Metabolic balance guide

Insulin resistance is when your body does not respond to insulin as well as it should. In prediabetes, blood sugar is higher than normal, but not high enough for a diagnosis of type 2 diabetes. People with insulin resistance and prediabetes usually have no symptoms.^[1]

• A1C (HbA1c): 5.7–6.4% is the prediabetes range.^[1]
• Fasting blood sugar: 100–125 mg/dL is the prediabetes range.^{[1, 6]}
• Glucose tolerance test (OGTT): a 2-hour value of 140–199 mg/dL is the prediabetes range.^{[1, 6]}

Risk factors include overweight or obesity, a large waist size, physical inactivity, being 35 or older, a family history of diabetes, smoking, a history of gestational diabetes and polycystic ovary syndrome (PCOS).^[1]

People with prediabetes have a high chance of developing type 2 diabetes within 5–10 years. At the same time, there are steps you can take to stop prediabetes from progressing or to reverse it, and to help prevent type 2 diabetes.^[1]

Metabolic syndrome is the name for a group of conditions that, when they occur together, raise the risk of heart disease, diabetes, stroke and other serious health problems. You are considered to have metabolic syndrome if you have three or more of the five conditions below.^{[2, 5]}

According to a 2009 joint statement that brought together the criteria of different organizations, there is no single waist size cut-off that applies to everyone; country- or region-specific cut-offs can be used. Measuring your waist remains a useful tool for initial screening.^[5]

The Turkish Dietary Guidelines describe measuring your waist while standing, midway between the lowest rib and the bony point of the hip, with a tape measure that does not stretch. This value reflects fat around the abdomen and the organs; the higher it is, the higher the health risks.^[6]

Fat that collects in the upper body and around the waist (the apple shape) raises the risk of heart disease, high blood pressure, diabetes and some types of cancer.^[6]

Healthy foods and drinks can help you manage insulin resistance and prediabetes. In the Diabetes Prevention Program, which included people at high risk of diabetes, losing 5–7% of starting body weight lowered the chance of developing type 2 diabetes.^[1]

For people with overweight, losing even 3–5% of current weight can help manage some of the risk factors for metabolic syndrome.^[4]

• A heart-healthy eating pattern, like the DASH plan, includes fruits, vegetables and whole grains, and limits saturated fat, salt, added sugars and alcohol.^[4]
• Choose whole grain products instead of white bread, bulgur pilaf instead of rice, and whole fruits and vegetables instead of their juices; eat more legumes. High-fiber foods help you feel full.^[6]
• Eat three main meals a day and don't skip breakfast. Don't watch TV or use your phone while you eat.^[6]
• Limit sugar-sweetened drinks and packaged fruit juices; choose water, milk or ayran (a yogurt drink) instead.^[6]
• Regular physical activity helps manage risk factors for heart disease. Ask your doctor what level of activity is right for you.^[4]
• The recommended amount of sleep for adults is 7–9 hours a day. Learning to cope with stress and quitting smoking are also part of lifestyle changes.^[4]

When lifestyle changes alone are not enough, your doctor may recommend medicine; medicines are usually used together with these changes.^[4]

I work from a functional medicine perspective: alongside your symptoms, I also look at your diet and lifestyle to try to understand the causes behind the problem. I offer counseling in person and online.

My services in this area include nutrition for insulin resistance and metabolic syndrome, weight management, and nutrition for cardiovascular diseases; I also do detailed body analysis. I prepare a medical nutrition protocol tailored to you and help you make healthy eating habits part of your lifestyle. My priority throughout is supporting gut health.

A nutrition plan does not replace the treatment your doctor recommends; it works alongside it. Talk to your doctor about any change to the medicines you take.