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Dietetic therapy for insulin resistance
Table of Contents
1. What does insulin resistance entail?
Insulin resistance (IO) is a condition characterized by reduced tissue sensitivity to insulin. In clinical studies, elevated blood glucose levels are observed when the insulin level is normal or too high. A distinction is made between liver insulin resistance and muscle insulin resistance. Insulin is a hormone produced by the beta cells of the pancreas in response to a consumed meal. It serves, among other things, to regulate blood sugar levels by lowering blood sugar levels by introducing glucose into the cell interior via insulin receptors, which are present in most cells of the body. In the case of insulin resistance, glucose cannot enter the cell because the cells do not react to insulin, which leads to a constant increase in blood sugar levels that cannot be used as an energy source for the cell. In response to this, the pancreas produces even more insulin, which increases the resistance of cells to this hormone. An excess of insulin in the blood can lead to the development of overweight, obesity, non-alcoholic fatty liver, high blood pressure, lipid metabolism disorders, and infertility (Mirabelli et al., 2020).2. Insulin resistance is the cause
The causes of insulin resistance are not entirely known. Some of the causes are genetic. Among the factors that increase the risk of developing this disorder are: excessive calorie intake, lack of physical activity; increased amount of fat tissue within the abdomen (so-called trigeminal fat), free emotional stress, ?? body aging. Gastric fat accumulates in the internal organs and releases excess fatty acids.3. Insulin independence - Symptoms may manifest
Insulin resistance may be asymptomatic for a lengthy period, however, over time, concerning signals begin to appear: - weight gain, - drowsiness following meals, - mood deterioration, - irritability, - memory and concentration difficulties, - darkened skin thickening (skin changes most commonly occurring around the elbows and neck), - chronic fatigue, - hunger pangs around 2-3 hours post-meal, - sensation of cold, - heightened cravings for sweets, - complications in shedding pounds.4. Insulin resistance - the diagnosis
In order to diagnose insulin resistance, the following tests should be carried out: - fasting glucose and insulin levels; - OGTT test, which is to determine fasting glucose and insulin levels, one hour and two hours after ingestion of 75 g of glucose solution. The results of these tests enable the calculation of the HOMA-IR index, which is the ratio of fasting glucose and insulin levels. A HOMA-IR index of over 2.0-2.5 indicates insulin resistance.5. Dietary therapy for insulin resistance
A healthy lifestyle, including a well-balanced diet, is essential in treating insulin resistance. Dietary recommendations for insulin resistant people are: reduction in calorie intake. On the one hand, people with insulin tolerance very often struggle with excess body weight. on the other hand, being overweight or obese contributes to the development of insulin resistance. Weight loss lowers the level of free fatty acids and increases the sensitivity of cells to insulin (T. McLaughlin et al. 2019). People with insulin resistance are advised to reduce their body weight and start a low-calorie diet. The calorie deficit should be determined individually, so that body weight decreases slowly and steadily (0.5 to 1 kg per week). reduction in the number of meals to 3-4 per day; provision of a larger amount of energy in the first half of the day; avoidance of snacks between meals. Insulin is produced in response to the meal and the rise in blood sugar levels. It is not only responsible for the distribution of glucose to the cells, but also stimulates the synthesis of fats. In the breaks between meals, the insulin level in the blood drops, making it possible to break down excess fat; daily intake of a large amount of vegetables. Vegetables contain polyphenols that reduce blood sugar levels and increase the sensitivity of cells to insulin; restriction of fruit intake to 1 portion per day; daily intake of at least 25 g of dietary fiber. Dietary fiber is found in whole grain products (millet, rice, pasta), vegetables, and fruits. limitation of dairy products to 1-2 portions per day; reduction in the intake of saturated fatty acids and trans fats; restriction of red meat