Insulin resistance is a condition in which cells have a harder time taking up glucose from the bloodstream. It's a precursot to Type 2 Diabetes and Metabolic Syndrome, which refers to a cluster of symptoms that increase the risk of cardiovascular disease, is a hallmark symptom of Polycystic Ovarian Syndrome (PCOS), and affects 40% of adults in the United States. Insulin Resistance is a BIG problem in the United States and worldwide, and has a dramatic effect on health, fertility, and pregnancy outcomes.
What is Insulin Resistance?
Before I tell you what insulin resistance is, it's important to know what insulin is and how it's supposed to function. Insulin is a peptide hormone made by the beta cells in the pancreas, an endocrine gland that sits behind your stomach. It has a number of roles including maintaining normal blood sugar levels, promoting cell growth and division, and regulating carbohydrate, lipid, and protein metabolism. In a healthy individual, when sugar is eaten (or carbohydrates that the body then converts to sugar), the pancreas releases insulin into the bloodstream, where it travels with glucose to cells throughout the body. Insulin acts as a sort of key that tells liver, fat, and muscle cells to take in glucose, which lowers the amount of glucose in the bloodstream.
Insulin resistance occurs when the liver and muscle cells stop responding to insulin. Similar to someone who is hearing impaired needing you to knock or speak louder in order to hear you, insulin has to "knock" louder in order to tell these cells to take in glucose. More and more insulin is needed for this response to work. When the beta cells of the pancreas can't keep up with this increased production of insulin, glucose can accumulate in the bloodstream leading to conditions of Prediabetes and Type 2 Diabetes.
How do I Know if I Have Insulin Resistance?
While there are specific tests that help identify insulin resistance, they're quite complicated and are mostly used for research purposes. Instead, most doctors do a blood test that measures the amount of glucose in the blood. While one time measurements can give us some clue as to how the body is handling sugar, the most informative test is something called Hemoglobin A1c (HgA1c). This test is beneficial as it gives us your healthcare provider a view of what your blood sugar has looked like over the last three months.
All red blood cells have a protein on them called hemoglobin, which is responsible for delivering oxygen to cells. As glucose travels through the blood, it attaches to hemoglobin. While everyone has some glucose attached to their hemoglobin, those with higher blood glucose levels have more, which is what the HgA1c test measures. A normal HgA1c level is below 5.7%. You can talk with your doctor about getting a HgA1c, which requires a simple blood test that can often be done in-office or in a lab, and doesn't require any special preparation, unless being done at the same time as other labs.
Does Insulin Resistance Affect Fertility?
The short answer is yes, insulin resistance affects fertility for both men and women. It has a number of mechanisms by which it does this, but insulin resistance can disrupt the normal process of ovulation, leading to anovulation (or, not ovulating or ovulating regularly), and can also cause poor egg and sperm quality, increase miscarriage risk, and in women undergoing IVF, insulin resistance may increase the need for gonadotropins. In women, excess insulin also tells the ovaries to make more androgens, or male hormones, which lead to the common symptoms of acne, hair loss, and hirsutism in women with PCOS.
Can I Get Pregnant with Insulin Resistant?
While you can get pregnant with insulin resistance, it does make it more difficult to get pregnant, and can increase your risk of developing gestational diabetes and pre-eclampsia during pregnancy. It is best to try and manage insulin resistance before you get pregnant.
What Can I Do to Help Manage Insulin Resistance?
I'm so glad you asked! The most common medical treatment for insulin resistance is a medication called Metformin that helps improve the body's response to insulin, decreases the stomach's absorption of glucose, and decreases the amount of glucose the liver makes. While this medication is helpful, there are also many lifestyle factors that go a long way in helping to manage and reduce insulin resistance. Here are some of them:
Get Regular Movement. Some of the most important changes you can make are to incorporate 30-60 minutes of moderate intensity exercise into your routine most days of the week, including both cardio and strength training. Read more on my blog post HERE.
Eat Quality Foods. Eating a diet high in lean protein, healthy fats, and plenty of fruits and vegetables is the basis for an insulin resistance diet. The diet I recommend for all couples trying to conceive is the Mediterranean diet, which you can read more about on my blog HERE.
Eat More Fiber. Fiber is one of the best things you can eat when trying to tackle insulin resistance, and studies have shown a direct correlation between higher fiber intake and lower insulin resistance. Fiber is found in whole grains, beans, legumes, and in the skin of many fruits and vegetables, especially berries, apples, pears, artichokes, carrots, cauliflower, broccoli, and kale.
Limit Sugar and Refined Carbohydrates. Sugar, and simple carbs like traditional white breads, pastas, and baked goods all act as sugar in the body, so limiting these foods is essential when trying to manage insulin resistance. Carbohydrates are not inherently bad, but the type of carbohydrate does matter greatly. Focus on whole grains, such as brown rice, quinoa, whole wheat, oats, barley, spelt and einkorn, all of which help maintain optimal blood sugar levels.
Limit alcohol. While consuming an occasional alcoholic beverage doesn't have a clear relationship with insulin resistance, chronic binge drinking is known to cause insulin resistance.
Improving Testosterone Levels in Men. Studies have shown a correlation between higher testosterone levels and lower insulin resistance in men. You can support healthy testosterone levels by exercising regularly, getting plenty of vitamin D, limiting alcohol consumption, managing stress and cortisol levels, and reducing your exposure to estrogen-like chemicals.
Because nutrition is so important when managing balancing blood sugar levels and supporting fertility, I've created a FREE 7 Day Mediterranean Meal Plan, complete with recipes and a shopping list, so you can start eating well TODAY without the headache of spending countless time sorting through recipes on Pinterest.
References:
Axe, J. Insulin resistance diet. Retrieved from:
CDC, (September, 2022). All about your A1c. Retrieved from: https://www.cdc.gov/diabetes/managing/managing-blood-sugar/a1c.html
Chavarro, J. E., Rich-Edwards, J. W., Rosner, B. A., & Willett, W. C. (2009). A prospective study of dietary carbohydrate quantity and quality in relation to risk of ovulatory infertility. European journal of clinical nutrition, 63(1), 78–86. https://doi.org/10.1038/sj.ejcn.1602904
Link, R. & Mawer, R. (2022). 8 proven ways to increase testosterone naturally. Retrieved from: https://www.healthline.com/nutrition/8-ways-to-boost-testosterone#5-Proven-Ways-to-Increase-Testosterone-Levels-Naturally
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