There are various factors which lead to insulin resistance. Which includes 

• Age and gender
• History of Gestational diabetes or family history of diabetes.
• Excess smoking or excessive alcohol consumption
• Inherited conditions like myotonic dystrophy and inherited lipodystrophy.
• Sleep disorders such as sleep apnea.
• Hormonal conditions such as Cushing’s syndrome, acromegaly, and hypothyroidism
• Certain ethnic backgrounds are more prone to developing insulin resistance
• Some medications can lead to insulin resistance like steroids, antiretroviral drugs, and certain antihypertensives.
   

Other than the above causes certain factors are interlinked. 

Let us look at it in more detail.

Role of visceral fat in IR

Excessive carbohydrate intake especially processed food which is high in calories leads to weight gain.

Obesity is one of the main factors which is significantly linked to insulin resistance. However, it does not directly lead to insulin resistance.

So what would be the main reasons? 

We all are aware that excess carbohydrates (sugar) and high-calorie consumption lead to obesity. However, some may not know that a person will develop insulin resistance before he/she gains weight or becomes obese.

Do you know why? It is because of an increase in visceral fat in the body.

Now, you might wonder where the visceral fat comes from and how it relates to insulin resistance.

It all begins with the excess carbohydrate intake, raising blood sugar levels and making the pancreas produce more insulin. This leads to increased uptake of excess sugar into the cell, thereby leading to storing excess sugar in the liver as glycogen. 

This process continues if the person continues to eat excess carbs which in turn leads to abdominal obesity. Not only overweight or obese people, but even normal-weight people can also get fat deposition in the abdomen. Which is also known as visceral fat. A person with normal weight and high visceral fat or abdominal fat is also known to have  “normal weight obesity”.

Visceral fat is the dangerous abdominal fat which deposits around our organs. Which can also release a large amount of free fatty acids into our blood, as well as inflammatory hormones. The action of insulin is prevented by free fatty acids and inflammatory hormones. So there is an increased production of insulin. This condition is called insulin resistance.  So excess insulin production is called hyperinsulinemia, which can lead to increased hunger, altered metabolism and thereby leading to weight gain or obesity.

Excessive fructose intake in IR

High intake of fructose from added sugars, syrups, and fruit juices, and excessive intake of ripened fruits are all linked to insulin resistance. 

Blessy’s Story

Blessy is a software developer who has lived a sedentary lifestyle for more than 4 years. She is one of my patients who is very health conscious and she never eats processed food or desserts but she chooses fruits instead of those processed food and desserts. She used to have proper 3 meals a day along with fruit salad rather than desserts and she also prefers fresh juices rather than carbonated beverages. 

You might think that it’s good that she is consuming healthy foods. But it is not true and this is where her problem started and she got fatty liver grade – ll and pre-diabetes. 

When she came to me for a dietetic opinion she thought it might be due to her lack of physical activity. Yes, it might be one of the causes but it is not the main reason. 

Do you know why?

This is because of her dietary habits which she has followed from her childhood where 60-70% of her sugars are from fructose. Even though it is healthy, too much sugar or calories is not good for our body, especially fructose. 

Fructose does not stimulate the production of insulin as much as glucose does and it is metabolised in the liver and promotes lipogenesis, which is stimulation of fat production.

So, both fructose and alcohol consumption can promote fat accumulation in the liver, which leads to fatty liver that also causes insulin resistance. 

The excessive amount of fat which gets stored in the fat cells inhibits the liver’s ability to effectively manage blood sugar levels, causing cells to respond poorly to insulin, increasing the risk of developing fatty liver especially non-alcoholic fatty liver disease (NAFLD), type 2 diabetes and obesity.

Lack of physical activity

Physical activity increases insulin sensitivity and builds muscle mass which allows our body to improve the uptake of glucose from the bloodstream into the cells.

A lack of physical activity might have the opposite effect due to poor muscle mass and lack of cell sensitivity which cause insulin resistance. Furthermore, a lack of physical exercise and a sedentary lifestyle are linked to weight increase, which might worsen insulin resistance.

Overall, diet, obesity, visceral fat, physical activity and fatty liver are all interlinked and lead to insulin resistance. 

Chronic inflammation occurs due to increased oxidative stress in our body which may also cause insulin resistance. A decrease in the gut microbiome due to gastrointestinal problems may worsen insulin resistance as well as cause other metabolic problems.

Insulin resistance has been linked to other chronic illnesses, including heart disease, NAFLD, PCOS, Alzheimer’s disease, and cancer. 

Insulin resistance often leads to increased insulin production, also known as hyperinsulinemia.

Conclusion

In conclusion, to prevent insulin resistance and diabetes, Plan to change your 

• lifestyle including the following:
• Well-balanced diet
• Regular physical activity
• Sleep hygiene
• Improving your mental health.
  
  
  Varsha
  Senior Clinical Dietitian, Simplyweight