Insulin resistance is on the rise, and so are people’s waistlines. The ‘obesity epidemic’ is in fact an epidemic of diabetes, metabolic syndrome and cardiovascular disease - conditions that put undue strain on healthcare systems even before the COVID-19 pandemic.
Why ‘‘undue’? Because insulin resistance itself, the physiological phenomenon at the heart of diabetes, metabolic syndrome, cardiovascular disease and obesity, is completely 100% treatable using only diet and lifestyle practices. Yup - you don’t even really need herbs. But, just because I'm a herbalist, you'll also find my top 5 herbs for treating insulin resistance right here in this article.
Diabetes and insulin resistance
The International Diabetes Federation estimated in 2017 that the number of people with diabetes globally had increased from 108 million in 1980 to 422 million in 2014 - that’s a 290% increase. These numbers are only expected to increase by 48% by 2045, roughly the same time period.
It is clear that the global shift towards a Western diet high in sugar and fructose, coupled with a more sedentary, high stress lifestyle brought about this huge initial increase in diabetes incidence. In turn, it must be clear that in order to reverse the numbers, we need to exercise, eat and live a bit differently.
The most alarming thing is that even more people are walking around with ‘prediabetes’ - a state of insulin resistance, sometimes called metabolic syndrome or ‘syndrome X’ - and they don’t even know it. In 2018, as many as 1 in 3 adults in the United States were thought to be insulin resistant - most of these will go on to develop full-blown diabetes.
Insulin resistance is also called metabolic syndrome, 'syndrome X' and 'prediabetes'
So what is insulin resistance?
We need insulin to transport sugars, vitamins, amino acids and essential minerals from the bloodstream into the cells. When the blood becomes nutrient-rich after a meal, the pancreas secretes the hormone insulin in response - think of it like a key that unlocks the cell, allowing nutrients to flow in.
In this high insulin environment - called ‘hyper-insulinaemia’ - the body is focussed on burning sugar, not fat. Elevated insulin prompts the secretion of IGF-1 (insulin-like growth factor 1) from the liver, which in turn shuts off growth hormone (GH) secretion. GH promotes the building of lean muscle mass and the burning of fat - so, for as long as insulin is coursing through our arteries, the prevalence of IGF-1 means that we cannot burn fat or build lean muscle.
Back in our hunter-gatherer days, carbs consisted of 22-40% of our total calories - nowadays, Americans consume 50-60% of their total calories as carbs. This shift towards a carb-heavy diet means the pancreas has to keep pumping out insulin in response. Eventually, like any other hormonal system in the body, overstimulation of insulin receptors - the locks that the key needs to open the cell - causes them to malfunction. Receptors start dying off, or not responding to insulin - they become ‘desensitised’ or resistant to it.
After a carb-rich meal, insulin is typically elevated in the blood for 2-3 hours in a non-insulin resistant person - but in someone who has been ‘desensitised’ to the effects of insulin, it sticks around for much longer. And if someone is consuming carbs at every meal - cereal or oatmeal in the morning, a sandwich for lunch, a sweet snack mid-afternoon and dessert after dinner - they will be under the effects of insulin, not being able to burn fat or build lean muscle, all day long and into the night.
Not all cells respond to insulin in the same way - some are starving, which makes the person eat even more carbs, and some become overfed and inflamed, such as the blood vessels, leading to heart disease. Hyperinsulinaemia also strips the body of essential nutrients such as chromium and magnesium, as these are required for insulin to bind to cells and do its work. This and other deficiencies associated with insulin resistance - namely zinc, B vitamins and omega-3 fatty acids - adds to a picture of an overfed individual who is “starving at their core” (Paul Bergner, herbalist).
High insulin levels also block the absorption of vitamin C into the cell, which predisposes us to viral respiratory infections and worsens disease outcomes. Along with vitamin D status, insulin resistance could be the key we need to unlock to help reduce the damage to people’s lives and livelihoods caused by the current pandemic.
Overstimulation of insulin receptors causes them to become desensitised, or resistant, to the effects of insulin over time
What to do about it?
Carbs are addictive, there’s no doubt about that. Overcoming a sugar addiction has been likened to giving up heroin - it’s no easy feat. However, here are just some of the benefits you will experience if you manage to kick the carbs for good.
weight loss
a healthier relationship with stress
increased immunity
better sleep
more energy
more control over your emotions and appetite.
