Blood Sugar, Hormone Imbalance & Insulin Resistance: What the Heck?
Your Blood Sugar May Be Driving Your Hormone Imbalance
Blood sugar balance is important for so many aspects of our lives, especially a happy mind, stable moods and healthy hormones! In this article we will take a deep dive into the importance of stable blood sugar, and how when dysregulated it can wreak havoc on our bodies, particularly our hormones and metabolism!
HORMONES ARE INTERCONNECTED
When diving into understanding blood sugar imbalances it's important to consider how interconnected insulin, the hormone that controls blood sugar, is to sex hormones like estrogen and testosterone.
High insulin levels can tell the ovaries to make more testosterone, which in turn can cause facial hair and acne.
High insulin levels also lower sex hormone binding globulin (SHBG) — this dumps estrogen into your system and can contribute symptoms of estrogen excess like PMS symptoms, sore breasts, fibroids, heavy menses and even conditions such as PCOS and Endometriosis.
Cells that get too much insulin can become resistant to it, and chronically high insulin increases estrogen, and increases the cells’ resistance to insulin. This creates a vicious cycle where higher insulin creates higher estrogen, which can lead to higher insulin and insulin resistance, which usually leads to weight gain, which then leads to the production of more estrogen!
Lifestyle changes to lower insulin levels, correct insulin resistance and balance the blood sugar can go a long way in lowering inflammation in the body, helping to restore hormone balance and even lose weight.
Blood sugar spikes & crashes can lead to:
Inflammation
Acne
Ovulation disruption
Unwanted hair growth
Excess fat storage
Metabolic issues
Poor sleep quality
Mood issues; specifically anxiety
HPA axis dysfunction
Thyroid issues
Issues with the body's detoxification processes
Irregular cycles
PMS
WHAT IS INSULIN AND HOW IS IT RELATED TO BLOOD SUGAR?
Insulin is a peptide hormone that is produced by the beta cells in the pancreas. The pancreas produces and secretes insulin and glucagon, the hormones responsible for blood sugar regulation. As the levels of blood sugar rise, signals are sent to the liver, muscle and fat tissues to take up glucose from the blood and store it as glycogen, which is a fatty acid chain. In fat cells, glucose is stored as triglycerides, and in muscle and liver cells, it is stored as glycogen. Insulin is necessary for glucose to enter cells where it is used for cellular energy production (ATP). GLUT4 transporters on the cell wall receive a signal from insulin receptors to allow glucose into the cell. As glucose and insulin levels in the blood drop, the pancreas stops secreting insulin and instead secretes glucagon, stimulating tissues to break down glycogen to release glucose into the blood, in order to maintain blood sugar balance.
HOW BLOOD SUGAR BALANCE WORKS:
In response to high blood glucose, Insulin takes the sugar from the blood and moves it into the cells to be stored. When the body’s cells do not respond normally to insulin, the blood sugar levels also do not respond in an ideal way. The pancreas attempts to re-establish normal blood sugar by producing extra insulin in response to eating a meal – resulting in high blood insulin levels overall.
The primary role of insulin is to coordinate the use and storage of food energy.
Chronic insulin elevation causes cells to down-regulate insulin receptors and reduce responsiveness to insulin, and therefore cells don’t take up as much glucose. Cells establish homeostasis at a new level of hyperinsulinemia and elevated insulin is required to elicit a normal response from the cell. This is referred to as insulin resistance. The result is that nutrients such as glucose are not efficiently cleared from the blood. The glucose is still present in the blood and therefore the pancreas continues to secrete insulin, further causing hyperinsulinemia. These high levels of circulating insulin end up promoting the storage of fatty acids in adipose tissue, and the body does not break down stored fatty acids in the presence of insulin.
Let me explain…
Adipocytes, the cells that make up our fat tissues, are inherently more insulin resistant than many other cells, such as muscle cells. Adipose tissue, especially in the abdomen, secretes hormones that perpetuate hyperinsulinemia and insulin resistance. The presence of insulin suppresses the break-down of fat, and increases fat storage, promoting abdominal adiposity, in other words, that stubborn weight around your midsection you can't seem to lose!
