Wondering what your waist to hip ratio says about your health?
Let’s look at some of the research on substance abuse, recovery, insulin resistance, and metabolic syndrome from the nutrition and recovery meta-analysis I’m working on.
Given the high incidence of insulin resistance and metabolic syndrome in the addiction/recovery community (1-11,26), the importance of insulin resistance in the pathogenesis of many chronic diseases (12), and its eminent reversibility with improved diet and lifestyle (12), it is important that we all embrace and facilitate optimized lifestyles to improve the future health and well-being of the addiction and recovery population.
The overall prevalence of metabolic syndrome in this country (now over 34%) (13) is extremely concerning even before you factor in any potential current or previous co-occurring substance abuse disorders because it significantly increases the risk of heart disease (14-16), stroke, (17) type 2 diabetes (14,16), kidney disease (18), various cancers (13, 19-25)), and all-cause mortality (16).
But the fact is that alcohol and drug abuse are compounding all these problems (3), as heavy drinkers have been shown to have a 1.71 times greater risk of metabolic syndrome when compared with non-drinkers (26). The contributing factors are extremely complex and include the disruption of the very delicate balance between the body’s ability to produce energy (metabolism) and its cellular protective mechanisms (1) — an increase in cell damage and nerve damage from overactive receptors (27), altered mitochondria functionality (28), hormonal imbalance (94), and a reduction in energy production and antioxidant potential (28, 29)
So, let’s break it down and then take a look at what can be done.
Metabolic syndrome isn’t really a disease perse, but a constellation of cardiovascular disease risk factors often found together. It’s defined slightly differently by various organizations such as the WHO, NCEP (National Cholesterol Education Program), and IDF (International Diabetes Federation) (30), but the World Health Organization defines it as a pathologic condition characterized by abdominal obesity, insulin resistance, hypertension, and hyperlipidemia (30,31).
While light to moderate drinking actually lowers the risk for metabolic syndrome (32,33), heavy drinking is associated with an increased risk (1, 3-6, 8-10, 26, 29), and what qualifies for heavy will always vary person to person. Chronic consumption of alcohol is known to suppress insulin and insulin-like growth factor signaling in the liver and the brain (34), and insulin plays a central role in the pathogenesis of metabolic syndrome, because hyperglycemia, atherosclerosis, and cholesterol gallstones can all be caused by insulin resistance. (35) Furthermore, drinking in excess of the dietary guidelines is associated with an increased risk of impaired fasting glucose/diabetes mellitus (6), hypertriglyceridemia (6), abdominal obesity (6), and high blood pressure (6), as well as a reduction in HDL cholesterol. (5), all of which are metabolic abnormalities found in metabolic syndrome.
Resolving metabolic syndrome and in particular the related insulin resistance can be a time-consuming process, so it may take a bit of time after initial abstinence is achieved; researchers looked at alcoholics with at least 6 months of sobriety, and still found a significantly blunted blood glucose (as well as glucagon and insulin) response after infusion with glucose (36), and they suggested it was related to the nervous system damage by alcohol, particularly in the hypothalamus (36).
Aside from being a risk factor for coronary heart disease (41), diabetes ( 42 ), PCOS (12), and metabolic/cognitive dysfunction (12), insulin resistance is also associated with that nagging, stubborn, and persistent high waist to hip ratio that’s common in recovery (37-40). The good news is that insulin resistance is largely reversible by optimizing diet and lifestyle including fiber-rich whole foods, physical activity, and a focus on sleep and stress management (12)
Let’s start with diet: Only 5% of the US is eating enough fiber (43), and low fiber diets are associated with increased risk for insulin resistance (44). Not surprisingly then, we have plenty of evidence that vegan or vegetarian diets are associated with improved glycemic control (45-49), but you don’t have to go full vegan to see an improvement; much of the rationale here is the role of fiber, so even just focusing on consuming MORE fruits and veggies and LESS animal products and low fiber processed foods is associated with lower longitudinal insulin resistance, and lower risk of prediabetes and T2D (46).
But it’s not just the food that matters.
