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Healthier World with Quest Diagnostics
Action from Insight: Tackling Insulin Resistance (18 min)
00:18:20
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- [00:04]
A
Welcome to Healthier World with QUEST Diagnostics. Our goal is to prompt action from insight as we keep you up to date on current clinical and diagnostic topics in cardiovascular, metabolic, endocrine, and wellness medicine.
- [00:19]
B
The best way to combat chronic disease is to stop it in its tracks. And really, the earlier, the better. The growing rates of prediabetes and diabetes all stem from an initial condition called insulin resistance. We're here today to review the regulation of glucose by insulin, discuss how insulin resistance is measured, and review actionable ways to reduce insulin resistance. I'm Dr. Tricia Winchester, a former molecular biology scientist who has spent the past decade in cardiometabolic education. There's always something new and exciting to learn, and today we're bringing you an expert from the QUEST Cardiometabolic center of Excellence at Cleveland Heart Lab, the leader for the patient program for my heart, Patty Bianchi. Patty is a registered dietitian, nutritionist, and certified diabetes care and education specialist. Patty, thank you for joining me today.
- [01:06]
C
Thanks for having me, Trish.
- [01:07]
B
All right, can you first walk us through what happens under normal circumstances when someone consumes a meal and then what happens when someone is insulin resistant?
- [01:15]
C
Of course. So under normal circumstances, when you eat, the food is broken down into glucose or blood sugar. So blood sugar enters the bloodstream and that signals the pancreas to release insulin. Insulin then helps blood sugar enter the body's cells so it can be used for energy. Insulin also signals the liver to store blood sugar for later use. When blood sugar enters the cells, the levels in the bloodstream decrease, and that signals insulin to decrease, too, and turn off. So lower insulin levels alert the liver to release stored blood sugar. So energy is always available, even if you haven't eaten for a while. With insulin resistance, the cells in your muscles, fat and liver, they don't respond well to insulin and can't easily take up glucose from your blood. So as a result, your pancreas compensates and makes even more insulin to help glucose enter those cells. So as long as your pancreas can make enough insulin to overcome your cell's weak response to insulin, your blood glucose levels will stay in the healthy range. Over time, though, insulin resistance may continue to increase and or pancreatic function may decline, which can eventually and gradually elevate your blood sugar and and A1C levels.
- [02:44]
B
Yes. The body is so amazing at keeping everything in sync for as long as it can. The pancreas is really compensating, making more and more insulin to get the cells to take up the glucose. Another way to Think about this is like insulin being a knock on the door for the cells to respond and take in the glucose. And when someone is insulin resistant, they have to knock harder, I. E. Make more insulin to achieve the same goal of getting glucose in the cells. So we have a good understanding of what insulin resistance is and how it is the foundation to glycemic issues. There just hasn't been a good way to be able to identify it. And that's really why Quest research and development team worked so hard to develop a simple blood test called the Insulin Resistance Panel with SCORE to be able to identify this condition. In fact, we have another podcast dedicated to this condition that goes a bit deeper into the test, its development, and its utility. It's an important topic because being insulin resistant increases the likelihood to progress to the next stage where you see changes in your glyxemic measure, like a fasting glucose or an A1C like you mentioned, Patty. So really, the earlier you can identify the first sign of going down that path, the more impactful diet and lifestyle will be, hopefully to a point at which patients will never need or require pharmaceutical medications. And that's why we're here today to hear you share actionable ways to address insulin resistance. Let's start with lifestyle.
- [04:01]
C
Lifestyle changes primarily is the best way to tackle insulin resistance, including things like weight loss, eating a healthy diet and being physically active can help reverse insulin resistance and lower your risk of type 2 diabetes and heart disease. You know, simply put, weight loss and physical activity may help your body respond better to insulin. Research has shown that losing just as little as 4, 5 to 7% of excess weight can reduce the onset of type 2 diabetes by 58%. You know, that's only 10 to 14 pounds for someone who weighs about 200 pounds. So too much body fat, as we've mentioned, you know, it's not good for your health. But compared to the fat that lies just underneath your skin, which is called subcutaneous fat, it's visceral fat that builds up around your organs, like your liver, stomach, stomach, and intestines. It's more likely to raise your risk for serious medical conditions. You know, your waist size is also a really easy way to get a rough estimate of this. So I encourage you to wrap a tape measure around your waist, right over your belly button, and no sucking in the stomach. And in women, 35 inches or more is a sign of visceral fat. And in men, it's about 40 inches or more.
- [05:23]
B
So insulin resistance can clearly be an underlying factor that can Influence both weight gain and also weight loss. For example, when insulin is high, like an insulin resistance, it's telling the body to store glucose, I. E. Gain weight.
