- What is insulin resistance?
- What are the clinical features of insulin resistance?
- What causes insulin resistance?
- Benefits of following an insulin resistance diet
- What can happen if you are insulin resistant and do not follow the proper diet?
- Tips for following an insulin resistance diet
- How can you make following an insulin resistance diet easy on yourself?
- Best recipes for an insulin resistance diet
- What recipes are popular among people with insulin resistance?
- Source
There has long been an established link between insulin resistance and type 2 diabetes.
It is the strongest predictor of the development of type 2 diabetes in the future, and the consequences can be serious (1,2).
The main implications of insulin resistance are high blood sugar (hyperglycemia), high blood pressure (hypertension), dyslipidemia (raised levels of fats in the blood), and an increased risk of inflammatory and prothrombotic states (2).
A prothrombotic state is an abnormality of blood coagulation that increases the risk of thrombosis (blood clots in blood vessels).
As previously mentioned, the progression of insulin resistance can lead to type 2 diabetes. It can also lead to metabolic syndrome and non-alcoholic fatty liver disease (NAFLD) (2).
Insulin resistance can be defined as a compromised biologic response to insulin stimulation of target tissues. These are primarily the liver, muscle, and adipose tissues.
Insulin resistance leads to the body having difficulty clearing excess glucose in the cells and tissues of the body, resulting in a compensatory increase in the production of insulin (2,3). This leads to something called hyperinsulinemia.
In this article, we will explore where the similarities and differences lie between insulin resistance and type 2 diabetes. We will also discuss how making adaptations to your diet may help to reduce insulin resistance , and where to find the best recipes and further support.
Read on to find out more about this fascinating condition, and how you can empower yourself to manage it with dietary and lifestyle changes.
For some people, these may be all they need to slow or prevent the progression onto pre-diabetes and type 2 diabetes.
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What is insulin resistance?
What is the difference between insulin resistance and diabetes?
You may have heard of insulin resistance often being discussed alongside diabetes.
This will come as no surprise once you learn a little more about the two conditions, as they are intrinsically linked. Yet, they do also have key differences too.
When there is excess glucose (sugar) in the blood, which reduces the ability of the cells to absorb and use this sugar for energy, this is insulin resistance. Whilst, over time, this increases the risk of someone developing type 2 diabetes; what happens in the body is different from someone who actually has type 2 diabetes.
In a state of insulin resistance, when your pancreas can still make enough insulin to counteract the body’s reduced ability to absorb sugar for energy, the risk of developing diabetes is reduced. Blood sugar levels are then more likely to remain in a healthy range (5).
However, over time if measures are not taken to control your blood sugar levels, the pancreas becomes overworked as it is continually trying to battle with raised blood sugar levels to bring them down by producing more insulin.
Eventually, the pancreas stops producing enough insulin or the insulin it does produce is less effective. This leads to the development of pre-diabetes and, then, commonly, on to type 2 diabetes (5,6).
While there are differences between insulin resistance and type 2 diabetes, insulin resistance remains a crucial feature of this metabolic, severe condition.
What are the clinical features of insulin resistance?
What can be worrying about insulin resistance is that often, it does not have any symptoms. Some people who have pre diabetes may get patches of darkened skin in the armpit area or on the neck. This is a condition called acanthosis nigricans.
There are several other possible clinical presentations of insulin resistance, and these vary depending on different factors. These include individual clinical history and physical examination.
How you may individually present with insulin resistance also depends on your risk of associated conditions, such as polycystic ovary syndrome (PCOS) or metabolic syndrome.
For example, people who have insulin resistance linked to PCOS may experience irregular periods or unexplained weight gain. Those who have insulin resistance related to metabolic syndrome may experience gout.
Other conditions associated with insulin resistance, and that may influence how it presents in an individual, include (2):
- Microvascular diseases, including retinopathy, neuropathy or nephropathy
- Macrovascular diseases, including some types of cardiovascular disease such as peripheral artery disease and stroke
- Xanthelasma or xanthomas (4)
- Pre-diabetes and type 2 diabetes
As already mentioned, insulin resistance can also be completely asymptomatic, meaning it does not cause any symptoms. You may have insulin resistance and associated clinical obesity, dyslipidaemias, and hypertension, yet show no signs (2).