Over time, our cells respond to insulin resistance by making less insulin receptors on the cell, and thus circulating insulin is unable to have a sufficient effect to clear enough glucose from the blood. Both Insulin Resistance and Hyperinsulinemia can be present for years before there is an onset of symptoms or showing up on our blood work.
Insulin Resistance = high blood glucose over time
Factors that Contribute to Insulin Resistance:
Stress & HPA Axis Impact:
Cortisol, secreted during and following stress, causes most cells to stop up-taking glucose in order to keep more glucose in the blood for use by skeletal muscles, as a part of our fight or flight stress response. Cortisol secretion is also increased in hyperinsulinemia. During chronic stress, glucose in the blood exceeds cellular demands, causing a rise in insulin, and eventually causing insulin resistance. The presence of cortisol can also downregulate the GLUT4 transporters and ultimately decrease the uptake of glucose into the cell.
Chronic stress often causes poor sleep, which creates higher cortisol levels and cravings for high-energy, quick burning fuels such as sugars, simple carbohydrates, and salty or oily snacks. Insufficient sleep and high cortisol has been associated with a higher risk of type 2 diabetes, and insulin resistance.
High cortisol leads to hyperglycemia (high blood sugar) and demand for insulin. When this becomes chronic it can result in Insulin Resistance as well as increased abdominal adiposity and inflammation.
Stress can often lead to emotional eating where we make poorer food choices and opt for those foods that are inflammatory such as sweets or salty fried foods, which continue to dysregulate our blood sugar.
The Liver:
The liver is especially susceptible to insulin resistance. Insulin is secreted from the pancreas directly into the portal vein, so the liver is exposed to 2-3x the amount of insulin than the rest of the body. Liver cells (hepatocytes) store excess glucose as glycogen. When there is no signal to break down these glycogen (fatty acid) stores, it can build up and be converted into LDL cholesterol, triglycerides and eventually lead to fatty liver disease.
As women, we tend to have more of a burden on our livers due to a variety of factors
including the constant breakdown of our hormone metabolites, and exposure to xenoestrogens that can disrupt our hormonal balance as well as put more stress on the liver. These can be found in cleaning products, beauty care products, plastic water bottles, commercially raised animals products and dairy as well as in the environment. Supporting our livers, both pase 1 and phase 2 detox pathways can be a big help when dealing with hormonal imbalance as well as blood sugar dysregulation.
The Thyroid:
Blood sugar levels and thyroid health are closely connected as well. When the adrenals become stressed they release cortisol, which equals increased inflammation in the body. The release of too much cortisol can lead to chronic fatigue, mood swings and even increase thyroid antibodies. Constant blood sugar fluctuations impact thyroid function as well. Blood sugar fluctuations can weaken and inflame the gut, lungs, and brain as well as imbalance hormone levels, exhaust the adrenal glands, disrupt detoxification pathways and impair overall metabolism.
During insulin surges the thyroid effects are depressed and conversion of T4 to T3 is suppressed. T3 helps to upregulate all metabolic processes in the body, including GLUT4 transport and rate of the bodies glucose consumption.
When T3 is downregulated it means our glucose is used at a slower rate and stays in the blood longer, which ultimately leads to insulin resistance.
Androgens & PCOS:
Insulin stimulates the secretions of androgens from the ovaries and adrenals, reduces Sex Hormone Binding Globulin (SHBG), increases circulating Testosterone & Estrogen, which can lead to hormone imbalance, estrogen dominance and particularly PCOS. In fact, insulin resistance is a major cause of PCOS.
Disruption of the Microbiome:
People with a less diverse microbiome have been found to have reduced insulin sensitivity, increased markers of inflammation and higher BMI. The microbiome can be disrupted in several ways, most commonly the use of NSAIDS, Hormonal Birth Control, Antibiotics, excessive alcohol use, food intolerance and chronic stress. We can increase our microbiome health by taking a good quality prebiotic & probiotic, eating fermented foods, removing food intollerences from the diet, lowering overall inflammatory load, as well and herbs that support gut health.
Risk factors, Signs and Causes of Insulin Resistance / Dysregulated Blood Sugar Balance
Conventionally accepted “risk factors” for Type 2 Diabetes are actually caused by insulin resistance, including weight gain around the abdomen, high LDL cholesterol, high triglycerides, PCOS and even cardiovascular disease.
