How Lifestyle Choices Affect Insulin Levels
Producer Potts 0:19
So I was stalking your social media, because I wanted to know what people have been asking you. And so I noticed this question, and it’s a big, nerdy question. So, you know, it’s, it’s a meaty one. But I’ve noticed a lot of people want to know, How does sleep and stress impact insulin? And then where does nutrient density ie eating, like a neutral for diet fall into the hierarchy of what makes the biggest impact? I know, that’s probably a big question. But people I see have been asking about it. So let’s talk about it.
Dr. Sarah 0:55
Yeah, so this is fascinating, because I think that, culturally, first of all, we want to blame people for their health problems, right? There’s this whole, this is what health ism is right? Healthism is the idea that you need to take personal responsibility. And if you have any health challenges, it’s because you failed to take personal responsibility. So they must be your fault. And it just completely ignores genetics and epigenetics, access to medical care, social determinants of health. And, like all of the things that we can’t control, right access to a grocery store, what is our budget? How many jobs do we need to work to make ends meet? Like, there’s so many things that influence health, beyond food. And then with insulin resistance, whether you’re talking about PCOS, or type two diabetes, right? There’s this there’s this like idea that that is, that is your fault, because you ate too much sugar, right or too much refined carbohydrates, right that it is, you know, this very simplistic idea that too much sugar in the bloodstream causes insulin resistance, or at least with type two diabetes, right. And it is so much more complex than that. And diet is not as big of a contributor to insulin resistance, as lifestyle factors, stress, sleep, and activity. So I’m pulling out all three of those because they all are really, really important in terms of how they’re influencing how much insulin is produced and how sensitive our cells are to insulin. And then how effective insulin is, once it binds with its receptor in the cell then, getting the glucose transporter molecule into the cell membrane so that it can bring sugar into the cell that is controlled by lifestyle. So this has been shown in a variety of studies. So for activity to activity is really cool, because for a little while, after we’ve done some exercise, our muscle cells can bring sugar basically into them without insulin. So there’s this really cool, like little bypass of insulin in terms of like our muscles after working out that is beneficial. But there’s also this whole collection of studies that is what people volunteer for these studies. These are heroes in science. There’s a bunch of bedrest studies where they take healthy people and they say you’re not allowed to get out of bed for three days.
Dr. Sarah 4:28
Yes, suffer the insulin resistance that is caused by the amount of that’s, it’s Yeah, we don’t want that fast. So literally, we are not as sensitive to insulin, the effects of insulin. If we’ve been sick and been lying in bed for a few days. Once we like to get up and get moving, we can come back like it’s not like it’s not like a light switch that you turn it off and then it can never turn back on. Again. It’s more like a dial and it’s very sensitive to all kinds of things. But studies show that being sedentary basically makes our bodies less responsive to insulin. And then there’s also a huge variety of studies that look at what’s called short sleep. So people also volunteer for these studies where they’re, like, only allowed to sleep. It’s either like four or five or six hours, usually. And sometimes it’s fragmented and sleeps on the fragmented sleep lens. They’ll do things like text, the person 10 math problems that they have to solve on an by text message every hour during the night is like a typical way that they 100%
Producer Potts 5:51
Can we back up just a little bit? Because like, you say, you said movement, but then you said exercise and like, there’s nothing on the internet about walking as an exercise. So like, how much movement? Are we talking about? Like, like cleaning your house? Or like, how much movement do we need to have to wear not have like, how much of a couch potato can we be is what I want to know. So Does all movement count?
Dr. Sarah 6:13
Actually, studies usually measure this by looking at insulin sensitivity, it’s like one of the things that they’ll look at for understanding, like how, how, at what point do the benefits of activity kick in. So literally, there’s been studies where they call them exercise snacks. So it’s not, it’s not like you’re eating while you’re exercising, it’s these tiny little amounts of exercise. So they’ll do things like have people walk up one flight of stairs, or do like a single bicep curl with like three seconds of effort, or do you know at 10 Second, like sprint on the bike, and all of these show benefits, so benefits to insulin sensitivity, benefits to cardio metabolic fitness is another one that like strength, like, they’ll measure that. And then sometimes they’ll measure things like blood pressure, or serum cholesterol. So the more consistent we move, obviously, the better higher physical fitness, higher cardio, metabolic fitness is definitely a good thing. But every bit of movement we do contributes to that. So ideally, we would get 150 minutes per week of moderately intense activity. So that is, a brisk walk would be considered moderately intense.
