Could Blood Sugar Be the Real Reason You're Not Losing Weight?

The diabetes-weight connection is trickier than you think.

You probably know that weight gain ups your risk of diseases like diabetes. But you might not realize how complicated that link really is, says Osama Hamdy, MD, medical director of the obesity clinical program at Joslin diabetes center in Boston and author of The Diabetes Breakthrough.

"The cycle starts when you gain weight," Dr. Hamdy says. The kicker is that once you have blood sugar problems, it's much harder to do the one thing that can really help: slim down. That may be why the majority of people with type 2 diabetes—about 80 percent—are overweight or obese. The good news: dropping pounds is not impossible if you understand the complex dance between blood sugar, belly fat, and insulin—and how to interrupt it.

The Vicious Cycle, Explained

Every time you eat, your pancreas produces insulin. This hormone helps your body harness the energy provided by food by "unlocking" your cells, helping to move sugar (aka glucose) inside each one, where it's used for fuel.

The problem starts with insulin resistance, in which your cells no longer respond to the hormone. Weight gain can bring it on, especially if you add visceral fat (the kind around your abdominal organs) because it churns out inflammatory chemicals that harm cells' response to insulin.

Think of your body as a car, says David G. Marrero, PhD, president of health care and education at the American diabetes association. "Fill the trunk with 500 pounds of gravel and it's harder to run. It needs more gas and it wears out the engine to get the same level of performance." That's obesity. "Now think of insulin as the gas line between the fuel tank and the engine. Insulin resistance squeezes it, so when you need more fuel, it's harder to get."

Since it's tough for insulin-resistant cells to take glucose from your blood, sugar levels build up. Over time, this may lead to diabetes, which can damage your blood vessels and yield more weight gain. That's because extra blood glucose signals to your pancreas: "Make more insulin!" But the more you churn out, the easier weight piles on because insulin also encourages your body to store the extra sugar as fat.

Shedding pounds can slow down the disease. "You gain more efficiency with every pound of gravel you take out of the trunk," Marrero says.

small portions

Eat Less, but Eat Often

If you have diabetes—especially if you take insulin—it's important to avoid blood sugar dips. So cutting out snacks as a way to shrink your calories isn't an option. But just because you have to eat more often doesn't mean you have to eat more. "You don't need an extraordinarily large number of calories to function, even with diabetes," Marrero says. "Eating small portions throughout the day is a good way to cut calories while keeping your blood sugar steady." If you're on the go, plan snacks in advance, says Jessica Crandall, RDN, a certified diabetes educator and spokesperson for the academy of nutrition and dietetics. Try packing 1 ounce of turkey jerky with whole-wheat crackers or a piece of fruit.

Think Balance, Not Calories

When dieting, "you need to be like the three bears and get the right mix of carbs, protein, and fiber to keep blood sugar balanced," Crandall says. Focusing solely on calories can actually hinder weight loss. "You need protein to support muscle and metabolism, fat for the absorption of vitamins and carbs to sustain energy."

Per meal, aim for 30 to 45 grams of carbs, 20 grams of protein, and 7 to 10 grams of fiber. For example, Crandall recommends a breakfast of scrambled eggs (you can use an egg substitute to cut calories without slashing protein), diced sweet potato, black beans, and salsa. Or, on rushed mornings, try Greek yogurt topped with sliced fruit and a handful of almonds.

Get Moving

Exercise helps muscles take in glucose without the need for insulin and improves insulin sensitivity over time, Dr. Hamdy says. People with diabetes should start slow: "Aim to get at least 175 minutes of exercise a week, but in short bouts, 10 minutes here and there, all day long." (If you're not already active, talk to your doctor first.)

And don't skip strength training! Muscle mass declines with age, but diabetes can accelerate the rate of that loss, says Rita R. Kalyani, MD, assistant professor of medicine in the division of endocrinology, diabetes, and metabolism at Johns Hopkins university school of medicine. Lifting weights can help curb muscle loss. Plus, more muscle means more calories burned, even at rest.

Chill Out to Lose Weight

Stress kicks off your fight-or-flight response, which prompts the body to produce less insulin and release more glucose, ensuring that you have plenty of fuel in case you need to fight off—or flee from—a threat, Marrero says. This is great if you have to, for example, outrun a hungry tiger, but you don't need the extra fuel when you're dealing with modern stressors, like your commute or an upcoming bill. "That's why it's important to reduce your stress load and learn to cope—without using food or alcohol," Marrero says. Make sure you get plenty of sleep each night, walk as much as possible during the day and try supplementing your regular workouts with stress-relieving activities, such as yoga, meditation, or tai chi.

Eat Fiber to Battle Belly Fat

The benefits of fiber-rich foods—like oatmeal, lentils, and beans—are twofold. First, because your body digests fiber slowly, it helps slow down the digestion of sugars, too, which can even out blood glucose spikes. Second, fiber is a known belly fighter: A study from wake forest Baptist medical center in Winston-Salem, N.C., found that for every extra 10 grams of soluble fiber eaten per day, participants lost 3.7 percent of their visceral fat over five years.

Healthy Fats From Healthy Sources

Avocados, nuts, and olive oil—all are great sources of monounsaturated fatty acids or MUFAs. And a 2007 study published in the journal Diabetes Care noted that a diet high in MUFAs can prevent fat from being distributed around the belly.

Whole Grains

To keep your blood sugar under control, it's best to choose complex carbohydrates over simple, refined grains. And there's another bonus: Whole grains blast your belly. In 2008, a 12-week study published in The American Journal of Clinical Nutrition found that participants who ate a diet rich in whole grains lost significantly more belly fat than those who consumed refined carbs instead.

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