Some signs of insulin resistance we can look for include:
Body composition changes/ increased adipose tissue in the abdomnal region
HBA1C creeping up over time
Fasting blood glucose creeping up over time
LDL cholesterol elevated
Triglycerides elevated
Low thyroid function / Hypothyroid
Signs of poor circulation and blood stagnation
Nutrient deficiencies
Fatigue
PCOS
Weight:
Obesity is a widely accepted risk factor for Type 2 Diabetes, while research increasingly shows that weight and BMI are not accurate predictors. Trained or toned muscle is much more efficient at using glucose and reducing insulin than untrained muscle or adipose tissue, meaning your body is going to use its glucose stores much more efficiently if you are active, and creating tone in your muscles.
What does this mean?
It means that exercise is a well-studied method of lowering blood glucose, and regular exercise can rapidly reduce insulin resistance, regardless of weight loss being an effect of the exercise. Lack of exercise or sedentary life could be considered a clearer risk factor for Type 2 Diabetes than obesity. It has been shown that 10-15 minutes of walking after a meal can reduce a blood glucose spike! So get walking!
So how do blood sugar, hormone balance and insulin resistance play into each other?
Simply put: The more dysregulated our blood sugar is, the more stressed our bodies become and the greater risk we have of developing insulin resistance. The more adipose tissue we accumulate because of our insulin resistance, the more our hormonal balance can be thrown off. Estrogen is produced in fat cells, therefore excess fat cells make excess estrogen. Excess estrogen leads to a whole host of hormone issues. Excess weight from hormonal imbalance and lack of exercise lead to higher levels of insulin in the body, and needless to say, Insulin Resistance, which is yet another risk factor for hormonal imbalance in women. It all becomes a viscous cycle!
But not to worry! Insulin resistance and hormonal imbalance are reversible through dietary and lifestyle changes + herbal support!
Ways to Balance Blood Sugar & Reverse Insulin Resistance:
Balance meals with fiber rich carbohydrates, protein and fat. Increased fiber in diet slows the absorption of glucose into the blood.
Reduce simple carbohydrates; transition to whole grains when possible.
Eat a protein rich breakfast, ideally within an hour of waking. This is honestly one of the most important factors of balancing blood sugar! Starting your day with protein and healthy fats helps to stabilize your blood sugar, and sets up your metabolism for the whole day.
Do not drink coffee on an empty stomach, or without protein in the morning. Drinking coffee first thing without protein causes big blood sugar spikes.
Eat small frequent meals throughout the day and ideally eat before you are hungry. Getting “hangry” causes the body to go into fight or flight stress response, which releases glucose into the blood. Keep snacks on hand, and get to know your body and how often you need to eat. Snacks that are high in proteins and good quality fats are the best to keep your energy up and balance blood sugar.
Increase Monounsaturated fats and EFA’s: olive oil, Omega-3 fish oils, wild salmon, trout, sardines, halibut, herring, mackerel, raw nuts and seeds, and raw milk.
Include bitter greens in the diet to help stimulate digestion and clearance of toxins in the liver.
Eat the rainbow to increase phytonutrient and bioflavanoid content and reduce oxidative stress and inflammation.
Manage stress with herbs, exercise and mind body medicine. Stress causes the body to release cortisol, which also releases glucose into the blood. This is a HUGE factor here. I know we are all under a lot of stress in our day to day lives, but getting a handle on chronic stress is vital to be able to balance both hormones and blood sugar. Stress is one of the leading causes of inflammation and disease in the body.
Prioritize 7-9 hours of quality sleep
Daily movement! All movement is beneficial for blood sugar regulation. 10-15 minutes of walking after a meal can reduce a glucose spike. Ideally waking 30 minutes per day to move the lymphatic system.
Exercise & Weight training can increase glucose uptake for up to 2 hours or more! Toned muscle is much more insulin sensitive than untoned muscle!
Herbs & Minerals for Blood Sugar Regulation
Here we want to focus on herbs that increase insulin sensitivity, regulate the stress response, lower cortisol, and support liver detoxification. Depending on the person you can also include herbs to support cardiovascular function, improve energy and improve sleep.