- [05:37]
C
Correct. So insulin resistance could be one factor holding someone back from losing weight. You know, in insulin is intricately involved in metabolism and energy storage. As you said, Trish, and as we discussed, under normal conditions, insulin helps store excess glucose in the liver and muscles. When there are high levels of insulin in the blood, this can lead to an increase in that visceral fat and also inflammation throughout your body. And it can ultimately cause you to gain weight and also have trouble losing it, too.
- [06:14]
B
Agreed. And that's why today's topic is so important, addressing this root cause head on. You mentioned that losing weight is a great way to combat insulin resistance because losing the weight means that the body switches from storing glucose to using it. All right, so what else?
- [06:29]
C
So I know, we know it's no secret that exercise can help prevent chronic diseases, and insulin resistance is no different. So exercise can help with insulin resistance in a few ways. In the short term, during moderate intensity aerobic exercise, muscles utilize glucose from the blood, which kind of helps to, you know, quote, unquote, clear out out the excess glucose from the bloodstream and allows it to be utilized in the long term. A consistent exercise program increases insulin sensitivity and reduces A1C levels. The recommendation for moderate intensity aerobic exercise is 150 minutes a week. But we can't forget the benefit of also adding strength or resistance training to your exercise regimen. Whether it's using dumbbell weight machines at the gym or even your own body weight, think of doing a squat or a push up, you're going to reap the benefits of building and increasing muscle mass. Because increasing muscle mass can also improve the body's ability to utilize glucose. This is also known as insulin sensitivity. As we said, the current recommendation for strength training is two times a week, and it targets all major muscle groups. However, what's really crucial to remember here is all movement is beneficial. So walk the dog for five minutes, get up from your desk, or pace while you're talking on the phone. These small doses of any physical activity done throughout the day breaks up sedentary time and can help lower glucose and insulin levels. Recent research has actually shown walking after you eat can specifically benefit your blood sugar. The data showed that even a five minute walk after a meal prevented a blood sugar from spiking as high as it would if you ate and then stayed sitting. I don't know about you, but five minutes is definitely Something that I think can be very realistic and very doable here.
- [08:36]
B
Yeah. And as someone who primarily sits at a desk, I'm taking notes on the things that I can incorporate into my routine. Some are more within reach than others, and really everyone will gravitate to different goals that are within reach of them. The most challenging for me, though, is my diet. What can you tell us about key factors to take into account?
- [08:54]
C
Yes, it's also key in managing insulin resistance to promote healthy blood sugar levels. So, first and foremost, I encourage you to focus on your fiber intake. So, fiber is a carbohydrate that's found in plant foods, and it's not easily broken down or absorbed in the body, unlike simple carbohydrates that break down into sugar and. And cause these rapid spikes in your blood sugar levels. So you can eat carbs, of course, but we want to choose wisely. So go for carbs and fruits, veggies and beans. You know, it's ideal to avoid foods that cause blood sugar spikes, whether it's sugary drinks like soda or even sports drinks, or refined carbohydrates that include things like white bread and white pasta, or packaged baked goods, and also even processed foods like chips or fried foods or granola bars, which contain unhealthy fat, and salt, which can contribute to inflammation. And choose those sources of protein wisely. Let's look for some healthy sources. If you eat animal protein, stick with some lean sources like chicken or turkey without the skin, fish or eggs. And limit things like beef, lamb, and pork. You may want to even consider incorporating more plant protein from things like beans, lentils, soy like tofu, and also nut butters like peanut butter or almond nut butter. And also swapping out some saturated and trans fat, which we know are found in meat, cheese, and also fried foods. For some healthier fat options that we already even mentioned a little bit. Nuts and nut butters, seeds and avocado. You know, a crash diet really is not the answer here. Adopting healthy habits is. So making changes to your diet really can seem so daunting at times. But focusing on small, manageable changes is really key. So one or two small changes will make it easier to stick with this and more likely to become a habit.
- [11:02]
B
Small habits build up into big changes. Sometimes the biggest obstacle is the learning curve to try new things, but also need to be reminded that it's small changes. And at the end of the day, I get a choice to pick my hard pick between hard to make a diet change or hard to lose the weight that will be gained or hard to manage the chronic condition it could lead to when stacked against each other. The easiest of the hard is to just make the diet change initially to prevent all the other things from happening. Well, you may have now just gotten a sneak peek into my own pep talk to make better decisions on food, but, hey, that message may resonate with others, too. So. All right, moving on. Patty, you discussed weight loss, physical activity, and dietary habits. Any other important factors I do want to touch.