What causes insulin resistance?
Insulin resistance is a complex condition. Several factors are linked to an increased incidence of insulin resistance, which we will list here (5).
Genetics
For some, the development of insulin resistance (and type 2 diabetes) is down to their family history. If you have a first-degree relative (parent, brother, or sister) with these conditions, you are more likely to develop it yourself.
Ethnicity
People from the following ethnic groups are more likely to develop insulin resistance and type 2 diabetes. Note that this list is not extensive.
- African Americans
- Native Americans
- Asian Americans
- Hispanic/Latino
- South and East Asian
Age
The risk of developing insulin resistance increases with age. The age at which this is thought to increase varies depending on the information source, but it is broadly believed to be somewhere above the age of 40 (5,7).
Existing medical conditions.
As already mentioned, several conditions are linked to the incidence of insulin resistance. These include, but are not limited to:
- Hypertension and hypercholesterolemia
- Gestational diabetes (diabetes in pregnancy)
- Heart disease or stroke
- PCOS
- Certain medications, including corticosteroids, can also increase the risk of developing insulin resistance
- Sleep apnea can also increase your risk
As well as the potential (or partial) causes listed above, two more key areas are thought to be strongly linked to the incidence of insulin resistance (5).
Physical inactivity
Doing regular exercise can help to prevent insulin resistance (5,8). If you are physically active, this helps your body to move sugar into the muscles for storage and promotes an increase in your insulin sensitivity.
All physical activity counts, although resistance exercise and a combination of cardio and resistance are thought to be particularly beneficial (8).
Bodyweight
Bodyweight is thought to be one of the leading causes of insulin resistance. Excess weight, particularly around your middle, known as visceral fat, can put unnecessary pressure on your organs.
It can lead to the production of hormones that can contribute to chronic inflammation in the body, which, as previously discussed, plays a vital role in the development of insulin resistance. This chronic inflammation can also increase the risk of cardiovascular disease and non-alcoholic fatty liver disease.
One study at John Hopkins University found that for people with pre-diabetes if they lost 5-7% of their body weight over 6 months, they reduced their risk of developing type 2 diabetes. This risk reduction was significant at up to 54% for the following three years.
Speak to your healthcare provider if you are concerned about your weight. It is important that any measurements of body weight are considered in context with overall health status.
We will now go on to discuss how your diet can help to prevent and manage this condition.
Benefits of following an insulin resistance diet
How can following an insulin resistance diet improve your insulin resistance and your overall health?
Being that one of the main risk factors for developing insulin resistance is thought to be excess weight; following a diet may help manage your risk.
It is worth noting that achieving sustainable weight loss is not easy. Achieving a consistent calorie deficit may be enough to make weight loss initially, but this does not account for the physiological responses for long term weight loss.
As you lose weight and your body adapts to fewer calories, you also may begin to expend fewer calories than you did when you weighed more.
In essence, energy expenditure can decline as you lose weight. Also, your body weight is regulated by something called a negative feedback circuit. This influences food intake, and when you lose weight, it is accompanied by endocrine adaptations.
These adaptations can increase your appetite and decrease your satiety, so the same amount of food won’t fill you up in the way it used to. These are just some of the mechanisms that highlight the complexities of the human body and losing weight.
While it is possible to lose weight and keep it off, it is more challenging than many standard ‘diet plans’ would have you believe. Calorie restriction is essential, but more so, are long-term sustainable dietary changes and a gradual approach, all supported by behavior change and professional support.
Reverting back to how diet can help, you will recall that one of the main consequences of insulin resistance is hyperglycemia or high blood sugar levels. Choosing foods that can help to manage this is, therefore, a good idea when it comes to making dietary choices to help improve your insulin resistance.
The following foods can worsen hyperglycemia in those with insulin resistance if eaten too frequently:
- White bread, rice, and pasta, especially eaten in large quantities
- Sweets/candy/sugary desserts
- Biscuits
- Cakes
- Sugary soft drinks
- Added sugar, such as from the sugar added to hot drinks
- Sugary alcoholic beverages, such as cider, fruit beers, mixers with sugary mixers, and many ‘alcopops.’
