Guest post by: Dr Mariah Mosley

The prevalence of diabetes type 2 has increased significantly in the last 30 years.  Currently an estimated 23.1 million people in the United States5 (which is 7.2% of our population) have been diagnosis with this illness. That is an unfortunately high number for a preventable disease!  Naturopathic doctors often focus on prevention of disease, and with pre-diabetes, treating insulin resistance is key. 

Physiology 101

Insulin is a hormone made in our pancreas that signals to our cells to absorb and use the sugar (glucose) in our bloodstream.  During “insulin resistance”, the cells in our muscles, liver, body fat, etc start ignoring the signal from insulin, and this leads to high levels of glucose in our bloodstream.  This is often the first stage of diabetes type II.

It has been common medical knowledge for years that insulin resistance is linked to obesity, an unhealthy diet filled with refined sugar and processed carbs, and a sedentary lifestyle.  But being a very black/white thinker, I am left still wondering, but what exactly is the ROOT CAUSE of the insulin resistance? Is it the diet? The lack of exercise? The excess weight? Let’s go into this a bit more…

Studies have shown that surgical removal of the adipose tissue does not improve insulin sensitivity, so the adiposity itself doesn’t seem to be the root cause. But what is leading up to the adiposity is of importance: lack of exercise and poor diet. Exercise makes muscles more sensitive to insulin, which can actually reverse insulin resistance.1  And an unhealthy diet is correlated to insulin resistance in a way you may not expect.  Recently it has been found that insulin resistance is linked to imbalances of the gut microbiome4 (aka all the trillions of bacteria and microorganisms in our intestines).

Insulin Resistance and the Gut

So it seems that the poor diet actually changes our microbiome, lowering our beneficial gut bacteria and increasing the harmful dysbiotic bacteria, which then leads to obesity, inflammatory bowel diseases, lower immunity, cardio-metabolic disorders, neuropsychiatric diseases, and even cancer8. Different strains of bacteria are correlated with different diseases, and it is still unknown if there is an overgrowth of bacteria specifically correlated with insulin resistance.  However, there has been a study that showed loss of the bacterium Akkermansia muciniphila lead to impaired intestinal integrity, which ended up inducing insulin resistance, and then supplementation with the A. Muciniphila and adding butyrate (to heal intestines) reversed it back10!

There also has been success on treating insulin resistant diabetes with fecal transplants (a process of restoring the common bacteria back into digestive tract by an infusion of stool from a healthy donor). One study showed that after just 2 weeks with fecal microbiota transplantation, insulin sensitivity was improved significantly9. This supports the theory that insulin resistance may start with the gut microbiome.

460–377 B.C., Hippocrates, the father of modern medicine: “All disease begins in the gut”

The Upshot

So what can you do?

  1. EXERCISE DAILY: The American Heart Association reports that since muscles are more sensitive to insulin after exercise, a person can actually reverse insulin resistance with physical activity and a healthy diet1. In fact, just lifestyle changes ALONE can reduce the risk of pre-diabetes developing into diabetes by over 58%2.
  2. CLEAN UP DIET:  Try to have a diet high in whole foods, organic vegetables, fiber, and healthy fats. Try to limit (or eliminate completely) the highly refined sugars and processed carbohydrates that do more damage than good. Having high fiber in the diet can support the beneficial bacteria (legumes, beans, dark colored vegetables, fruits, whole grains, nuts).
  3. RAISE ADIPONECTIN:  One of the causes of insulin resistance that has been found is hypoadiponectinemia3 (low adiponectin).  Adiponectin is protein hormone found in adipose (fat) tissue that directly sensitizes the body to insulin. It helps the body break down fat to use as fuel, and regulate the glucose. Low adiponectin is shown to be linked to insulin resistance, as well as metabolic syndrome,  inability to lose weight, diabetes, and obesity.  You can raise adiponectin with healthy fats (nuts, fish, *olive oil*, avocado- think Mediterranean Diet), curcumin, adequate sleep, and glycine. Read more about adiponectin and weight loss here.
  4. AVOID ANTIBIOTICS (unless absolutely necessary):  Antibiotics are typically way overprescribed in our culture.  I have seen prescribers give antibiotics (which kill bacteria only, not viruses) to patients with upper respiratory viral infections. The antibiotics then end up affecting the bacteria (both good and bad) in our gut. This is problematic because our gut bacteria is normally beautifully balanced to keep the good guys (beneficial bacteria) high, and the harmful bacteria low. When the antibiotics come in and disrupt the balance of good/bad, sometimes the bad bacteria can begin to proliferate becoming more abundant than our good bacteria, and this causes some pretty big problems.

References:

  1. American Heart Association Prevention and Treatment for Pre-diabetes.  https://www.heart.org/en/health-topics/diabetes/prevention–treatment-of-diabetes/prevention-and-treatment-for-prediabetes#.WKbsShKLRTY
  2. The Diabetes Prevention Program (DPP). Description of lifestyle intervention. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282458/
  3. Journal of Clinical Investigation. Adiponectin and adiponectin receptors in insulin resistance, diabetes, and the metabolic syndrome. https://www.jci.org/articles/view/29126
  4. Current Diabetic Repot. The Gut Microbiome as a Target for the Treatment of Type 2 Diabetes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6013535/
  5. Center for Disease Control and Prevention. Prevalence of Diagnosed Diabetes. https://www.cdc.gov/diabetes/data/statistics-report/diagnosed.html
  6. Nutrients. The Impact of Diet and Lifestyle on Gut Microbiota and Human Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4303825/
  7. Medical News Today. The gut microbiome: How does it affect our health? https://www.medicalnewstoday.com/articles/290747.php
  8. Human gut microbiome: hope, threats, and promises. https://gut.bmj.com/content/67/9/1716
  9. Cell Metabolism. Improvement of Insulin Sensitivity after Lean Donor Feces in Metabolic Syndrome Is Driven by Baseline Intestinal Microbiota Composition. https://www.ncbi.nlm.nih.gov/pubmed/28978426
  10. Science Translational Medicine. Commensal bacteria contribute to insulin resistance in aging by activating innate B1a cells. https://stm.sciencemag.org/content/10/467/eaat4271