The research on improvements in insulin sensitivity from exercise is abundant as well (50-55); in fact, some research shows a single bout of moderate exercise can increase glucose uptake by at least 40%, (51) Another study showed glucose uptake remained elevated for up to 120 minutes after physical activity and insulin sensitivity was improved for 16 hours post-exercise. (55). Furthermore, weight loss (which can be difficult BECAUSE OF the insulin resistance) will actually help REVERSE insulin resistance — a tricky loop to solve, but since exercise can promote weight loss, any benefits in insulin sensitivity from exercise would be magnified by any resulting weight loss. (50)
Another contributing factor to insulin resistance is inadequate sleep (56-61), and the amount of sleep a person needs will vary so it’s important to learn what YOUR body needs. Quality and quantity of sleep are linked to obesity, glucose homeostasis, and type 2 diabetes (56),and so they can have a profound effect on insulin resistance. The unfortunate irony is that sleep disturbances are extremely common in the early stages of recovery from alcohol dependence, and they may persist for months despite continued abstinence (62), so sleep hygiene will be especially important.
Here are some tips: Stay off screens for an hour before bed, make wake-up times consistent every morning (this signals melatonin production), including weekends, set your thermostat as close to 65 as you can, get plenty of physical activity, avoid caffeine for 6 (preferable 8 or more) hours before bed, make sure you have a comfortable mattress and pillow, and allow more time than you think you need to get ready for bed. Try incorporating some kind of relaxing ritual like a bath, a sleep meditation, and/or some lavender essential oils. In some cases, prescription medication in the short-term may also be warranted.
Research also shows a strong connection between chronic stress and insulin resistance (63-68), so implementing stress management tools like meditation, breathwork, gratitude, and especially yoga which the most extensively studied mind-body practice with respect to effects on insulin resistance. (65) will be equally important to improving diet and getting adequate sleep and physical activity.
If all this seems like too much to manage on your own, reach out. I have a specific, individualized, and incremental approach to implementing these strategies in a way that won’t seem so overwhelming.
- Prevalence of the Metabolic Syndrome in Substance-Dependent Men 7 https://www.researchgate.net/profile/Naresh-Nebhinani/publication/288197794_Prevalence_of_the_metabolic_syndrome_in_substance-dependent_men/links/568a531f08ae1975839d7700/Prevalence-of-the-metabolic-syndrome-in-substance-dependent-men.pdf
- Metabolic Syndrome in Drug Abuse 113 https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1196/annals.1403.004
- Association of drinking pattern and alcohol beverage type with the prevalence of metabolic syndrome, diabetes, coronary heart disease, stroke, and peripheral arterial disease in a Mediterranean cohort 114 https://pubmed.ncbi.nlm.nih.gov/18216378/
- Cross-sectional relationship between alcohol consumption and prevalence of metabolic syndrome in Japanese men and women 267 https://pubmed.ncbi.nlm.nih.gov/20534949/
- Association Between Alcohol Consumption and Metabolic Syndrome in a Community-Based Cohort of Korean Adults 268 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424649/
- Patterns of Alcohol Consumption and the Metabolic Syndrome 269 https://academic.oup.com/jcem/article/93/10/3833/2627323
- Habitual Alcohol Consumption and Metabolic Syndrome in Patients with Sleep Disordered Breathing 281 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161276
- Prospective study of alcohol consumption and metabolic syndrome 313 https://pubmed.ncbi.nlm.nih.gov/18469271/
- Lifetime Alcohol Drinking Pattern is Related to the Prevalence of Metabolic Syndrome. The Western New York Health Study (WNYHS) 314 https://www.researchgate.net/publication/7258760_Lifetime_Alcohol_Drinking_Pattern_is_Related_to_the_Prevalence_of_Metabolic_Syndrome_The_Western_New_York_Health_Study_WNYHS
- Alcohol consumption and the prevalence of the Metabolic Syndrome in the US.: a cross-sectional analysis of data from the Third National Health and Nutrition Examination Survey 315 https://pubmed.ncbi.nlm.nih.gov/15562213/