Producer Potts 7:40
So like cleaning your tub.
Dr. Sarah 7:44
Definitely. Right? Yeah. Like a
lot of gardening is sort of moderately intense.
Producer Potts 7:48
Depending on that workout to like, per day, what’s the math on that?
Dr. Sarah 7:59
Let me just hang on, I should be able to do this in my head. But since you, it’s 21.4 minutes. Okay. So with myself for saying 22 minutes 22. So someone’s like just starting out, and they like are just starting out to get happy, healthy, you know, and happy, of course, but like, I messed up my words that but like, if someone’s just starting out, it can be as simple as like, just make sure over the course of the day, you’re moving 20 minutes, but that can be broken up into Yeah, you getting up to do this, and you’re getting up to do that. So it doesn’t have to be like this intense day to make an impact if you
Dr. Sarah 8:33
decided that walking was what your activity would be. So first of all, what’s moderately intense walking for you is not the same as what’s moderately intense walking, for me, that is measured by the amount of exertion, not by how fast you’re going. So a great way of gauging it is like how much you’re huffing and puffing. So moderately intense is I can say a whole sentence before I then have to like, catch my breath. Vigorous would be I can only say a couple of words like two three words before I have to catch my breath. So if you’re noticing your breathing a little bit more, but you can say a whole sentence you are in that moderate range. If you can, like go on a full soapbox rant, it’s probably more like mild activity, mild activity is still beneficial. But where the guidelines are and it’s well supported by the scientific literature is 150 minutes per week is a minimum. So if your starting point is walking, you know around the block, and maybe that takes five minutes at your pace that is moderately intense for you. And that’s like that’s all you can do. First of all, that’s a great starting point. That’s amazing. But you could do that four times in the day. And you’re going to hit those serves. Serving Targets not serving. Yeah, exercise minute To
Producer Potts 10:00
the amount that we need to like, not have issues with our insulin from that one specific thing. Okay, so I interrupted you and you were about to talk about sleep and insulin. Yes. And then we haven’t even touched on stress. I know, this is like a huge question. But I know that people have been asking about this. So if you don’t mind not,
Dr. Sarah 10:14
I mean that this is fascinating stuff. And I think it’s not very well understood, because there’s so much of like, the low carb diet sort of propaganda out there. That is, like, like messaging that the solution is to change your diet. But actually, lifestyle will get you even more like insulin sensitivity, bang for your effort compared to diet changes, doesn’t mean diets are not important. Like definitely, we can also talk about some of the diet changes that can really help. But lifestyle is actually going to be a bigger magnitude of
Producer Potts 10:46
sleep and stress and movement have more of an impact than what we’re eating or not eating, essentially. Yeah, that’s really good to know. I think that’s really helpful for people. Yeah.
