A natural approach to insulin resistance
by Marcelle Pick, OB/GYN NP
Here are the topics in this article:
Insulin resistance — also called syndrome X — is so pervasive today
that we evaluate nearly every woman who visits our clinic to determine her level
of risk. Most are taken aback when they learn they either already have insulin resistance
syndrome (some are even pre-diabetic) or are well on their way to developing it.
Experts estimate that 25% of all Americans suffer from insulin resistance. We believe
the percentage is much higher among perimenopausal women.
Because insulin is one of the “major” hormones, it’s also impossible
for your body to balance its “minor” hormones (estrogen, progesterone
and testosterone among them) until your insulin metabolism is balanced first. To
put it simply, if you have hot flashes and you are insulin resistant, it’s
going to be nearly impossible to cure the hot flashes without first healing the
insulin resistance. (Cortisol is also a “major” hormone; to understand
its role in hormonal balance, read our related article on
The good news is that you can heal insulin resistance. This has
been a primary focus of our practice at Women to Women for over a decade, and our
approach has been quite successful. Let’s explore our methods and how they
might help you.
Why all the concern about insulin resistance?
Over 80 million Americans suffer from insulin resistance, and it appears to sit
at the center of a web of related health problems. Women who are insulin resistant
are at much greater risk of obesity, diabetes, hypertension (high blood pressure),
heart disease, high cholesterol, breast cancer and polycystic ovarian syndrome (PCOS).
There is some evidence that insulin resistance may contribute to endometrial cancer.
It has also been implicated in Alzheimer’s disease.
Insulin resistance often accompanies the most common complaints we hear at Women
to Women — fatigue
and weight gain. As women approach menopause, they become increasingly intolerant
of carbohydrates and find it easier to gain weight, especially around their waists.
Afternoon blahs, sugar crashes and carbohydrate cravings may all be early insulin
Insulin sensitivity — the way it should work
All of the food we eat — fats, proteins and carbohydrates — is broken
down during digestion into proteins, micronutrients and glucose. The body uses the
proteins and nutrients in cellular metabolism, immune function, and cell replacement.
The body uses glucose as its basic fuel, which is carried by the bloodstream to
Our demand for fuel varies from moment to moment, but the brain needs our blood
sugar level to remain stable. So getting the cells the energy they need without
changing that level is a critical function — and that’s the role that
insulin plays. Insulin signals the cells to absorb glucose from the bloodstream.
The body monitors what we’ve digested, blood sugar levels, and cell demands,
and releases insulin in just the right amounts. That’s why a healthy body
is described as “insulin sensitive.”
How insulin resistance develops
Our metabolism evolved eons ago, when our diet included fewer (and more complex)
carbohydrates. Today most calories in an average diet come in the form of carbohydrates,
and most of those are simple carbohydrates — sugars that quickly enter the
bloodstream. The body has to release high levels of insulin to keep the level of
glucose in the bloodstream from spiraling out of control. But in time the cells
quit responding to this signal. At this point the body is “insulin resistant.”
One immediate consequence is that the body is forced to release even more insulin.
Letting blood sugar get too high is simply not acceptable. The resulting excess
of insulin in the bloodstream is called hyperinsulinemia. But the body
wasn’t designed for these prolonged high levels of insulin, which disrupt
cellular metabolism and spread inflammation. Diabetes occurs when the body is unable
to keep blood glucose under control. But as we have noted, that is only the most
obvious disease caused by insulin resistance. There are many negative health effects
before full-blown diabetes.
Syndrome X and menopause
Of special concern to women is how insulin resistance disrupts fat metabolism. When
the cells won’t absorb the extra glucose, the liver has to convert it into
fat. Fat cells are loaded with glucose receptors, so this is a vicious cycle. Ironically,
while the insulin-resistant woman is gaining weight, her cells are actually “starved”
for glucose, so she feels exhausted and tends to eat carbohydrate-heavy foods in
search of energy.
These extra fat cells are also little estrogen factories. So weight gain contributes
to the estrogen dominance that causes so many symptoms during the early stages of
Symptoms relating to syndrome X usually predate the onset of menopause, but most
women do not complain of them until then. A woman’s health can deteriorate
rapidly during menopause with the decrease of estrogen levels in the body. And digestive
issues that were once merely a hassle become an affliction when the body’s
natural defenses against inflammation (estrogen being one) are depleted.
In addition, women approaching menopause are particularly prone to becoming insulin
resistant due to metabolic changes related to fluctuations in adrenal and thyroid
secretions. In fact, the decrease of certain hormones, like estradiol, may trigger
a resistance to insulin in patients who never experienced it before. Certain blood
pressure medications can mask symptoms without treating the problem. Frequently,
women unwittingly make their symptoms worse by trying to lose weight with low-fat,
How do I know if I’m insulin resistant?
The unfortunate truth is that anyone can become insulin resistant — even if
she is thin because we have access to a lot of refined carbohydrates (white bread,
sugar, bagels, pasta, potatoes, sodas, processed foods with added fructose, etc.).
In fact, most of us are likely to be somewhat resistant to insulin. It is just a
matter of degree. The more processed and refined food that we eat, the more insulin
we require to metabolize it. The more insulin in our blood, the less responsive
our cells become. As we age, this continual exposure wears out our tolerance for
refined carbohydrates and reduces our sensitivity to insulin.
