How to Reverse Insulin Resistance

Want to learn how to reverse insulin resistance? Find out what it is, why it appears and how to reverse it with lifestyle changes and keto!

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It has been a while since I’ve published an article vs, just a recipe! This past year or so has been…… interesting.  I want to lay it all out there and maybe it can be a learning lesson for others.  As you may know, I have adult-onset type 1 diabetes and I strive really hard for non diabetic blood sugars.  Keto has been amazing for that. 

My A1c was 5.2 a year ago.  While many doctors would be happy with that, it is still higher than a healthy non diabetic A1c.  In 2020 and life as we know it was turned upside down, my eating and strict control were disrupted.  Disrupted.  I say that as though it was passive.  It wasn’t.  I CHOSE to disrupt it obviously. 

I left strict keto for a while and went more low carb.  It was this slippery slope and I found myself tumbling at times and then working my way back up the hill and then repeat.  I got my latest A1c a few weeks ago and it was 5.6.  Leaving keto, even though I stayed lowish carb, cost me .4 in my A1c which is actually quite a bit.  It was a wake-up call for me.  Especially since I had been struggling with keeping my blood sugars within range.  It is almost impossible to keep them in range when carbs are higher. 

The ironic thing is that I was talking to my husband and I joked that my blood sugar was refusing to come down and that his was probably sitting at a beautiful 83.  He hadn’t eaten in a few hours and so, just in fun, we decided to check his blood sugar and it was 150.  Which was a HUGE eye opener.  I gave him one of my CGMs and he monitored his blood sugar and realized that his was WAY higher and basically at prediabetic or Type 2 Diabetic levels. 

After some experimentation and blood tests – he is without a doubt insulin resistant.

We both made the commitment to go back to keto and not leave it again.  Within a week back on keto, my blood sugars were back in range 100% of the time.    I forgot how beautiful that flat line was. And for reference, the gray “in-range” is set to 70 and 120 so I keep pretty tight control.

So let’s dive into keto and how to reverse insulin resistance.

To preface this, for those that don’t know, I’m in the final stretch for my Master’s Degree in Complementary and Alternative Medicine. I’ll be graduating later in 2021.

Keto and Insulin Resistance

I’m sure you’ve probably heard in passing that keto causes insulin resistance.  But does it really? I’m here to challenge you to dig deeper into that before believing that outright. Because, if you look at the data, it actually IS (in part) how to reverse insulin resistance rather than what causes it.

Y’all know I love science so I’m going to take you through the main argument for why people say keto causes insulin resistance and then take you through the science to explain why, in fact, it might not be the case.

There definitely are studies and trains of thought that found that keto causes insulin resistance.  Now, if you are unfamiliar with insulin resistance, then let’s take a quick tangent and talk about the basics.

What is Insulin Resistance

Insulin resistance, at the most basic level, is when the body has a decreased sensitivity to insulin.  This means that more insulin is required to do the work of escorting energy (glucose in this case) into the cells and systems.  It is estimated that half of the adults in the US have insulin resistance to some degree [4].

I think many people discount the importance of insulin.  But it literally affects every cell in our bodies. 

You might be asking yourself if insulin is so important and insulin resistance is so prevalent then why is it not something that is looked at right away?  Great question.  One reason is that insulin resistance can occur outside of high blood sugars.  Meaning, your blood sugar can be totally normal, and you still have high insulin.  This is more in the beginning stages of insulin resistance. So while your blood sugars may be normal, your insulin (if measured) will not be normal.   Eventually, the body beings to become resistant in the presence of constantly high insulin.

Once the body gets to the point where it can’t keep the blood sugars low AND insulin levels are high, that is when Type 2 Diabetes officially presents.   

This problem is two fold.  We now have more glucose circulating in the blood stream (higher blood sugar) and higher insulin in the body.  Why is this a problem?  Well…..

Is High Blood Sugar Bad?

It most certainly is.  Now, the American Diabetes Association (ADA) has, what I feel to be, absolutely ludicrous ranges that they deem as acceptable. 

Many studies show that anything above 140 does damage.  In my own research, fasting levels above 85, yes 85, and post prandial numbers above 125 actually do damage.  I’m going to do an entire post on this shortly, so stay tuned for the research that I’m referring to!

Is High Insulin Bad?

The answer is 100%.  Take a look at the list of diseases associated with high insulin [1] (and this is just a small subset) :

Cancer

Atherosclerosis

Cardiomyopathy

Thrombosis

Diabetes

Non-alcoholic fatty liver syndrome

Alzheimer’s

Chronic inflammation

Obesity

Peripheral neuropathy

Osteoporosis

Nephropathy (which can lease to kidney failure)

Reproductive issues

And so much more.

Again, when there is constantly higher insulin, the cells become resistant to insulin.  Interestingly, it has been shown, and argued, that there is a cart and horse problem between elevated insulin levels and insulin resistance.  Meaning, it is both a cause and result [2].

How Do We become Insulin Resistant?

There are several things to consider when looking at the origins of insulin resistance.  Several factors are genetics, ethnicity, age, too much insulin, obesity, inflammation, oxidative stress, air pollution, smoking, diet, sleep habits, and sedentary living.  This is not an exhaustive list, but you can see how there are so many things that influence insulin resistance.