- Prevalence of Metabolic Syndrome in a Japanese Population and its Association with Lifestyle 316 https://www.med.or.jp/english/journal/pdf/jmaj/v48no09.pdfhttps://www.med.or.jp/english/journal/pdf/jmaj/v48no09.pdf
- Mechanisms of Insulin Resistance at the Crossroad of Obesity with Associated Metabolic Abnormalities and Cognitive Dysfunction https://www.mdpi.com/1422-0067/22/2/546
- Metabolic Syndrome Prevalence by Race/Ethnicity and Sex in the United States, National Health and Nutrition Examination Survey, 1988–2012 https://www.cdc.gov/pcd/issues/2017/16_0287.htm
- The metabolic syndrome https://www.sciencedirect.com/science/article/abs/pii/S0140673605663787
- The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis https://pubmed.ncbi.nlm.nih.gov/20863953/
- Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence https://pubmed.ncbi.nlm.nih.gov/15983333/
- Metabolic Syndrome and the Risk of Stroke in Middle-Aged Men https://www.ahajournals.org/doi/full/10.1161/01.STR.0000204354.06965.44
- The Metabolic Syndrome and Chronic Kidney Disease in U.S. Adults https://www.acpjournals.org/doi/full/10.7326/0003-4819-140-3-200402030-00007
- Metabolic syndrome and breast cancer in the me-can (metabolic syndrome and cancer) project https://pubmed.ncbi.nlm.nih.gov/20615887/
- A prospective study on metabolic risk factors and gallbladder cancer in the metabolic syndrome and cancer (Me-Can) collaborative study https://pubmed.ncbi.nlm.nih.gov/24586723/
- Metabolic risk factors and primary liver cancer in a prospective study of 578,700 adults https://pubmed.ncbi.nlm.nih.gov/21805476/
- Metabolic risk score and cancer risk: pooled analysis of seven cohorts https://pubmed.ncbi.nlm.nih.gov/25652574/
- Metabolic risk factors and cervical cancer in the metabolic syndrome and cancer project (Me-Can) https://pubmed.ncbi.nlm.nih.gov/22330614/
- Metabolic factors and risk of thyroid cancer in the Metabolic syndrome and Cancer project (Me-Can) https://pubmed.ncbi.nlm.nih.gov/21380729/
- Metabolic factors and the risk of pancreatic cancer: a prospective analysis of almost 580,000 men and women in the Metabolic Syndrome and Cancer Project https://pubmed.ncbi.nlm.nih.gov/20826833/
- Habitual Alcohol Consumption and Metabolic Syndrome in Patients with Sleep Disordered Breathing https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161276
- Cellular and Mitochondrial Effects of Alcohol Consumption https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037055/
- Chronic alcohol abuse and nutritional status: recent acquisitions https://www.europeanreview.org/wp/wp-content/uploads/284.pdf
- Metabolic Syndrome in Drug Abuse https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1196/annals.1403.004
- The Global Epidemic of the Metabolic Syndrome https://link.springer.com/article/10.1007/s11906-018-0812-z?aff_id=1262&error=cookies_not_supported&code=dc9c18dc-a602-4560-bdfd-5b7fee399ba0
- Alcohol and blood pressure: the INTERSALT study https://www.bmj.com/content/308/6939/1263.full
- Moderate Alcohol Consumption and Insulin Sensitivity: Observations and Possible Mechanisms https://www.sciencedirect.com/science/article/abs/pii/S1047279707000117
- Moderate alcohol consumption increases insulin sensitivity and ADIPOQ expression in postmenopausal women: a randomised, crossover trial https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2491412/
- Alcohol, insulin resistance and the liver–brain axis https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1440-1746.2011.07023.x
- Dissecting the Role of Insulin Resistance in the Metabolic Syndrome https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874866/#R2
- LONG-TERM ABSTINENT ALCOHOLICS HAVE A BLUNTED BLOOD GLUCOSE RESPONSE TO 2-DEOXY-D-GLUCOSE https://academic.oup.com/alcalc/article/37/6/586/205073?login=true
- High waist-to-hip ratio levels are associated with insulin resistance markers in normal-weight women https://www.sciencedirect.com/science/article/abs/pii/S1871402118305125
- Behavioral covariates of waist-to-hip ratio in Rancho Bernardo. https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.80.11.1358
- Relationship between obesity, alcohol consumption, and physical activity of male office workers in South Korea https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1442-2018.2011.00639.x
- The relation between drinking pattern and body mass index and waist and hip circumference https://www.nature.com/articles/0802874