To recap, when you eat foods that quickly raise your blood sugar levels, it puts extra pressure on your pancreas.
The pancreas has to compensate by producing high insulin levels, to account for the excess sugar in the blood.
When you are insulin resistant, your body ‘blocks’ the insulin from working properly to correctly lower this level of sugar in the blood. Over time this can lead to pre-diabetes and then type 2 diabetes.
On the whole, less processed foods and a diet lower in added sugar will prevent the progression of this cycle.
When you eat foods that have a lower sugar load, your pancreas does not have to work so hard to get your blood sugar levels down. When you have insulin resistance, this is significant as it can slow the progression of the condition.
Eating a diet rich in unprocessed foods and low in added sugar can also help you achieve or maintain a healthy weight if that is your goal. Less processed foods are often higher in fiber, which can fill you up more, slow the absorption of sugar into the bloodstream, and is also great for your gut health.
To improve your blood sugar levels through diet, eat more foods in the list below.
There is no one perfect ‘diabetic’ diet, although there are some fundamental principles to consider. Eat more:
- Wholegrain carbohydrates such as brown/granary/seeded breads
- Wholegrain rice and pasta
- Non-starchy vegetables and fruit
- Beans and lentils
- Nuts and seeds
- Healthy proteins such as lean poultry, moderate amounts of red meat, oily and white fish and seafood, eggs, tofu, and other alternative meat-free proteins
- Unsweetened dairy foods such as yogurt, milk and, in moderate amounts, cheese
A diet high in saturated fat has also been associated with insulin resistance. Certainly, from a heart health perspective, it is widely agreed that unsaturated fats can be protective, while a diet high in saturated fat can increase cholesterol levels. Raised LDL cholesterol levels are a risk factor for increased cardiovascular disease risk.
Government guidance in the UK continues to advise people to reduce their intake of saturated fats and replace them with unsaturated fats (9). People must be aware that this does not mean they have to eat a low-fat diet.
This out-of-date advice is often followed by an increase in dietary carbohydrates (often refined, white carbohydrates) that can increase blood sugar levels if eaten regularly and in large quantities.
Hopefully, following a nutritious diet rich in vegetables, fruits, whole grains, and containing saturated fats has a positive impact not only on your risk of developing insulin resistance but on your overall health.
What can happen if you are insulin resistant and do not follow the proper diet?
While there are many variables involved in whether you develop insulin resistance, one thing is clear – your diet can help reduce or manage your risk.
It can also help to maintain the condition and prevent it from developing into type 2 diabetes if you are already classed as being insulin resistant.
If, however, symptoms or clinical risk are ignored, and no dietary or lifestyle adaptations are made, you may be increasing your risk of insulin resistance leading on into type 2 diabetes.
Sometimes this risk is unavoidable, but it is wise to consider where you may be able to make some changes to your diet and lifestyle.
Always consult a professional such as a registered dietitian if you would like any support with changing your diet.
Tips for following an insulin resistance diet
What foods should you keep in your home if you want to follow an insulin resistance diet?
There are many ways to get creative in the kitchen when you decide to make positive changes to your diet! Yet, there are certainly some key ingredients that can help to make the process much easier. Keep these foods in your house if you want to follow an insulin resistance diet:
- Plenty of fruit and vegetables. They don’t have to be fresh – frozen, tinned, and dried all count. If you are choosing tinned or dried fruit or vegetables, ensure to go for varieties without added salt and sugars.
- Whole grains, such as brown rice, pasta, and bread. These are excellent sources of dietary fiber and can help to slow down the absorption of sugars into your blood when you eat a mixed meal. Be careful with your portion sizes if you are aiming for lower carbohydrate intake, or if you are trying to lose weight. You can have plenty of high-fiber vegetables, protein, and unsaturated fats to make your plate filling for low-carbohydrate diets.
- Other whole grains, including quinoa, buckwheat, whole-wheat couscous, and Freekeh
- Unsaturated fats. Olive oil, vegetable oils, olives, avocados, seeds, nuts, and oily fish are all fantastic sources.
- Lean proteins. If you eat meat, this may include poultry and fish, with lower amounts of red and processed meats. If you don’t, you should get adequate protein by including plenty of beans, lentils, and other pulses and high protein sources such as soy or tempeh.