Dr. Sarah 10:56
So sleep is probably the hardest one for people to change, because I feel like our society is not doesn’t like respect, sleep and doesn’t isn’t well set up for us to prioritize sleep in our lives. But there was this one study, which I think was published in 2023. That it was done in dogs, I think. But they basically compared six months of a very unhealthy diet and how that impacted insulin to one night of lost sleep, and showed one night of lost sleep had a worse bigger impact on insulin sensitivity than six months of a bad diet. There’s a whole pile of studies in humans that have either had them do the short sleep for like four or five, six hours for a few nights in a row and shown that that makes them more not necessarily like full type two diabetes, but it makes them less sensitive to insulin. So insulin sensitivity is measured on a spectrum. And there’s like a cut off, at which point it’s called insulin resistance. And then there’s another cutoff at which point is called type two diabetes. So they’ll measure that spectrum. So not getting enough sleep a few nights in a row causes us to be less sensitive to insulin. But even just a single all-nighter will cause bad, bad insulin sensitivity shifts. So getting enough sleep on a consistent basis, if I remember correctly, not getting enough sleep increases the risk of developing type two diabetes by like, maybe it’s type two diabetes plus insulin resistance. It’s a huge effect. It’s like two and a half times. I shouldn’t ride. Let me find that study. So I can actually quote it. Yeah, that’ll be good. You find it. Okay, this is from a study out of Canada that was published in 2009. And it showed that sleeping less than six hours per night increased the risk of type two diabetes by 50%. And then when diabetes and impaired glucose tolerance were paired together, so that’s like, the in between, so I’m insulin resistant, but it’s not quite so bad enough to cause it to be type two diabetes yet, that sleeping less than six hours a night increased risk to 2.4 times. So crazy is a huge effect. And I feel like that’s not something when someone gets a diagnosis like oh, hey, you’re fasting insulin and blood sugar a little bit high right? Like you get that often in your annual blood work. When you get a physical it’s often the doctor is gonna go do you get enough sleep? Maybe maybe like work on seeing what how you can restructure your day so that you’re spending, you know, spending more time in bed or maybe you have insomnia or you’re stressing
Producer Potts 13:53
me out about not getting enough sleep, and now I’m having stress so like, you know. It’s like, it’s like a Yeah, it’s like a thing because like, I don’t know how many times you lay in bed and you’re like, oh, I should be getting more sleep and I’m not sleeping and then you stress out about not sleeping like it’s it’s I feel like it’s the vicious cycle. And then you’re like, well, I’ll just get up and be productive because at least I’ll be doing something. I feel like so many of us are like
Dr. Sarah 14:23
that. That is true. But so sleep and stress have this vicious cycle because not getting enough sleep increases stress and then being stressed erodes sleep quality, right makes it harder to sleep makes it harder to stay asleep. But the cool thing is, there’s like a reverse good cycle with that. So I guess the other thing to say is that also chronic stress causes insulin resistance and stress is another big risk factor for type two diabetes. Stress is like a much harder one to measure and get exactly like that, like 2.4 times the number because we’re all stressed, and like how stressed somebody is there’s ways that people will measure things like heart rate variability. But it’s, it’s a lot. It’s not as easy to measure, like, how much sleep did you get? You know what I mean? Like, how stressed Are you is a much harder thing to answer because it’s so dependent on how resilient you are as a like, as personality traits, but then also, how much resilience Have you built through life experience, like how many coping strategies that you have that are productive versus like maladaptive, right, like, stress is a hard one. So stress also increases insulin resistance, and stress and sleep and activity, actually, they kind of all work together. So, one of the things that we can do to reduce our stress is work on getting enough sleep. And the cool thing is, prioritizing sleep can then reduce stress that can then make sleep better. So they, as much as they’re like a vicious cycle that can work against us, they can be a really important positive feedback loop that works for us as well. So things that can help is getting some activity. So activity helps reduce stress, but also has been shown to improve sleep quality. And it doesn’t seem to matter what time of day, we’re active. Some studies show that being active right at the end of the day doesn’t help. But some studies show that it does, it probably has to do with more if that’s your routine, like routine exercises is good exercise, that’s kind of like if you’re exercising really hard, late at night, and you’re not used to it, that probably isn’t as good. But then you know, if that’s when it fits into your schedule, keep doing it, you will get used to it, and then it will be good. So getting some activity can help reduce stress and improve sleep, not eating right before bed can help to improve sleep, getting some spending some time outside, and help to reduce stress and improve sleep. And that could be some active time. And then like there’s legit