intake – high intake of animal protein aggravates insulin resistance, while plant protein increases the sensitivity of cells to insulin (M. M. Adeva-Andany et al. 2019). complete elimination of sweetened beverages and sweets from the diet; limitation of salt intake to 5-6 g per day; proper composition of meals that should contain carbohydrates, proteins, and fats; supplementation of vitamin D and vitamin B12 in people taking metformin; limitation of alcohol consumption to 20 g of pure ethanol per day for women and 30 g of pure ethanol per day for men. Recommended dietary patterns for people with insulin resistance are dietary treatment with a low glycemic index, the Mediterranean diet, and the DASH diet.6. A diet with a low glycemic index
The glycemic index (GI) determines the rate of increase in blood glucose after ingestion of a food containing 50 g of digestible carbohydrates, as a percentage, compared to the increase in glucose levels after ingesting 50 g pure glucose. Based on the glycemic index, products are divided into: products with a low IG < 55%, products with a medium IG of 55-69%, products with a high IG > 70%. Products with a low IG cause a slow increase in blood glucose levels and a small insulin response, leading to a longer feeling of satiety. Products with a high IG are quickly digested and absorbed in the digestive tract, leading to a rapid increase in blood glucose levels and a large insulin response, which results in inhibition of fat breakdown and increased fat synthesis.7. Glycemic index of selected food items (A.. Jeznach-Steinhagen 2020)
White bread 75Rye bread 64Buckwheat 45Couscous 65Oat flakes 55White rice 64Beetroot 64Carrot cooked 47Carrot raw 16Apple 38Watermelon 72Kiwi 53Strawberries 40Apricots 57Chickpeas 28Cooked chickpeas 22Doughnut 76White chocolate 40 Factors affecting IG: fineness the finer the product, the higher the IG; heat treatment the longer it is heated, the higher the product; storage conditions products stored at low temperatures have a lower IG; protein content the more protein contained in the food, the lower its IG; fat content the addition of fat reduces the IG of the food; fiber content the more fiber a product contains, the lower its IG; anti-nutrients in the product (e.g. Phytic acid, oxalic acid) reduce the IG; fermentation and acidification lower the IG of products; ripeness the riper the fruit, the higher its IG.8. The Mediterranean Diet
The Mediterranean diet contributes to a decrease in body weight and waist circumference index. This leads to a reduction in insulin secretion and HOMA-IR index (K. D. Gołąbek, B. Regulska-Ilow 2019). The Mediterranean Diet is characterized by a high consumption of vegetables and fruits, dried seeds of leguminous plants, whole grain cereals, olive oil, and nuts while limiting the intake of meat, fish, eggs, and dairy products. The restriction of animal-derived products means that the Mediterranean dietary pattern is low in saturated fats but rich in valuable components such as vitamins, minerals, polyphenols, and essential unsaturated fatty acids. Polyphenols have a positive impact on the insulin sensitivity of cells, the reduction of oxidative stress, and the reduction of inflammation. They are present in vegetables and fruits. The more intense the color of the vegetable or fruit, the more polyphenolic compounds it contains. (M. Mirabelli et al. 2020)9. The DASH dietary regimen
The DASH dietary regimen is also advantageous for insulin resistance. It leads to a substantial improvement in the sensitivity of cells to insulin. However, it must be combined with an appropriate caloric deficit and consistent physical effort. The DASH dietary regimen involves a high intake of vegetables, fruits, whole grain products, fish, poultry, nuts, and low-fat dairy products. Red meat, eggs, sweets, and sugary beverages are limited.10. Insulin insensitivity and engagement in physical activity
The diet should be combined with engagement in physical activity (minimum 150 minutes per week). Regular involvement in exercise has a positive effect on weight loss and improves the sensitivity of cells to insulin. It is recommended to start an aerobic (oxygen) activity with low or medium intensity. This can be walking, cycling, swimming, nordic walking, or dancing. It is important that the type of activity suits your preferences and health. Insulin insensitivity is a metabolic disorder in which changing the lifestyle is of utmost importance.