Cinnamon: Improves insulin sensitivity and controls fasting glucose. Dosage 2-10 g/day; easiest to take as capsules or in foods/ smoothies. Cinnamon has soluble sober as well as insulin sensitizing chemicals. Helps to normalize GI function, slow the rate of sugar absorbed into the bloodstream, while also increasing insulin sensitivity. May take 3-4 months to see improvement in blood glucose levels.
Fenugreek: Soluble fiber slows the absorption of sugar into the bloodstream and increases insulin sensitivity. It has been found to lower cholesterol and triglycerides. Extensively researched in diabetics and found to consistently lower elevated blood sugars. Dosage is 10 g 1-2x/day with meals, easiest in capsules.
Bitter melon: Increases sensitivity of the body to insulin, increases rate of sugar uptake by the cells and powerfully antioxidant. Use with caution with other prescription blood-sugar lowering medications; can synergize and cause hypoglycemia. Prevents hyperinsulinemia and reduces high triglycerides. 250 mg cap 2x/day or 1-2ml tincture 2x/day.
Aloe Vera: Supplementation with aloe vera may help improve HBA1C levels and lower blood glucose. It is also highly anti inflammatory, and supports digestive health.
Turmuric: Curcumin has been studied to help regulate blood sugar by stimulating insulin production and improving overall sensitivity to insulin. It has also been shown to reduce oxidative damage and lower inflammation in people who have Type 2 diabetes.
Medicinal Mushrooms {Reishi, Turkeytail, Shiitake, Maitake}: Traditionally used for metabolic regulation, liver support, antioxidant properties as well as ability to improve adaptability to stress. Overall seem to improve glycemic control.
Ginseng: Both quinquefolius and ginseng species are found to improve glycemic control. Regulates stress response and improves energy, which could help someone’s ability to exercise or make dietary changes.
Tulsi: Anti-hyperglycemic effects on fasting glucose in human clinical trials. Studies suggest that its action is through increasing insulin sensitivity in the cells.
Berberine rich herbs: 1g berberine shows decreased fasting blood glucose, triglycerides, LDL and total cholesterol.
Milk Thistle: Supports and protects the liver and upregulates phase 1 liver detoxification.
Dandelion Root: Loaded with inulin and other soluble fibers to slow absorption of glucose. Bitters help to normalize digestive function, helping to regulate blood sugar and reduce sugar cravings.
Chromium: works closely with insulin in facilitating the uptake of glucose into cells. Glycinate 400-1000 mcg/ daily
Magnesium: repletion is necessary for the complete response of the cell to insulin binding. More than 50% of people with Type 2 Diabetes were studied to have Mg deficiency. Magnesium helps insulin response and action as well as glucose tolerance. Supplement with 400-500 mg/day, increase dietary sources such as leafy greens, seeds, nuts, dandelion leaf, & nettle leaf.
Whew! I know that was a lot! Hopefully not too scientific, but enough to give you a good understanding of the intricate balance between all these systems and why we need to pay attention to our blood sugar levels! This is a huge topic, and you can really dive deep, so this is just an introduction! My hope is that this might give you some insight on issues that have been going on in your body and help you to be your own health detective, and move towards greater balance and vitality!
One great way to do this is to get yourself a glucose monitor. You do not need anything fancy, you can get them at your local drugstore. You can check your fasting glucose first thing in the morning before you eat or drink anything, and then continue to check your blood sugar 1/2 hour, one hour and two hours post eating to see how what you are eating is affecting your blood sugar! It is really fascinating and can help to create more awareness of what spikes our blood sugar and how eating more proteins and fats can help to mitigate those spikes!
As always, please share this article if you feel called, leave a comment below or reach out with any questions!
Resources:
Diabetes and Systemic Barriers to Health by Ember Peters in the American Herbalist Guild Journal, spring 2020 https://www.americanherbalistsguild.com/jahg-back-issues
Romm, A. (2017). Botanical Medicine for Women’s Health (2nd ed.). St.Louis, MO: Elsevier
Gottfried, S. (2013). The Hormone Cure. New York, NY: Scribner.
Bergner P. 2006. Insulin Resistance: Pathophysiology and Natural Therapeutics. North American Institute of Medical Herbalism, Portland, OR.