When we think about the side effects of poor metabolic health, we tend to think about weight gain, chronic disease, or autoimmune disorders. And while these conditions are closely tied, they all share a common denominator: high blood sugar.
Processed foods and nutrient-poor carbohydrates trigger chronically high blood sugar levels. This eventually leads to insulin resistance, which creates a trickle-down effect of hyperglycemia, prediabetes, and diabetes.
But diabetes isn’t the first stage of poor metabolic health. There’s actually a precursor most doctors don’t talk about.
I’m referring to a condition known as hyperinsulinemia: the first red flag of metabolic syndrome.
A quick definition of hyperinsulinemia
Hyperinsulinemia occurs when the insulin in your blood exceeds normal or healthy levels. It’s essentially the result of a blood sugar spike when your body can’t manage the increase of circulating insulin.
Hyperinsulinemia is common with pre- or type 2 diabetes, although it’s more often a sign of insulin resistance. Since it typically doesn’t cause symptoms, it can be difficult to diagnose. Your best bet is to order lab work covering your fasting plasma glucose (FPG).
Left unchecked, hyperinsulinemia will eventually lead to prediabetes, but the two conditions are not necessarily the same. Below are some of the most critical differences:
- Even if you have a ‘normal’ HbA1c, you can still have hyperinsulinemia. Studies show approximately one in three people have hyperinsulinemia even with typical blood glucose levels and an average HbA1c.
- You can struggle with a condition like hyperinsulinemia and not be prediabetic (yet). Conversely, if you’re diagnosed with prediabetes, you’re already suffering from hyperinsulinemia.
- Hyperinsulinemia and insulin resistance can take 10 to 15 years before turning into type 2 diabetes. Prediabetes, however, can develop into type 2 diabetes in five years or fewer.
As you can see, both prediabetes and hyperinsulinemia share the same underlying mechanism. If you’re insulin resistant, you’ll eventually develop hyperinsulinemia. Left alone long enough, hyperinsulinemia may turn into prediabetes.
With this in mind, the question becomes. . .
Do you have prediabetes, or hyperinsulinemia?
The biggest difference between the two is how insulin resistant you are.
You may have hyperinsulinemia if:
- Your CGM shows your blood sugar hasn’t returned to normal two to three hours after eating
- Your blood work shows a plasma insulin level above 2 µU/mL and a serum glucose concentration under 60 mg/dL (although this isn’t the case in all patients, particularly those with insulinoma, a tumor that secretes insulin).
- You present with the classic signs of insulin resistance: blood pressure higher than 130/80, a waistline over 35-40 inches, and low HDL cholesterol (40 mg/dL or lower for men and 50 mg/dL or lower for women)
In contrast, you may be suffering from prediabetes if:
- Your A1C ranges between 5.7% and 6.4%
- Your fasting blood sugar falls between 100 to 125 mg/dL (you can use a CGM to identify this)
- You start to have physical symptoms of insulin resistance: headaches, brain fog, poor sleep, fatigue, and more.
Regardless of your diagnosis, you should know both conditions are entirely manageable. Many people discover they can reduce and even reverse hyperinsulinemia with simple lifestyle changes in under three months.
How to combat hyperinsulinemia
The best way to reverse hyperinsulinemia is to improve your insulin sensitivity.
This process is simple, but not necessarily easy.
I suggest starting with sustainable lifestyle shifts:
Prioritize whole, real food
This includes anything that grows on the ground or eats things that grow on the ground — think red meat, fish, eggs, and dairy products. It’s a good idea to increase your intake of animal protein and natural sources of fat, then reduce your sources of ‘near-food objects’ (AKA processed foods).
Contrary to popular belief, people with diabetes and prediabetes should significantly limit their carbohydrate intake. I recommend a ‘proper human diet’ such as keto, ketovore, carnivore, or other low-carb diets. I’m not necessarily against plant-based diets, but you should keep a close eye on the ingredients label.
Above all, you should throw out foods and ingredients that worsen hyperinsulinemia, including:
- Seed oils and vegetable oils (they boost insulin resistance)
- Food with added sugar (they alter gut microbiota)
- Fake food alternatives (think margarine and synthetic caffeine)
Time your meals
When it comes to reversing insulin resistance, when you eat matters just as much as what you eat. This is because eating too much too frequently can prevent your body from normalizing insulin levels.
The good news is that timing meals becomes trivially easy on a whole, real food diet. This is because animal protein, eggs, and dairy will keep you fuller for longer and reduce your carbohydrate intake.
Because you’re far less likely to be hungry on a whole, real food diet, you’re far more likely to eat less throughout the day. This eventually leads to a natural form of intermittent fasting where you only want to eat food one or two times per day.
If you’re struggling to start or don’t want to dive in cold turkey, you can try a few ‘baby steps’ that will point you in the right direction. You might consider:
- Avoiding late-night snacks at least three hours before you go to bed
- Cutting back on sugary drinks (including soda, fruit juice, and sweetened coffee)
- Throw out artificial or fake sugars that could interfere with your metabolic health
Keep this up for one or two weeks, and it won’t take long for your hunger cues to normalize.
Get proper sleep and exercise
Diet has the biggest impact on hyperinsulinemia. However, surrounding factors like sleep and exercise can dramatically speed up the reversal process.
One study, for example, finds that less blue light exposure at night could lead to better outcomes for those with hyperinsulinemia. Getting the right amount of sleep for your body could also reduce insulin resistance and lower your risks for blood sugar spikes.
What does ‘enough sleep’ look like for humans? Depending on the individual, it could be seven to nine hours. The best way to learn what the right number is for you is to get a wearable device that monitors sleep and rest recovery.
Exercise also has a powerful role to play — and you don’t necessarily need a gym to reap the benefits. Building lean muscle ultimately improves your energy expenditure throughout the day. Even seated soleus pushups (aka flexing your calf muscles) can reduce your insulin response by 60% and cut glucose levels by 52%.
I recommend focusing on strength training first, since it’s the most effective way to build muscle and increase energy expenditure. However, light cardio work (including walking after meals) can also have a powerful effect on how your body responds to insulin.
If you’re unfamiliar with workout routines, I wrote a guide covering exercise for metabolic health.
Taking the first step toward better metabolic health
Anywhere from 1 in 4 people to 1 in 3 people suffer from hyperinsulinemia. But as you can see, it’s anything but an immutable illness. A few lifestyle changes and dietary shifts can help you reduce and even reverse your diagnosis before it progresses into prediabetes.
Of course, it’s difficult to take the next step for your health if you don’t even know where you stand. You’re welcome to use my free online metabolic health calculator to get a list of customized suggestions from my team.
