always start with diet! Obviously we review carbohydrate intake, especially fructose and increase proteins. Personally, I think fasting is a great tool here. A short 3 day fast is enough to start the reversal process, after that you might implement intermittent fasting, like a 5:2 or 16:8.
Next, I encourage building muscle mass, especially the gluts and quads….big muscles help stabilise glucose levels and if that’s under control, the pancreas won't produce excess insulin.
Then, we resolve any sleep or gut issues, sound circadian rhythms i.e. awake time and asleep time, can also help keep blood glucose stable. Most of the time some simple magnesium, a goodnight routine and a little mediation is all it takes.
Supplements I use to help with insulin sensitivity include myo-inositol, magnesium, taurine, choline and chromium. Plus the very terrible tasting but highly effective nigella sativa!
It wont be resolved overnight, but I often find if patients take a step by step approach and tackle insulin resistance along side their weight loss efforts, the results are great.
REFERENCES:
Hoehn, K. L., Salmon, A. B., Hohnen-Behrens, C., Turner, N., Hoy, A. J., Maghzal, G. J., Stocker, R., Van Remmen, H., Kraegen, E. W., Cooney, G. J., Richardson, A. R., & James, D. E. (2009). Insulin resistance is a cellular antioxidant defense mechanism. Proceedings of the National Academy of Sciences of the United States of America, 106(42), 17787–17792. https://doi.org/10.1073/pnas.0902380106
Format:
Hong, H. R., Jeong, J. O., Kong, J. Y., Lee, S. H., Yang, S. H., Ha, C. D., & Kang, H. S. (2014). Effect of walking exercise on abdominal fat, insulin resistance and serum cytokines in obese women. Journal of exercise nutrition & biochemistry, 18(3), 277–285. https://doi.org/10.5717/jenb.2014.18.3.277
Nauli, A. M., & Matin, S. (2019). Why Do Men Accumulate Abdominal Visceral Fat?. Frontiers in physiology, 10, 1486. https://doi.org/10.3389/fphys.2019.01486