Alisa Turner - Integrative Health Coaching

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. 

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  2.  Metabolic Syndrome in Drug Abuse 113 https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1196/annals.1403.004
  3. 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/
  4. Cross-sectional relationship between alcohol consumption and prevalence of metabolic syndrome in Japanese men and women 267 https://pubmed.ncbi.nlm.nih.gov/20534949/
  5. 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/
  6. Patterns of Alcohol Consumption and the Metabolic Syndrome 269 https://academic.oup.com/jcem/article/93/10/3833/2627323
  7. 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
  8. Prospective study of alcohol consumption and metabolic syndrome 313  https://pubmed.ncbi.nlm.nih.gov/18469271/
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  13. 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
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  18. 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
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  20. 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/
  21. Metabolic risk factors and primary liver cancer in a prospective study of 578,700 adults https://pubmed.ncbi.nlm.nih.gov/21805476/
  22. Metabolic risk score and cancer risk: pooled analysis of seven cohorts https://pubmed.ncbi.nlm.nih.gov/25652574/
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  24. Metabolic factors and risk of thyroid cancer in the Metabolic syndrome and Cancer project (Me-Can) https://pubmed.ncbi.nlm.nih.gov/21380729/
  25. 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/
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  33. 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/
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  50. Effect of Physical activity on Insulin Resistance, Inflammation and Oxidative Stress in Diabetes Mellitus https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782965/
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