- [11:47]
C
Also on other factors that we don't talk about nearly enough is the role that stress and sleep plays in insulin resistance. You know, stress is a natural reaction. Stress releases hormones that, like cortisol that produce that flight or fight response. You know, it pushes you to take action when needed. This response is so critical in how we deal with stress. But there's really some drawbacks here. So while that fight or flight response happens automatically, that doesn't mean that it's always accurate. So sometimes we respond in this way even when there's no real threat. So constantly being in a state of fight or flight, so such as when you're faced by repeated stressors, can also be harmful to your health. So elevated levels of cortisol over time can disrupt your body's glucose metabolism by increasing inflammation, which in turn increases blood sugar levels and then promotes insulin resistance. And you know what, guys? Not all stress can be avoided. But finding strategies, whether that's relaxation techniques like deep breathing and meditation, can help you better react and manage your emotions and thoughts, including those that cause stress. And I'm sure it's probably no surprise as well that sleep and physical health are connected. So according to the National Sleep Foundation, 63% of American adults do not get enough sleep. That's needed for good health, safety, and even optimum performance sleep. 63% guys of Americans do not get enough sleep. That is a very sobering number.
- [13:32]
B
Yeah, that is a surprisingly high number.
- [13:35]
C
A recent study showed that people who sleep less than six hours a night are at considerably higher risk for type 2 diabetes than those who sleep seven to eight hours a night. So if you aren't getting enough sleep, you feel hungrier and are therefore likelier to eat excessively and possibly gain weight. So our habits and behaviors, even during the day, can impact how we sleep at night. Whether it's getting regular physical activity, exposure to daylight, or cutting back on caffeine in the afternoon and evening, they're all really helpful. And some other sleep hygiene tips to consider and think about is keeping to a consistent sleep and wake schedule, even on the weekends, which I know can be tougher. So all of these items, physical activity, good nutrition, sleep and stress management, they're all areas within our lifestyle that we can improve upon to help reverse insulin resistance.
- [14:36]
B
So many awesome pearls that you are sharing in terms of very actionable items that can make a big difference. This is a great segue into the For My Heart patient education program. This is a service the Quest Cardiometabolic center of Excellence at Cleveland Heart Lab offers. Can you tell us about the program?
- [14:52]
C
So at For My Heart, we are focused on prevention through lifestyle change and behavior modification. You know, we like to focus on meeting the patient where they're at because everyone is at a different piece in their journey. So we provide personalized coaching to help individuals reduce cardiometabolic risk and achieve optimal health with a focus on nutrition, physical activity, weight management, and stress and sleep habits. You know, most of us know what we should be doing to improve our health. We all know that we should be eating right or moving more. But let's face it, life does get in the way. So maybe you work a very demanding job or you have children that you care for, or possibly you're a caretaker to your aging parents. Whatever the case may be, we tend to feel pulled in so many directions. And then on top of it, your physician may walk in and say, hey, you have insulin resistance. And guess what? You should consider making some lifestyle changes to help reverse that. That can seem like such a daunting task. And also, it's yet another thing on our already long to do list. So our clinical educators can come in and help you reflect on your current situation and guide you towards making changes that feel right to you. Again, meeting the patient where they're at, someone may not be ready to start changing everything that they're eating. Whether it's, you know, their sugary cereal at breakfast. Let's just. Or whether it's, you know, they detest exercise and they just can't get themselves motivated to do anything there. So at that point, we have to work with them and say, where are the areas that you are open to change? And where can we start to peel that layer of the onion a bit? You know, maybe it's the afternoon slump time, that 4pm Maybe someone's grabbing that quick chocolate or quick candy for that pick me up. Hey, is that an area that we can start to swap? Maybe we can find something else that's a little bit more wholesome to have as a healthy snack there. Or from a physical activity perspective, you know, maybe you are mostly sedentary at your job and sit in front of a computer like most people do, unfortunately. Hey, is there a way that we can start just getting up more during your day? Maybe set a little reminder on your computer to pop up every, I don't know, hour, hour and a half. Hey, just get up, stretch your legs, move around. You know, it's not going to feel natural at first, but as you continue to start to do, your body is gonna start to probably crave that as the new normal.
- [17:25]
B
Awesome. It's those little habits that once we start to implement, can really be impactful over time.
- [17:31]
C
And I think you put that perfectly. It's the small changes, the small little habits over time and building on them to make the big result.
- [17:39]
B
Patty, thank you so much for sharing your insight today. Thank you on behalf of the many patients that you've spoken to and have helped them to achieve better lifestyle habits.
- [17:48]
C
Oh, you're so welcome. It's been such a pleasure to be here and talk about this topic that's near and dear to my heart.
- [17:59]
A
That's a wrap on this episode of Healthier World with Quest Diagnostics. Please follow us on your favorite podcast app and be sure to check out Quest Diagnostics Clinical Education center for more resources, including educational webinars and research publications. Thank you for joining us today as we work to create a healthier world one life at a time.