4

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Why am I insulin resistant even though I'm lean?

Asked on January 21, 2015
Created November 25, 2010 at 7:01 AM

I've been paleo for about 18 months now, and pretty strict about it for the most part. I eat pretty low carb, probably between 40 and 60 grams of carbs a day.

But my blood glucose is persistently on the high side, around 6.0 mmol in the morning and it stays around that figure pretty much all day, up to about 7 mmol an hour after a meal.

I know these aren't really high values, but the fasting morning value is on the borderline for medical treatment.

I'm quite lean, no real visible bodyfat to speak of so I'm definitely not your average insulin resistant fatty. I do a reasonable amount of exercise, maybe 100km of cycling per week, but not much in the way of high intensity interval stuff at all.

Is my pancreas a bit tired after 10 years on a vegetarian diet? I've had untreated hashimotos for the same period as well, maybe that has caused this? So many variables it's hard to work out what's what.

Maybe I need to hit the weights...

E35e3d76547b18096a59c90029e7e107

(15613)

on November 26, 2010
at 09:03 AM

If by ALA you mean alpha linoleic acid rather than alpha lipoic acid, can I exhort you not bother and to take some animal form omega-3 instead, which the body can use a *lot* more effectively? If you meant lipoic acid (or something else entirely) then I don't know enough about it tbh.

40e925ddc9657e211c9a2ee83c2cc579

(364)

on November 26, 2010
at 04:35 AM

Great post, thankyou.

40e925ddc9657e211c9a2ee83c2cc579

(364)

on November 26, 2010
at 04:06 AM

Thanks for the great answers everyone. I really appreciate people taking the time to provide such complete and well thought out responses. I've got a few things to try and investigate, starting with just monitoring to see exactly what my bg is doing over a period of time.

A968087cc1dd66d480749c02e4619ef4

(20436)

on November 25, 2010
at 12:06 PM

Definitely hit the weights! I'm a T2 diabetic and working out just helps tremendously with controlling blood sugar. The book Body by Science explains why. Walking is great too - medical studies on walking show that it lowers insulin resistance. Also just found out that caffeine increases insulin resistance by the same amount that metformin lowers it! I am working on cutting that way back.

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5 Answers

9
E35e3d76547b18096a59c90029e7e107

(15613)

on November 25, 2010
at 09:17 AM

That low carbers will become physiologically insulin resistant, as Eva has mentioned and that this is a normal adaptation, has been well established by Peter and Stephan. Still, while it is obviously evolutionarily sensible for your body to spare glucose to run your brain, you might reasonably want to lower your blood glucose. Perhaps our bodies are not perfectly efficient at adapting glucose sparing/glucose use to precise amounts of glucose (and there's something of an all-or-nothing effect to the insulin resistance switch).Given that, there are various things that might be raising your blood glucose.

For one thing, in addition to Eva's suggestion of raising carbs, possibly switching into a glucose-burning metabolism and seeing what happens (it seems to take low carbers 3 days of eating 150g of carb before they can pass an OGTT for example), you might also try further reducing your carbs. If your body is sparing its glucose for your brain, but you're eating more than it needs, then it might not be surprising that your blood glucose is sometimes running high.

If you're eating lots of protein that also might be elevating blood sugar, since the job of glucagon is to ensure that blood sugar remains tolerable while insulin moves amino acids into cells, and all excess protein will be converted into sugar by the liver. If you're regularly eating 40-60g of carbs then your protein needs are likely diminished anyway.

The type of exercise you're doing might also temporarily raise blood sugar levels, since extended cycling might raise cortisol levels, pushing glucose into the blood stream, so that you have the energy to perform the exercise. Hence while exercise is typically a good thing, depleting muscle glycogen and creating a sink for glucose, in the short term it can certainly raise blood sugar and some paleo-people think that "chronic cardio" can sufficiently raise cortisol to actually break down muscle and increase blood sugar over the long term (especially when combined with high carb intake). In any case, if reducing blood sugar and increasing muscle insulin sensitivity is your goal, then short, sharp, very intense exercise would seem to be the order of the day. I wouldn't exhort you to cut out the 'cardio' exercise, just to not worry about elevated blood glucose shortly after a workout.

