Lifestyle Before Medication

A pharmacist's perspective on health and metabolic disease

Hyperinsulinaemia: Best management practice

A major aspect of my thesis was reviewing the literature to find out just how much of an impact hyperinsulinaemia had on metabolic disease.   I posted that review back in November.

What bugged me though about that review is that it only told part of the story.  It had been drummed into me as a clinician that you do not attempt to diagnose a condition unless you have a clear plan for treating said condition should the test come back positive.  To me, this meant that I should not go to the effort of working out the best way of diagnosing hyperinsulinaemia, unless I could also give the clinicians a clear plan for how to tell their patients to manage their condition.

Today, that review was published and you can read it here  “Hyperinsulinaemia: Best management practice.”  The abstract is below.  I’ll admit that I don’t like the layout, but this was pointed out to them during the proofing process.

A big thank you to my co-authors, Grant Schofield (The Fat Professor), Caryn Zynn (The Whole-Food Dietitian) and Mark Wheldon.

Also, though a big thank you to those of you who, late last year, gave me suggestions as to which supplements I should investigate.  I could not include them all but it was certainly interesting to find which ones had the evidence and should be included.

My review shows that restricting carbohydrates is probably the best dietary option for managing hyperinsulinaemia, although you will get some success with low-fat and Mediterranean regimes.  Physical activity is also important, while medication may or may not be beneficial.





Chronic hyperinsulinemia associated with insulin resistance is directly and indirectly associated with many metabolic disorders that contribute to significant morbidity and mortality. Because hyperinsulinemia is not widely recognised as an independent health risk, there are few studies that assess management strategies. Medication management may not address the multiple issues associated with hyperinsulinemia. Lifestyle management includes physical activity, especially high intensity interval training, and dietary management. Reducing carbohydrate quantity and increasing nutrient density are discussed with carbohydrate-restricted and Mediterranean diets conferring additional benefits to a low-fat diet. Physical activity and dietary management provide the foundation for hyperinsulinemia management and may work synergistically. Of these principles, a combination of resistance and high intensity interval training, and carbohydrate restriction provide the two most effective frontline management strategies for managing hyperinsulinemia.

8 comments on “Hyperinsulinaemia: Best management practice

  1. puddleg58
    March 19, 2016

    Hi Catherine,


    you don’t seem to have a full-text link here, so here it is



  2. Kok-Hong
    March 20, 2016

    It is unfortunate the review did not explore fasting protocols and ketogenic diets.


    • pharmacistcatherine
      March 21, 2016

      While not mentioned directly, ketogenic diets are inferred under the umbrella of carbohydrate-restricted diets. When you only have about 5000 words, a lot of ground to cover, (with suggestions about what to include coming in from everywhere, including the journal itself) some concepts have to be left for a later article.

      With respect to intermittent fasting protocols, yes, perhaps that is an oversight, but when this article was first drafted in early 2013, I had not come across good evidence for intermittent fasting. When I rewrote the paper, I had a massive thesis deadline to meet and they were overlooked. However, given the quality of evidence I was trying to include – intermittent fasting protocols may not have had more than a sentence along the lines of “looks promising, more research needed”.

      Today, no fewer than three people have asked me about fasting protocols, so I have started looking at the evidence. Now the big question becomes, do I blog about it, or write another review article? I will appreciate advice on this question.


  3. Niel Rasmussen, MD
    March 20, 2016

    I would like to hear your thoughts on intermittent fasting and even longer fasting periods (every other day eating, etc) as another tool to reduce insulin levels and improve or reverse insulin resistance (and the chronic diseases that are associated). The scant literature on the subject seems to support metabolic benefits of this and it seems to be a logical tool that could be added to a carbohydrate restricted high natural fat diet to minimize insulin’s requirements. I am trying to add this concept to my lifestyle treatment for patient’s that are open to this. Have you any thoughts?


    • pharmacistcatherine
      March 21, 2016

      Neil, The theory looks promising. As mentioned above, I haven’t had a good look at the literature, but fasting will improve insulin receptor availability, GLUT4 regulation, and deplete cells of glycogen. All of these processes will assist hyperinsulinaemia management. In the table, where I have written “time” you can also substitute the word “Fasting”. You are right, the literature is a bit scant, so do I blog, about fasting, or spend a couple of months to try and do a good literature review to be published? If published in a peer-reviewed journal, there is more credibility especially if you are trying to educate your colleagues. What do you suggest?


  4. Harlee
    August 10, 2016

    Great research and article
    You may have noted this in your proofing
    In exclusions should Bmi be less than 17.9 rather than greater than


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