If you suffer from high cholesterol, high triglycerides, or hypertension, you should
get checked for insulin resistance, regardless of your weight or age. If you have
high blood pressure, it is likely that you are also suffering from insulin resistance.
High blood pressure medication will not cure insulin resistance.
Signs and symptoms of insulin resistance
You are at the highest risk for developing this condition if you have a family history
of type 2 diabetes or if you have suffered from gestational diabetes, hypertension,
or are seriously overweight.
Apple-shaped women, or those who tend to gain most of the weight around their abdomen,
show less tolerance for insulin. To assess your risk, measure yourself around the
smallest part of your waist (don’t hold your stomach in!) and the biggest
part of your hips. Divide the waist measurement by the hip measurement. A ratio
bigger than 0.8 for women (or 1.0 for men) indicates that your abdomen is obese
and you are at risk for developing insulin resistance.
Women with an abnormal amount of fat or cholesterol in the blood, or dyslipidemia,
especially those with low HDL levels and high triglycerides, may also be resistant.
I tend to look at the ratio of HDL to triglycerides. If I can divide the triglyceride
count by the HDL count and get 3.0 or higher, I immediately suspect insulin resistance.
A skin change called acanthosis nigricans, which is warty-like darkened
patches of skin at the neck and armpits, indicates insulin resistance in over 90%
of the women who experience it.
The good news is that insulin and glucose levels are very easily influenced by changes
in lifestyle, exercise, and diet. If you are diagnosed with insulin resistance,
there is a lot you can do to reverse its course.
Bringing insulin into check
At Women to Women, we understand that insulin resistance may be an underlying factor
in a range of health problems. Before designing a patient’s program, we always
take into consideration this possibility. Our goal at Women to Women is to enable
all our patients to feel energetic, lively, attractive, passionate, and excited
for years to come, as opposed to feeling lethargic, irritable, and hormonally imbalanced.
Thankfully, we have discovered that a lot can be done to decrease a patient’s
insulin sensitivity and bring their hormones back into natural balance.
When we evaluate a patient for insulin resistance, we recommend a blood test for
glucose and insulin levels after fasting for 12 hours and then again two hours after
a meal (preferably a high-carbohydrate meal). On the fasting tests, we hope to see
glucose levels of no more than 75–80 and insulin of less than 14; higher levels
indicate a risk of insulin resistance. Increased triglycerides make me suspicious
too. We also take into account the patient’s lifestyle, diet and exercise
patterns, as well as stress factors. All of this can be changed.
Talk to your primary care provider about being tested if you feel you are at risk.
Many younger practitioners are familiar with the concept of insulin resistance,
as it is now being taught in medical school. Unfortunately, old-school physicians
may still be unaware of its importance.
Insulin resistance diet
If a patient presents with insulin sensitivity, I recommend changes in her diet
and exercise habits. I encourage all of my patients to shop the outside aisles of
the supermarket, and to avoid the inner rows of processed food, sugar cereals, high-sodium
snacks and soda.
A diet that consists primarily of lean meats and other proteins; high-fiber grains,
vegetables and legumes; leafy greens; and fruit will substantially aid the body’s
ability to balance insulin levels. If a patient is already insulin resistant, I
recommend a meal plan consisting of breakfast, lunch, dinner, and two snacks. Each
meal should have no more than 15 grams of carbohydrates in the form of vegetables
and fruits (and prohibiting “white” food altogether, such as bread,
pasta, and sugar) and some lean protein. Each snack should contain only 7 grams
of similar carbohydrates.
Healthy fats, or those rich in essential fatty acids (EFA’s), are also important
in an insulin-resistance diet. EFA’s can be found in avocados, cold-water
fish like salmon and tuna, flax seed, and eggs and can also be taken in supplement
I also highly recommend a pharmaceutical-grade nutritional supplement, which can
help decrease carbohydrate and sugar cravings and normalize the hormonal function
in menopausal and perimenopausal patients. The
Personal Program is an at-home version of what we offer at the clinic, and
will satisfy the body’s nutritional demands in relation to insulin sensitivity.
Regular exercise of 30 minutes or more per day, 3–5 times a week is also beneficial
for regulating metabolic function and hormonal balance. Decreasing stress, thereby
lessening strain on the adrenal glands, will result in better overall health and
contribute to keeping the body’s insulin levels in check. Stopping smoking,
moderating alcohol intake, and encouraging proper sleeping habits will help alleviate
blood chemistry surges, which in turn will promote a thriving, well-balanced body.
Your body’s hormonal balance is like a symphony. Insulin is one of the loudest
and most important instruments. When its metabolism goes wrong, it throws off everything
else. We’ve seen over and over how women with menopause symptoms must reverse
their insulin resistance in order to find relief from other symptoms. It can be
done, and we’re here to help.
Our Personal Program is a great place to start
The Personal Program promotes natural hormonal balance with nutritional supplements,
our exclusive endocrine support formula, dietary and lifestyle guidance, and optional
phone consultations with our Nurse–Educators. It is a convenient, at-home
version of what we recommend to all our patients at the clinic.
If you have questions, don't hesitate to call us toll-free at
1-800-798-7902. We're here to listen and help.
Last Modified Date: 05/26/2011
Principal Author: Marcelle Pick, OB/GYN NP