- Relationship between obesity, insulin resistance, and coronary heart disease riskhttps://www.jacc.org/doi/abs/10.1016/S0735-1097(02)02051-X
- Invited Commentary: Insulin Resistance Syndrome? Syndrome X? Multiple Metabolic Syndrome? A Syndrome At All? Factor Analysis Reveals Patterns in the Fabric of Correlated Metabolic Risk Factors https://academic.oup.com/aje/article/152/10/908/55489?login=true
- Trends in dietary fiber intake in the United States, 1999-2008 https://pubmed.ncbi.nlm.nih.gov/22709768/
- Effect of high- and low-fiber diets on plasma lipids and insulin https://academic.oup.com/ajcn/article-abstract/32/7/1486/4692237
- Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221319/
- Plant versus animal-based diets and insulin resistance, prediabetes, and type 2 diabetes: the Rotterdam Study https://link.springer.com/article/10.1007/s10654-018-0414-8
- A plant-based diet in overweight individuals in a 16-week randomized clinical trial: metabolic benefits of plant protein https://www.nature.com/articles/s41387-018-0067-4?refPageViewId=55a111731005f37d%3FrefPageViewId%3D55a111731005f37d
- A Plant-Based High-Carbohydrate, Low-Fat Diet in Overweight Individuals in a 16-Week Randomized Clinical Trial: The Role of Carbohydrates https://www.mdpi.com/2072-6643/10/9/1302/htm
- Effect of diet composition on insulin sensitivity in humans https://www.sciencedirect.com/science/article/abs/pii/S2405457719303146
- Effect of Physical activity on Insulin Resistance, Inflammation and Oxidative Stress in Diabetes Mellitus https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782965/
- Increased glucose transport-phosphorylation and muscle glycogen synthesis after exercise training in insulin-resistant subjects https://pubmed.ncbi.nlm.nih.gov/8857019/
- Effects of exercise on glucose tolerance and insulin resistance. Brief review and some preliminary results https://pubmed.ncbi.nlm.nih.gov/3535414/
- Effect of physical training on insulin action in obesity https://pubmed.ncbi.nlm.nih.gov/3315786/
- Changes in Physical Fitness and All-Cause Mortality A Prospective Study of Healthy and Unhealthy Men https://jamanetwork.com/journals/jama/article-abstract/387859
- Exercise and Insulin Sensitivity: A Review https://www.thieme-connect.com/products/ejournals/html/10.1055/s-2000-8847
- Sleep disorders and the development of insulin resistance and obesity https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767932/
- Association between Inadequate Sleep and Insulin Resistance in Obese Children https://www.sciencedirect.com/science/article/abs/pii/S0022347606008341
- Inadequate sleep as a contributor to impaired glucose tolerance: A cross-sectional study in children, adolescents, and young adults with circadian rhythm sleep-wake disorder https://onlinelibrary.wiley.com/doi/abs/10.1111/pedi.13003
- Sleep Disorders and the Development of Insulin Resistance and Obesity https://www.endo.theclinics.com/article/S0889-8529(13)00036-4/fulltext
- Sleep Disorders, Public Health, and Public Safety https://jamanetwork.com/journals/jama/article-abstract/1104742
- Sleep Duration and Insulin Resistance in Healthy Black and White Adolescents https://academic.oup.com/sleep/article/35/10/1353/2596065?login=true
- Treatment Options for Sleep Disturbances During Alcohol Recovery https://www.tandfonline.com/doi/abs/10.1300/J069v26n04_06
- Investigation of the Relationship Between Chronic Stress and Insulin Resistance in a Chinese Population https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919480/
- Mechanisms of stress, energy homeostasis and insulin resistance in European adolescents–the HELENA study https://pubmed.ncbi.nlm.nih.gov/24907850/
- CHRONIC STRESS AND INSULIN RESISTANCE- RELATED INDICES OF CARDIOVASCULAR DISEASE RISK, PART 2: A POTENTIAL ROLE FOR MIND-BODY THERAPIES http://188.8.131.52/files/CHRONIC%20STRESS%20AND%20INSULIN%20RESISTANCE–RELATED%20INDICES%20OF%20CARDIOVASCULAR%20DISEASE%20RISK.pdf
- Investigation of the Relationship Between Chronic Stress and Insulin Resistance in a Chinese Population https://www.jstage.jst.go.jp/article/jea/26/7/26_JE20150183/_article/-char/ja/
- Chronic stress, metabolism, and metabolic syndrome https://www.tandfonline.com/doi/abs/10.3109/10253890.2011.606341?journalCode=ists20
- Central effects of stress hormones in health and disease: Understanding the protective and damaging effects of stress and stress mediators https://www.sciencedirect.com/science/article/abs/pii/S0014299908000277?via%3Dihub