Insulin Resistance and Binge Eating
By Amy Enright, RD
As practitioners in the field of eating disorders we all are working toward the common goal of helping our patients become intuitive and mindful eaters, making peace with food and body. What if our binge eating clients are eating intuitively, what if they are listening to their bodies, and what if their bodies are giving them the wrong messages about hunger and fullness? This is something we need to further explore.
Insulin resistance is on the rise. According to the National Health and Nutrition Examination Survey of 2003-2006, 1/3 of all men and women have Metabolic syndrome. Metabolic syndrome is defined as a cluster of co-morbid conditions: hyperglycemia, hypertension, dyslipidemia, visceral adiposity, hyperuricemia, elevated inflammatory markers and endothelial dysfunction which lead to insulin resistance and metabolic dysfunction. Insulin resistance is the body’s inability to use carbohydrates efficiently due to beta cell dysfunction. When a person consumes carbohydrates, the carbohydrates break down as sugar into the blood stream, then the pancreas releases insulin in response to the sugar. The glucose and insulin must connect in order to enter into the cell and allow the glucose to be used for energy. When insulin and glucose do not connect, this results in insulin resistance. The absence of carbohydrates available in the cells affects many functions inside the body, drains energy, promotes fatigue, disrupts mood, and causes the body to crave carbohydrates. An insulin resistant body presents as an underfed body, because it is not able to use the nutrients it is being given. If we review the common symptoms of binge eaters: rarely full, craving carbohydrates, fatigue, mood disruptions, in addition to the metabolic co-morbidities, they often fit the profile of an insulin resistant patient. Could our binge eating clients really be listening to their hunger cues and trying to give their body’s what they are asking for, and their body’s just aren’t using the nutrients?
You may be saying to yourself “what do I do if I suspect having a patient that is insulin resistant?” The first step in treating patients with insulin resistance is to establish a network of collaborative partners: physicians, endocrinologist, dietitians, and therapists that understand insulin resistance. The second step is getting some lab indices to confirm suspected insulin resistance. The simplest, evidenced based assessment tool is called the Homeostatic Model of Assessment for Insulin Resistance or the HOMA-IR, which requires fasting lab work of a glucose and an insulin level. The third step is medication; some can take several months to get to the therapeutic levels, so it’s important to get them started as soon as possible. Medications that aid with insulin resistance are biguanides, sulfonylureas, and GLP-1’s, and one or more of these are often needed to improve efficiency of carbohydrate substrate utilization in the body. The fourth step is addressing nutritional intake and exercise. Treatment for insulin resistance often includes a balanced diet, activity, and medications. While some research suggests particular dieting methods to improve insulin resistance, like most diets, physical results are temporary, and the emotional toll compounds the problem. Balance is the key, balancing carbohydrate intake with fat and protein can help the body use carbohydrates more efficiently. Research has proven that exercise is effective at improving insulin sensitivity in the body. The important thing to remember is that many insulin resistant patients struggle with low energy and fatigue, so may not adhere to or attempt physical activity at first, but as their bodies become re-fed, they will have more energy to engage in physical activity. Treating patients for insulin resistance, has been extremely rewarding, here are some of the comments I hear after they are able to start medication.
“Thank You! I never knew what full felt like!” “Is this how normal people feel? Full after eating?”
“I WAS listening to my body, but my body was telling me it was hungry all the time.”
“I feel like I can go about my day and not constantly thinking about what I am going to eat next.”
In conclusion, it is important that we listen to our patients’ symptoms and work together to identify any possible underlying physical causes of symptoms. By addressing the underlying physical condition of the insulin resistance, helps patients to have improved mood, energy, accurate hunger/fullness cues, and allows them to explore healing of their emotional self, make peace with food and body, and become mindful, intuitive eaters.
About the author:
Amy Enright, RD is an outpatient dietitian with the Upstate New York Eating Disorder Service. Using body composition analysis and metabolic testing she uses evidence based science to help patients understand what their body needs and implement recommendations. She oversees the Intensive Outpatient Program (IOP), coordinating treatment with multidisciplinary treatment team.
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