How to manage insulin resistance

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TalkingAnt
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How to manage insulin resistance

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A common pattern I have seen in PSSD is low insulin sensitivity, also called insulin resistance or prediabetes. Insulin sensitivity refers to how your body clears blood sugar. If it is low, your blood sugar could get too high and cause problems over time. I myself suffered from it until I implemented various lifestyle changes. The main side effects are fatigue (particularly after meals), poor sleep, reduced energy during exercise, and type 2 diabetes if it goes on too long. Improving my insulin sensitivity through diet and lifestyle changes has benefited me primarily through reducing fatigue. There seem to be deeper biological links between insulin resistance, mitochondrial function, and PSSD that have only just begun to be explored due to the cutting edge nature of the science of these systems, but I'd bet addressing insulin resistance will become a key part of PSSD treatment in the future. Additionally, well regulated blood sugar is linked to longevity.

If you suspect you have insulin resistance, you can have your doctor give you an Oral Glucose Tolerance Test. You should also test yourself with any cheap blood glucose meter that can be found at CVS, Walgreens, etc. What you are looking for is whether your blood sugar regularly spikes past 140 mg/dl after meals. Staying under 120 is more optimal. The standard is to measure your blood sugar 2 hrs post meal. A continuous glucose monitor (CGM) is even better but they are currently expensive and require prescription in most countries. Be on the lookout for consumer smart devices that offer CGM in the near future. Even if you pass an OGTT, your diet may be spiking your blood sugar to dangerous levels and thus at-home testing is key.

If you do have insulin resistance, here are some ways to improve it. Even if you don't, you may want to implement some of these for longevity purposes. You don't have to do all of these and you shouldn't start out with everything, but the more you do the more you will improve insulin sensitivity.

Low Carb/Keto Diet

20 - 100g of carbs per day can be considered low carb. Below 20 is generally ketosis-inducing (keto), but it varies per individual. Keto will give the strongest effect but can cause difficulties (ex "keto flu"). It's easier to gradually step into ketosis for short periods of time rather than jump into keto full time. Intermittent fasting can help with that. At minimum, one should determine how many carbs they can eat per meal without raising blood sugar beyond 120 mg/dl. Training your body to thrive on a low carb/keto diet will improve your cellular energy metabolism and insulin sensitivity. You will need to get used to counting carbs and looking up how many carbs are in things. Eventually it will become second nature. The more you exercise the more carbs you can get away with. You will not die from not eating carbs as your body can synthesize glucose from protein and fat, but you may feel like shit initially, which could indicate you need to supplement electrolytes.

Cardio Exercise

Cardio (running, fast walking, swimming, biking, etc) will burn the most calories and offset some of the carbs you eat. For optimal training of your cellular energy metabolism, you will want to get a lot of "zone 2" cardio (heart rate zone), which is roughly a pace at which you could talk but it's slightly difficult due to breathing. Not so hard that you can't talk but not so slow that it's easy to talk. That is where your body relies the most on fat metabolism and can stimulate mitochondrial function. HIIT like sprinting is crucial as well because it will deplete your muscle glycogen stores, which allows your muscles to uptake more glucose. Aim for at least 3 30min cardio workouts per wk.

Weight Lifting

Increasing your muscle mass will increase the amount of glucose your muscles can uptake from the bloodstream, thus increasing the amount of carbs you can eat before reaching problematic blood sugar levels. Aim to work each major muscle group at least once per wk.

Intermittent Fasting

Fasting can improve insulin sensitivity as well as cellular energy metabolism and has a lot of anti-aging benefits. A 24hr fast once a wk is a good starting regimen. A 3 day fast is the minimum required for autophagy but that is more for longevity rather than insulin sensitivity. Anything longer than a week is probably unnecessary and requires doctor supervision. You can drink water, coffee, tea, and zero-sugar electrolyte drinks on the fast. As with keto, you may get headaches indicating being low on electrolytes. You should continue medications/supplements.