good science behind mindfulness practice, it doesn’t have to be like, I’m sitting in the lotus position like, you know, going saying, oh, like mindfulness can be, there’s a lot of different forms, so it can be meditative. But also, there’s a lot of mindful practices like writing in a gratitude journal, or doing affirmations can be mindful practice, like there’s a lot of mindfulness practices that aren’t meditation. So all of those things have been shown to help improve sleep quality and reduce stress. So it’s kind of one of the things that if you think about it holistically, and if you think about how they all fit together, they can all help each other. And that’s also where nutrition can fit into the equation. So eating a higher quality diet, more like getting more nutrients, can help to improve sleep, can help to regulate the stress response, and can help to improve insulin sensitivity. So there’s a collection of nutrients that when we’re not getting enough of it, that does contribute to insulin resistance, I talked about vitamin D, and Bromium. In the book and how vitamin D and chromium both are really, really important for insulin sensitivity and reducing risk of type two diabetes, as well as other issues associated with insulin resistance like PCOS. But also the stress response, it can be modulated by nutrients, I talked about Vitamin C, Vitamin getting enough vitamin C, and actually, maybe even more than the daily value of vitamin C can help to regulate stress in the book. The other nutrient that’s really tied with stress is our nutrients magnesium and omega three fats like what we’re getting from seafood. So those have all been shown to help to regulate the stress response. They’re also on the list of nutrients that can improve insulin sensitivity. And, you know, there’s multiple different pathways, right nutrients are used for many, many, many, sometimes hundreds of different things in the body. So where nutrients can fit in, is by helping to regulate the stress response and help to support all of the various physiology of sleep and then also help things like muscle recovery if we’re going to start an exercise program to help there as well. So that’s where nutrients fit into the whole shebang. It’s much more about regulating insulin than it is much more about the important vitamins and minerals that we need for insulin to do all of the things that it does. Then it is about you know, eating too much too much sugar, right like it’s, I hope that is the take home here is that yeah, the simplistic view of like, you got type two diabetes because you ate too many donuts or whatever. It’s Oh, it’s so complex, it’s much more closely tied to lifestyle than to diet. It’s much more about what’s missing in the diet, right, like the nutrient dense foods getting enough vitamin C and magnesium and omega three fats, and vitamin D than it is about what there’s too much in the diet. And it’s also linked to social determinants of health to genetics, like there’s parts of this that are outside of our control, like you can write everything right, you can have the perfect sleep, perfect activity, perfect stress management, perfect, perfect diet, whatever that is. All of the nutrients, you can, you know, not smoke, not drink, right? Like all of those things can be dialed in. And there’s that, that’s at best 40 to 50% of health outcomes. That means there’s still 50 to 60% of things that are controlling what happens to you health wise, what you like, health outcomes are going to be that you do not have control over. And I think that doesn’t mean that we don’t want to give up on diet and lifestyle. That doesn’t mean that that’s pointless, right. But I think it helps to understand when you’re putting a lot of effort into diet and lifestyle, and then something bad happens. It’s not your fault. There’s things that happen outside of our control. Yeah, it’s a little bit scary. But also what I think of is really empowering information because 40 to 50% is totally worth it. Right? That is yeah, that is worth a lot. Yeah, it’s a huge, huge chunk that’s worth the effort I’m gonna put into living a healthier lifestyle and eating a higher quality diet. But also, it doesn’t mean it’s all my fault, right? It doesn’t mean like, Yes, I don’t have complete control. But that control was always an illusion, right? And it means that if something happens to me healthwise, I don’t need to blame myself for it. I don’t need to see my face, which is actually where we started answering this question. Well, no,
Producer Potts 22:06
I love how you bring it all the way back to the beginning and then I just want to point out it’s like, you know, a lot of people know you for your daily morning walks that you take us on together and that’s your time outside. That’s your exercise. That’s your stress reliever because you and your dog are relieving stress. Right. So like, you know, we just need to be more like Dr. Sarah and do morning walks outside and will be grateful. I am very,
Dr. Sarah 22:34
so close to such lovely green space. And yeah, I wish everyone was so fortunate as to live close, close. So that can fall into that social determinants of health right, like access to free park space nearby, right. Like not everyone has that a lot of people live in concrete jungles. Right? So absolutely. Yeah, no, that’s great.
Producer Potts 22:41
Well, you already talked a lot about where people can learn about this stuff and your book. So I guess the thing is to tell people to go buy your book. So go buy the book, everybody and thanks, Dr. Sarah. Thank you