There are three simple steps you can take to start increasing your sensitivity to insulin and reaping the benefits of normal glucose tolerance.
Step 1: Nutrient repletion
Magnesium and chromium are required for insulin to bind to cell receptors, so deficiencies in these nutrients can cause insulin resistance. However, stores of these nutrients are also drawn upon excessively by high circulating insulin levels, turning it into a vicious cycle of depletion.
The way to break this cycle is to supplement with high doses of these nutrients - 800mcg chromium and 1200mg magnesium per day, for example. The magnesium will need to be administered in divided doses throughout the day to prevent loose stools and encourage absorption. Other supplements to take in high doses include zinc, B complex, vitamin C and omega-3 oils. These are all perfectly safe.
Replenishing levels of these nutrients will not only make you feel better quickly - it will curb carb cravings right from the start, making it easier to cut down on simple sugars.
High doses of magnesium, chromium, zinc, vitamin C and omega-3 oils will curb carb cravings right from the start
Step 2: Eat protein for breakfast
There are several benefits to eating protein and fat instead of carbs for breakfast. Firstly, it sets the metabolism off to a good start. Avoiding a blood sugar spike in the morning will naturally prevent a dip later on in the day, so you’ll crave fewer carbs. Protein is heavily satiating, keeping you satisfied for longer, and amino acids are the building blocks of energy production at the cellular level, so you’ll have more energy, willpower and mental clarity.
Sound good? Eat 25-35g of protein for breakfast to reap these physiological benefits. For omnivores, this could be something like two eggs, some smoked wild salmon, spinach and avocado. Vegetarians and vegans will have to get creative with mushrooms, pulses, sprouts, nuts, seeds and hemp or pea protein powders.
Protein in the morning gives you energy without spiking your blood sugar
Step 3: Do some resistance exercise
Muscle cells become insulin sensitive through training, just as the untrained muscle cell becomes insulin resistant with inactivity. The best way to train muscles is by doing manual labour, though a simple weights routine, some burst cycling, running, or cross-training at the gym are all great options.
Engaging in resistance or burst exercise on most days for 15-20 minutes is sufficient to drastically improve insulin resistance, along with the two above steps. Medicated diabetics need to be very careful if implementing this regime as their blood sugar could drop to dangerously low levels - they will need to monitor carefully and reduce insulin doses if necessary.
Medicated diabetics must monitor their glucose levels carefully if embarking on this type of programme.
Next step: ditch the carbs
After implementing these steps for 2-3 weeks, you will be more physiologically prepared to reduce your carb consumption. Mentally, it will still be tough. Start by cutting out sweet treats and simple sugars, and then slowly cut out things like pasta, bread, potatoes, and excess alcohol. This might be depressing in many ways, so seek help from a natural health practitioner if you can. This is where herbs can come in.
I don’t think living carb-free should be everyone’s goal, but if you’ve got a family history of diabetes, cardiovascular disease or obesity, an increased waist:hip ratio and love your carbs, you may have to ditch them. The only way of knowing for sure is to do some blood tests - HbA1C, fasting insulin, fasting glucose, triglycerides and HDL cholesterol - and even purchase a home glucose monitor to test your individual response to the foods you commonly eat.
And now, onto the herbs! Here are my top 5 for treating insulin resistance along with the above dietary and lifestyle measures.
1. Trigonella foenum-graecum - Fenugreek
Fenugreek is an ancient medicinal legume - nutritive, warming and mucilaginous in nature. It is used to soothe the gastrointestinal mucosa in inflammatory digestive conditions and promote breastmilk production in lactating mothers. It was also traditionally a lymphatic and metabolic cleanser, indicated in sedentary people with poor dietary habits and increasing blood pressure.
Recently several studies have demonstrated fenugreek’s ability to lower blood sugar, insulin levels and serum triglycerides, and increase HDL cholesterol levels. Dosages in successful trials vary from 18-25 grams per day, with preparations in powder form as well as tea and alcoholic extracts all showing benefit.