Technically you will go into ketosis within 24-48h of fasting, so if you are already keto it will be easier. Otherwise expect unpleasant hunger and lethargy.

Time-Restricted Feeding

A close relative to IF, TRF is when you eat within a small window every day. 16-8 (fasting for 16h and eating within 8h) and 18-6 are popular routines. For example, my eating window is 10am-6pm (16-8). It doesn't have as strong as an effect on insulin sensitivity as IF but is more sustainable and can be paired with IF.

Get Better Sleep

Poor sleep can cause insulin resistance, and insulin resistance can cause poor sleep. It's a bit of a catch-22, but if your sleep is poor then you will want to address that if you can. If insulin resistance is impacting your sleep, then your sleep should get better if you improve insulin sensitivity by the other methods. (TODO: Link updated guide to sleep).

Metformin/Berberine

Taking metformin or berberine can improve insulin sensitivity over time. You must take them consistently- one dose isn't going to have much effect. But you really shouldn't resort to these unless you have really bad insulin resistance that must be addressed ASAP. And as soon as you stop taking them, the benefits will stop. But insulin sensitivity improvements you get from lifestyle changes will persist for some time even if you revert the lifestyle changes. These drugs will also not improve your cellular energy metabolism, which is a major goal here.

Once you get your insulin sensitivity to a good level, you can relax on the regimen a bit, but if your diet shifts to high carb and/or your lifestyle goes sedentary, you can end up back where you started. Being prone to insulin resistance really requires a lifelong dedication to maintaining your health.

A lot of the info here is based on the work of Dr Peter Attia. This is by no means an exhaustive guide so you should do some research into each of these points before undertaking. I hope this helps and please let me know if you have any questions!
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Youcanwin
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Re: How to manage insulin resistance

Unread post by Youcanwin »

Amazing post. Thanks for sharing. I am working on this currently.
Tree
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Re: How to manage insulin resistance

Unread post by Tree »

Thanks for the information., I suspect it's related to pssd. I was diagnosed with prediabetes. My diet is very clean so it caught me by surprise.
pssdperson
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Re: How to manage insulin resistance

Unread post by pssdperson »

Thanks for sharing, I suspect I also have insulin resistance. May I ala if you know if OGTT is better at detecting insulin resistance than HOMA IR?

As well, does anyone have any idea why we may have this? Epigenetics? A downstream effect?
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TalkingAnt
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Re: How to manage insulin resistance

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pssdperson wrote: Tue Jul 27, 2021 2:09 am if OGTT is better at detecting insulin resistance than HOMA IR?
It's not that one is better per say, you really would want to do both for an accurate diagnosis. Again it's also important to see what your blood glucose is doing after meals, because it could be the case that your insulin resistance is borderline detectable on the tests but your diet/lifestyle is bad enough to regularly spike glucose past 140 mg/dl.
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ryjoseph97
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Re: How to manage insulin resistance

Unread post by ryjoseph97 »

I had my labs yesterday and my glucose was at 86 mg/dl. But I think I have a metabolic disorder because I get exhausted after meals. It's been that way for about a year now. I'm doing inositol and magnesium but I think I want to add keto. Thanks!
Youcanwin
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Re: How to manage insulin resistance

Unread post by Youcanwin »

Hello, TalkingAnt. Can I speak with you man?
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TalkingAnt
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Re: How to manage insulin resistance

Unread post by TalkingAnt »

Youcanwin wrote: Fri Aug 06, 2021 3:55 pm Hello, TalkingAnt. Can I speak with you man?
Of course. You can DM me here or on Discord.
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Youcanwin
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Re: How to manage insulin resistance

Unread post by Youcanwin »

What do you think of carb-backloading 50g of carbs at night, for a total of 100g of carbs in a day? My Insulin is mostly normal.


Or is the deal okay just as long as you don’t exceed 120 ng/dl?
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