- Nuts and seeds. Unsalted versions of these crunchy little treats can add something different to so many meals! Try toasting them lightly and adding to cereals, on yogurt, in salads, and on top of stews. They add fiber, healthy fats, and plenty of flavors.
How can you make following an insulin resistance diet easy on yourself?
Don’t put too much pressure on yourself. Whenever you are trying to make changes to your diet, you will never get it perfect.
That is because there is no such thing as a perfect diet! Making small, positive changes gradually can have a huge impact, but it shouldn’t take over your life or make you miserable.
Lean on your peers and any professionals you’re working with. Peer and professional support is important when you’re trying to make lifestyle and dietary changes. Don’t try and take it on all on your own, and you will feel the benefit!
Try new recipes and ingredients. No one likes to get bored with the food they’re eating, and if it feels like a chore, you probably won’t stick with the changes. Try and mix-up your meals and keep it fun.
What foods should you avoid on an insulin resistance diet?
While all foods can be eaten in moderation, many years of nutrition research tells us there are some we should eat more than others. Foods that will not help your insulin resistance if eaten too frequently include:
- White and refined carbohydrates. Wholegrain versions are more nutritious and should make up the more substantial portion of your starchy carbohydrate intake.
- Added sugar. Too much sugar can be bad for your teeth and can lead to increased blood glucose levels. Try and avoid adding sugar to hot drinks and keep sugary desserts to a more occasional choice.
- Fizzy drinks
- Alcoholic drinks high in sugar
Best recipes for an insulin resistance diet
Where can you find the best recipes for an insulin resistance diet?
If you are looking for inspiration for following a diet that may help with your insulin resistance – there is no shortage online!
Many people favor a low carbohydrate diet when they are trying to improve their risk of progressing insulin resistance. Certainly, for managing type 2 diabetes, there is growing evidence to suggest this can be an effective approach.
If you are keen to try this route, there are several great places you can look online for tempting recipes.
- BBC Good Food Low Carb
- RecipesOlive Magazine
- All Recipes UK Low Carb Recipes
Remember that if you choose to follow low carbohydrate diets, there are some key nutrition considerations to be aware of. As with any dietary change, it is important to know that you may be making changes that leave you lacking in vital nutrients.
When it comes to a low carbohydrate diet, dietary fiber and B vitamins can be key nutrients that are lacking. Many cereal products are fortified with B vitamins, and if you are cutting back on starchy carbs, you will likely be getting less fiber.
To combat this, eat more of the following:
- Nuts and seeds. Ground flaxseed is a particularly useful ingredient to have in your house and can be added to cereals, yogurts, soups, stews, and salads.
- Beans, lentils, and pulses
- Vegetables and fruits. Dark green leafy veg is a particularly good source of B vitamins.
- Meat and eggs, to ensure you are not missing out on B vitamins
- Remember, you can still eat starchy carbs such as wholegrain rice and pasta on a low carb diet. Still, you may wish to choose smaller portions and have with unsaturated fat sources, a larger portion of protein, and plenty of vegetables.
How can you find ingredients for recipes for an insulin resistance diet?
The great thing about choosing a diet that improves your insulin sensitivity is that you don’t need any crazy ‘health’ foods! Usually, these foods are expensive, unnecessary, and carry no decent scientific evidence behind them.
The foods mentioned in this article do not need to make your usual shop cost any more, and they can all be purchased from regular supermarkets.
What recipes are popular among people with insulin resistance?
As already mentioned, some people do choose to enjoy a low-carb diet, or sometimes even a ketogenic diet. While there is good evidence to support the benefits of a low-carb diet for the management of type 2 diabetes, this is not the case for a ketogenic diet, and more evidence is needed to assess the long-term outcomes associated with following this diet.
There are some great recipes in our diabetes blog, and Diabetes UK has an extensive selection of recipes and meal plans.
Here are some more popular ideas for dishes that have been enjoyed by many people with insulin resistance:
- Chickpea and vegetable curry served with natural yogurt and crunchy salad
- Baked Mediterranean chicken with green vegetables
- Shakshuka (baked eggs) with toasted, seedy bread and olive oil
- Tuna, avocado and mixed green salad with olive oil and lemon dressing
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