It's February, which means it's heart health month.

So, this post is all about cardiovascular health, and more specifically about blood sugar regulation.

When people think of heart health, they usually think of hypertension, heart attacks, maybe diabetes, and cholesterol issues. Basically, they're thinking of overt manifestations of underlying metabolic dysfunction. And this is true. But cardiovascular disease develops over time.

What does insulin do?

One of the metabolic dysfunctions that I see most often in my practice is insulin resistance, which is a huge contributing factor in PCOS (PolyCystic Ovarian Syndrome).

Insulin is the hormone that helps regulate your blood sugar and allows glucose (sugar) from your bloodstream to enter your cells. Glucose can then be utilized in your cells to make ATP (cellular energy currency... think back to your grade school science!).

Think of insulin like a key that unlocks your cellular door so glucose can enter the cell.

What is insulin resistance and how does it affect heart health?

What happens in those of you who have blood sugar regulation issues (PCOS, pre-diabetes and pre-pre-diabetes, etc.) is that your cells become resistant to insulin i.e. you need a lot of insulin kicking and screaming at the door of your cell to allow glucose to enter. What this means is that your body now starts to dump more insulin even at the slightest provocation.

And the thing is, insulin is pro-clotting – it promotes clotting in your blood vessels. And high blood sugar is also inflammatory and pro-clotting. And inflammation in general increases insulin resistance. So, basically, we're laying the groundwork for developing cardiovascular disease.

There are different reasons why someone can have insulin resistance and it's usually not just one thing that causes it, but a multitude of contributing factors: food & nutrition, genetics, medical history, medication use, stress and sleep, movement and activity levels, hormonal changes, general inflammation levels, other social determinants of health, and more.

Should I test for insulin resistance? How do I do that?

Medical doctors don't typically run insulin levels along with your glucose but you can ask! It's an important one to run (and one of the most common tests I run alongside vitamin D and a full thyroid panel). It's a simple blood test. Here are some situations where it would be important to run:

• You have PCOS
• You have a family history of heart disease and/or type 2 diabetes
• Your blood sugar is "borderline"
• You feel hypoglycemic (shaky, nauseated, fatigued, angry) easily
• You have recently gained a significant amount of weight, especially around the midsection (*significant is subjective obviously)
• You have a history of (recurrent) miscarriage
• You had gestational diabetes or pre-eclampsia during your pregnancy
• You have yo-yo dieted in the past or your weight has yo-yoed in the past
• You retain a significant amount of water (not because of a medication or other known condition)

What can I do for healthy insulin and blood sugar levels?

Regardless of whether you've formally tested insulin or not, there are ways you can support your insulin and blood sugar levels:

• Have wholesome meals: carbs (whole food sources are preferred) + protein + fats + fibre so that your blood sugar rises slowly instead of spiking
• Eat your fruits and veggies (start where you are and move up to the recommended 6-10 servings)
• Get adequate restful sleep (or get help with sleep if you have issues!)
• Incorporate meatless days, maybe a Meatless Monday! Plant-focused diets have shown the best evidence
• Incorporate healthy fats like omega-3s and olive oil
• Move often (moving a few times per day even if it's for a short period of time is helpful)
• Decrease red meat consumption as red meat is higher in saturated fat that has been shown to worsen insulin resistance
• Avoid or limit foods that are inflammatory to you (for e.g. they cause digestive upset or skin rashes or headaches etc.)
• Limit refined and processed foods
• Incorporate some movement around the time that you have a dessert to help manage your blood sugar levels
• Work on self-care and stress management regularly
• Reach out for support, especially for guidance and sustainable habits