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. 

  1.  Prevalence of the Metabolic Syndrome in Substance-Dependent Men 7
  2.  Metabolic Syndrome in Drug Abuse 113
  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
  4. Cross-sectional relationship between alcohol consumption and prevalence of metabolic syndrome in Japanese men and women 267
  5. Association Between Alcohol Consumption and Metabolic Syndrome in a Community-Based Cohort of Korean Adults 268
  6. Patterns of Alcohol Consumption and the Metabolic Syndrome 269
  7. Habitual Alcohol Consumption and Metabolic Syndrome in Patients with Sleep Disordered Breathing 281
  8. Prospective study of alcohol consumption and metabolic syndrome 313
  9. Lifetime Alcohol Drinking Pattern is Related to the Prevalence of Metabolic Syndrome. The Western New York Health Study (WNYHS)  314
  10. 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
  11. Prevalence of Metabolic Syndrome in a Japanese Population and its Association with Lifestyle 316
  12. Mechanisms of Insulin Resistance at the Crossroad of Obesity with Associated Metabolic Abnormalities and Cognitive Dysfunction
  13. Metabolic Syndrome Prevalence by Race/Ethnicity and Sex in the United States, National Health and Nutrition Examination Survey, 1988–2012
  14. The metabolic syndrome
  15. The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis
  16. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence
  17. Metabolic Syndrome and the Risk of Stroke in Middle-Aged Men
  18. The Metabolic Syndrome and Chronic Kidney Disease in U.S. Adults
  19. Metabolic syndrome and breast cancer in the me-can (metabolic syndrome and cancer) project
  20. A prospective study on metabolic risk factors and gallbladder cancer in the metabolic syndrome and cancer (Me-Can) collaborative study
  21. Metabolic risk factors and primary liver cancer in a prospective study of 578,700 adults
  22. Metabolic risk score and cancer risk: pooled analysis of seven cohorts
  23. Metabolic risk factors and cervical cancer in the metabolic syndrome and cancer project (Me-Can)
  24. Metabolic factors and risk of thyroid cancer in the Metabolic syndrome and Cancer project (Me-Can)
  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
  26. Habitual Alcohol Consumption and Metabolic Syndrome in Patients with Sleep Disordered Breathing
  27. Cellular and Mitochondrial Effects of Alcohol Consumption 
  28. Chronic alcohol abuse and nutritional status: recent acquisitions
  29. Metabolic Syndrome in Drug Abuse
  30. The Global Epidemic of the Metabolic Syndrome
  31. Alcohol and blood pressure: the INTERSALT study
  32. Moderate Alcohol Consumption and Insulin Sensitivity: Observations and Possible Mechanisms
  33. Moderate alcohol consumption increases insulin sensitivity and ADIPOQ expression in postmenopausal women: a randomised, crossover trial
  34. Alcohol, insulin resistance and the liver–brain axis
  35. Dissecting the Role of Insulin Resistance in the Metabolic Syndrome
  37. High waist-to-hip ratio levels are associated with insulin resistance markers in normal-weight women
  38. Behavioral covariates of waist-to-hip ratio in Rancho Bernardo.
  39. Relationship between obesity, alcohol consumption, and physical activity of male office workers in South Korea
  40. The relation between drinking pattern and body mass index and waist and hip circumference
  41. Relationship between obesity, insulin resistance, and coronary heart disease risk
  42. 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
  43. Trends in dietary fiber intake in the United States, 1999-2008
  44. Effect of high- and low-fiber diets on plasma lipids and insulin
  45. Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis
  46. Plant versus animal-based diets and insulin resistance, prediabetes, and type 2 diabetes: the Rotterdam Study
  47. A plant-based diet in overweight individuals in a 16-week randomized clinical trial: metabolic benefits of plant protein
  48. A Plant-Based High-Carbohydrate, Low-Fat Diet in Overweight Individuals in a 16-Week Randomized Clinical Trial: The Role of Carbohydrates
  49. Effect of diet composition on insulin sensitivity in humans
  50. Effect of Physical activity on Insulin Resistance, Inflammation and Oxidative Stress in Diabetes Mellitus
  51. Increased glucose transport-phosphorylation and muscle glycogen synthesis after exercise training in insulin-resistant subjects
  52. Effects of exercise on glucose tolerance and insulin resistance. Brief review and some preliminary results
  53. Effect of physical training on insulin action in obesity
  54. Changes in Physical Fitness and All-Cause Mortality A Prospective Study of Healthy and Unhealthy Men
  55. Exercise and Insulin Sensitivity: A Review
  56. Sleep disorders and the development of insulin resistance and obesity
  57. Association between Inadequate Sleep and Insulin Resistance in Obese Children
  58. 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
  59. Sleep Disorders and the Development of Insulin Resistance and Obesity
  60. Sleep Disorders, Public Health, and Public Safety
  61. Sleep Duration and Insulin Resistance in Healthy Black and White Adolescents
  62. Treatment Options for Sleep Disturbances During Alcohol Recovery
  63. Investigation of the Relationship Between Chronic Stress and Insulin Resistance in a Chinese Population
  64. Mechanisms of stress, energy homeostasis and insulin resistance in European adolescents–the HELENA study
  66. Investigation of the Relationship Between Chronic Stress and Insulin Resistance in a Chinese Population
  67. Chronic stress, metabolism, and metabolic syndrome
  68. Central effects of stress hormones in health and disease: Understanding the protective and damaging effects of stress and stress mediators