In the book, Why We Get Sick, there is a simple questionnaire to evaluate your risk for insulin resistance.  The questions are as follows:

• Do you have more fat around your belly than you’d like?
• Do you have high blood pressure?
• Do you have a family history of heart disease?
• Do you have high levels of blood triglycerides?
• Do you retain water easily?
• Do you have patches of darker-colored skin or little bumps of skin (aka “skin tags”) at your neck, armpits or other areas?
• Do you have a family member with insulin resistance or type 2 diabetes?
• Do you have PCOS or erectile dysfunction?

He states that if you answered yes to one of these, you likely have insulin resistance.  If you answered yes to any two or more, then you most certainly have insulin resistance.

Keto and Insulin Resistance

I’m not going to cite any studies for this side of the equation, but the general consensus across several studies is that while fasting glucose numbers are actually quite good for those on a ketogenic diet, once carbs are introduced again, the post prandial (post meal) numbers suggest insulin resistance.  This has been cited in more than one study.

I really enjoyed listening to talks and reading Ben Bikman’s book Why We Get Sick.  He addresses this as Reverse Metabolic Inflexibility or even Acute Glucose Intolerance.  Basically what he is saying is that when you introduce carbohydrates after being in ketosis, the body can (and often does) have a small delay in shifting metabolic states. 

This is actually quite intuitive if you think about it.  Consider when you just start keto and are getting into ketosis for the first time. Your body goes through a pretty rough time as it transitions into ketosis.  Shifting into the metabolic state of fat burning is never a fun thing.  It is clunky.  It can be slow.  It can be anything but fun.  But eventually, it gets there. 

So what Dr. Bikman is suggesting is that the same is true going in the other direction and it presents as temporary glucose intolerance rather than long term insulin resistance.

I’ve heard a lot of theories and read a lot of studies and this makes the most sense.

How to Reverse Insulin Resistance

So, if you find yourself insulin resistant, what the best ways to reverse it?  There are 6 great ways that we will discuss as well as how keto can aid for each one [3].

1. Restricting Calories – What happens when we are constantly in a calorie surplus is that ultimately our bodies, specifically our cells, are not designed for a constant excess energy supply.  And when this happens, the response will be insulin resistance.  So blood sugars will rise and insulin will rise.  Keto swoops in beautifully here because often it is calorie restricted inherently because eating more fat allows us to be full for longer and therefore consume fewer calories. Keto helps us to be in what is called the “underfed” state which promotes a reduction in insulin resistance.
2. Reducing Body Fat – We have 2 main types of fat: visceral fat, which is the fat around the organs, and subcutaneous fat, which is the fat just underneath the skin.  Visceral fat, as it turns out, acts as an endocrine organ and can increase insulin resistance, both directly and indirectly.  Just one of the many reasons why visceral fat is quite dangerous, especially in high amounts.  Subcutaneous fat insulates us and can act as an energy source.  However, when these fat cells get too large, they can become dysfunctional and disrupt insulin signaling.  Now, what does keto help us with?  Burning fat and thereby improving metabolic health!
3. Restricting Carbohydrates – It is quite natural to imagine how a lower carb diet can aid in insulin resistance.  It will help to lower blood sugars and thereby lower insulin levels and then increase insulin sensitivity (the opposite of insulin resistance).
4. Ketones – Several studies indicate that ketones (ex, beta-hydroxybutyrate) may be able to reduce insulin levels and thereby reduce insulin resistance.  But what we know for sure is that ketones have been found to be an appetite suppressant that decreases calorie intake.
5. Intermittent Fasting – There are MANY studies available that show a strong link between intermittent fasting and the reduction in insulin resistance. Not to mention a massive amount of other benefits, but this is just one of them.
6. Physical exercise – Exercise has the ability to remove glucose from the blood without insulin.  I think this is fascinating and makes so much sense.  I just learned this little golden nugget.  This occurs when we flex our muscles.  So think about resistance training here.  But truly, ANY exercise is helpful.  Just pick something that you’ll actually do versus trying to do the best thing and then end up doing nothing.  Obviously, I have no points to talk about regarding keto here, but ketones are a great “pre workout”!

The primary takeaway is that insulin resistance is prevalent, pervasive, responsible for much of chronic illness, and reversible.

Lastly, you can find almost any study to support your position.  What I ask of you, however, is to use your critical thinking and make a few evaluations:

1. Who is funding the study and what is their goal?
2. Does the study make sense?
3. Could there be another explanation for the result?

I would love to hear from you about what you want for upcoming episodes.  You can find me in my Keto Facebook community where I like to hang out.

[1] https://diabesity.ejournals.ca/index.php/diabesity/article/viewFile/19/61

[2] https://pubmed.ncbi.nlm.nih.gov/18227495/

[3] https://www.ruled.me/the-ketogenic-diet-and-insulin-resistance/

[4] Bikman, B. (2020). Why we get sick: The hidden epidemic at the root of most chronic disease—and how to fight it. Dallas: BenBella Books, Inc.