2. Foeniculum vulgare - Fennel
Fennel is another nutritive seed given to breastfeeding mothers to promote lactation - it is also a warming antispasmodic carminative herb used in digestive conditions where there is gas or cramping. It is useful in irritable bowel conditions through its ability to calm an anxious mind, which in turn helps relieve digestive spasm.
Traditionally it was given for an overactive appetite and weight gain - and one small study testing the effects of fennel and fenugreek tea found that it decreased hunger and food consumption in overweight women, and increased feelings of fullness compared with a placebo tea. This is by no means definitive data, but the availability of fennel and its traditional use to curb food cravings makes it a useful addition to any natural protocol for insulin resistance.
3. Ocimum sanctum - Holy basil
Basil is a pungent, fiery herb traditionally used to detoxify the blood, liver, lungs and intestines. Various species of Ocimum have been used in traditional medicine to treat diabetes, but it’s the Indian O. sanctum or Holy basil that shows the most potential in terms of research. One clinical study showed a blood sugar lowering effect in patients with non insulin-dependent diabetes (type 2 diabetes) both on fasting and after meals, and another 2009 study showed significant improvement in the symptoms of diabetes - namely thirst, excess urination, excessive appetite and fatigue - after a 3 month treatment period. The dosage used in the second study was 2g daily in powder form. Another human study suggests that these effects are due to increased insulin sensitivity at a cellular level.
Holy basil is also an uplifting nervine and circulatory tonic, used for age-related memory loss, menopausal ‘brain fog’ and ‘stagnant depression’ (Winston, 2019) - where a person becomes ‘stuck’ after a traumatic event in their lives. As a mild adaptogenic herb, it could also help to protect the body against the adverse effects of stress - which, after all, is another symptom of poor glucose tolerance.
4. Cinnamomum spp. - Cinnamon
Cinnamon is another warming, stimulant yet sweet digestive herb - perfect for sluggish digestion in people who tend towards coldness and weakness of the respiratory and immune systems. Many animal studies have demonstrated the blood sugar lowering and insulin sensitising effects of cinnamon, and there are a couple of human studies too. One 2014 study of 50 patients with non-alcoholic fatty liver disease showed a reduction in a specific measure of insulin resistance along with fasting glucose, total cholesterol, triglycerides, liver enzymes and CRP, a general marker of inflammation. The dosage of cinnamon was two 750mg capsules of powdered cinnamon per day (1500mg in total), combined with appropriate dietary changes and an exercise regime.
Another recent study of 80 people with impaired glucose tolerance showed beneficial effects of an extract of Cinnamomum burmanii and Lagerstroemia speciosa at a dosage of 50-100mg once daily over 12 weeks. Compared to placebo, this combination improved insulin sensitivity and preserved pancreatic beta-cell performance.
5. Vaccinium myrtillus - Bilberry
Both the leaves and the fruit of bilberry are traditionally thought to have anti-diabetic properties. During the Battle of Britain in WW2, RAF pilots used bilberry to enhance night vision, and further research has led to the use of bilberry as a general remedy for eye problems, especially for damage to the retina caused by diabetes.
In a clinical study, male volunteers with type 2 diabetes were given an extract of bilberry equating to 50g of fresh bilberries, and their responses to a glucose-rich drink were measured. The extract significantly reduced post-meal glucose and insulin levels compared to placebo. Blueberries, which are botanically very similar to bilberries, also showed enhanced insulin sensitivity in obese, insulin-resistant volunteers after consumption twice daily for 6 weeks.
Food for thought...
Have you noticed that these ‘herbs’ are all widely available, highly accessible culinary ingredients? I often give them to my patients as tinctures and capsules, but this doesn’t mean you can’t simply incorporate them into your curries, herbal teas and smoothies with great results. Food is medicine and, once again, it’s the basic dietary and lifestyle changes that are most important where diabetes and insulin resistance are concerned.
References
Winston & Maimes (2019) Adaptogens: Herbs for Strength, Stamina and Stress Relief. Healing Arts Press: Vermont.
Wood, Matthew (2008) The Earthwise Herbal Repertory, Vol 1. North Atlantic Books: California.
Herbalist Paul Bergner's writings and teachings. Bergner devised a program to combat insulin resistance when he himself was diagnosed with it, and I have implemented it in my own practice with good results. If you are a medicated diabetic, please consult your doctor before embarking on this regime.