Also if you're stressed then this will raise blood glucose, even without eating anything, for much the same reasons as above; namely cortisol breaking down stored energy/muscle in order to provide energy for fight or flight. Aside from all the sensible courses for reducing stress, apparently vitamin C also works to counteract the work of cortisol (although I also seem to recall that vitamin C can raise blood sugar, so swing and roundabouts, but on the plus side, it's possible that vitamin C offsets the downside of high blood glucose. High caffeine intake, might also produce the same response, through inducing insulin resistance and raising cortisol (and other hormones) to push glucose into the bloodstream.

Of course, it's also possible that you're actually insulin resistant in a bad way, so it's worth ensuring you have adequate magnesium, vitamin D, chromium etc.

Also it's worth noting that the real cause of problematic insulin resistance is hepatic (liver) insulin resistance, which you certainly can have despite being lean. A vegetarian (high fructose, high pufa, high carb?) diet might well have induced that, so it might be worth being strict on the paleo things that can reduce that (low fructose, no alcohol, high SFA, low PUFA-including o-3, and adequate choline) in order to ensure another fatty liver reversal.

If you want to directly reduce your blood glucose you could also try eating lots of coconut, since the MCTs herein cause an insulin response and so should clear your blood of glucose (in preparation for the incoming fat).

Oh and also you might want to get an HbA1c test to see how much damage you're actually incurring from high blood sugar over the long term, which will be substantially more indicative than just a blood sugar test. For example, Peter's blood glucose was "prediabetic" despite eating virtually no carbs and high fat, yet his glycated haemoglobin count was very low.

40e925ddc9657e211c9a2ee83c2cc579

(364)

on November 26, 2010
at 04:35 AM

Great post, thankyou.

2
62ed65f3596aa2f62fa1d58a0c09f8c3

(20807)

on November 25, 2010
at 07:56 AM

Was this also your blood glucose on the vegetarian diet or are you only now testing it? It would be easier if I had an understanding of how your bg has changed over time. But here is a likely scenario that some other lowcarbers experience. When lowcarbing it, some people experience a physiological insulin resistance in which most of your cells convert to fat burning mode and so are reluctant to take in glucose. This saves the glucose in your blood for the few parts of the body (brain) that requires glucose. For some reason, some lowcarbers find that this state results in borderline high fasting blood glucose levels. However, seems like this condition, if that is what it is, is reversable by merely eating more carb for about a weak, such that more of your cells revert back to sometimes using glucose as a fuel and so they become less insulin resistant.

The difference between this physiological response to lowcarb and regular diabetes is that the first if natural, reversable, and serves a good cause, whereas regular diabetes is pathological and not so easily reversed. The first results in a constant borderline fasting blood glucose that stays about the same, but the second is the beginning of ever higher blood glucose levels and regular diabetes unless something is done about it. Since I don't know your exact situation, one option would be to simply eat more healthy carb for a week or so and track how your fasting blood glucose alters or doesn't alter in response. Might be interesting to see for yourself what is going on!

1
E9798942dfaa0cda97a8f9a71c128c5d

(168)

on November 25, 2010
at 03:04 PM

If you are lean, you could be lacking necessary muscle mass. Lean muscle literally "slurps" up excess blood sugar. You can add muscle mass by eating a paleo diet (concentrate on a ratio of 2 fat grams to 1 gram of protein), and with weight/resistance exercises and sprints. Go easy on the cardio. A little is OK. A lot (chronic) is not. And remember, coconut oil is your best friend. 3 TBS a day....Best fat there is.

Wendy, RN

1
07c5607b5639012aa228f0734b8b9160

on November 25, 2010
at 09:18 AM

You should take A1c and see if it's low. If it is then no worries.. Ups sorry... It was already here.

0
40e925ddc9657e211c9a2ee83c2cc579

(364)

on November 25, 2010
at 09:12 AM

I had a bg test when I was first diagnosed hypothyroid, and pre paleo diet. That figure was in the same ballpark, about 6 point something...

I'm monitoring my levels now with a meter, and have a few interventions planned (ala, cinnamon, hiit). I may try adding a few carbs before I try anything else.

E35e3d76547b18096a59c90029e7e107

(15613)

on November 26, 2010
at 09:03 AM

If by ALA you mean alpha linoleic acid rather than alpha lipoic acid, can I exhort you not bother and to take some animal form omega-3 instead, which the body can use a *lot* more effectively? If you meant lipoic acid (or something else entirely) then I don't know enough about it tbh.

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