It’s amazing to think that Type 2 diabetes was rare in our parent’s generation. But today, in many western countries, it is the fasting growing chronic condition – especially in women aged 50 – 59 years. In Australia alone, 280 Australians develop diabetes every day (Diabetes Australia). That’s one person every 5 minutes. The growth, according to researchers, is increasing at a faster rate than other chronic diseases such as heart disease and cancer.
Sitting in my study on a cold, wintery Saturday in New Zealand, the heater was on and the door was closed. Ignoring the housework, I was absorbed in a Diabetes Symposium run by the Australasian Society of Lifestyle Medicine. Presentations covered a variety of research, but the one I took the most interest in, was about liver and pancreatic fat. Having immersed myself in liver-health research and the role of menopause hormonal changes on the liver and gall-bladder when my own weight reached an all-time-high during menopause, it made sense to me, that fatty liver disease is a cause of mid-life women putting on belly-fat and becoming overweight and/or obese.
Both the liver and muscles are the two most important organs to not only use and store glucose and therefore, rely on the function of insulin, but they also use and store fat. It makes sense to me, that we need to be aware of what happens to these organs and tissues when they become resistant to the role of insulin – this is the hormone secreted by the pancreas that carries glucose to your brain, liver and muscles and in insulin-resistance, which is the pre-cursor to Type 2 Diabetes, both the liver and muscles become ‘resistant’ to the normal role of insulin.
When muscle and liver cells don’t uptake glucose from your blood, it spills over into urine – many of you with Type 2 diabetes or pre-diabetes know that the urine is an important diagnostic organ in diabetes. So too are fat cells. If the normal uptake of glucose into liver and muscle cells becomes disrupted, then you can develop insulin-resistance and the excess glucose is carried to your fat cells instead. As well, if your liver cells are acumulating too much fat, this is also associated with insulin-resistance and weight gain. I wasn’t surprised to hear one of the speakers, Professor Rosemary Stanton, mention that fatty liver disease can appear within 2 months of Type 2 diabetes arriving.
As such, women begin to change their health status, moving from “I wasn’t overweight as a young girl” to “What the hell happened? Here I am at 50+ and overweight and being told I’m pre-diabetic?” I hear this all the time from women. And yes, the health research stats in Australia, back up these changes in body-weight for women over the life-course. People with diabetes, are between two and four times more likely to develop heart disease – and for those of you who read my articles, you know that this is a topic that I’ve written about a lot.
Dr Cyrus Khambatta is a Type 1 Diabetic. He knows all about diabetes and has made it his passion to research what is going on and why. Listening to his talk, he spoke about going on a low-fat diet to un-do the fats building up in the liver and muscles. His research was fascinating.
“To master diabetes, you must first deal with the liver, because excess fats in the diet can cause hyper-inflammation of the liver and this in turn increases glucose spilling out into the blood (hyperglycemia).”
Every bit of research he presented (as well as others who presented later in the day) backed up my readings on women in menopause and their weight gain. And why, to reset our health, we must go on a low-fat, vegetarian or vegan diet. This is my approach too and it goes against all the emphasis on a high-fat, high protein Keto diet that is readily promoted these days. In the symposium, only one lonely academic voice was heard reporting on the benefits of a high-fat Keto diet for Diabetes management. But he was out-numbered and out-scienced by the seven other diabetes researchers who supported the new, low-fat nutritional approach to managing weight gain in Type 1 and 2 Diabetes management and insulin resistance.
Dr Cyrus Khambatta, Professor Neal Barnard (George Washington School of Medicine), Professor Rosemary Stanton (University of NSW), Professor Claire Collins (University of Newcastle), Professor Gary Williamson (Monash University) and the University of Glasgow’s Professors Mike Lean and Roy Taylor, were a united voice when it came to talking about diabetes research and liver fats and how, when it comes to both weight loss and Type 2 diabetes remission, our liver health matters first and foremost.
Every bit of their research matched my lonely readings as well and that is, in order to turn around weight loss and your risk of metabolic syndrome, you must go low-saturated fat and remove highly processed foods in order to allow your liver to reduce the storage of fats and abundance of sugars that have arrived over our life-time, leading to Non-alcoholic Fatty Liver Disease.
Highly processed foods increase your blood sugars, and if you couple this with a diet high in saturated fats from animals, then you also are eating too much saturated fat. This combination (processed foods and high fats) increases the load on your liver and an inflamed liver, not only collects more fat, but can’t process fat, which in turn means that more fat goes on to be stored in your fat cells.
For women in menopause, this can be a health disaster. As such, excess liver fat can lead to insulin resistance and the slippery slope towards Type 2 diabetes.
Low fat, Low GI and Vegan (with a B12 supplement) is the new nutritional approach to managing Type 2 diabetes and losing weight.
Whilst not all of you have Type 2 diabetes, many of you want to lose weight. As such, take heart that you need to stop worrying about all the protein and saturated fats that you may have been focused on in the past, get off that high-fat Keto diet if you are oveweight or obese and fill your fridge with lots of vegies instead.
It is well known that excess body weight and insulin resistance lead to Type 2 diabetes and other major health problems. What is less known is that women between the ages of 50-59 years in both the United Kingdom and Australia are the highest cohort in which the prevalence of Type 2 diabetes occurs.
But as Associate Professor Neal Barnard from Washington State University mentioned in the symposium, obesity tends to be uncommon in individuals whose diets are based on plant-derived foods. In clinical trials, two explanations have been offered.
- A high-fibre, low -fat diet has low energy density, which reduces eneregy intake.
- A low-fat, vegan diet increases the thermic effect of food. This is the increase in metabolism that occurs in the body which contributes to total energy expenditure.
But perhaps the strongest evidence comes from the fact that when a plant-based diet is consumed, the liver and muscles don’t store as much fat. Hence, intramyocellular lipids (fats stored in droplets in muscle cells) are lower, suggesting that when both muscle and liver fats are lower, our body burns more energy thorugh increased mitochondrial activity and post-prandial (after-eating) metabolism. (Kahleova, Petersen & Barnard, 2021).
This is particularly important, because the accumulation of excess fats in muscle and liver cells may also be associated with insulin resistance and Type 2 diabetes.
Over the past month, I have had a focus on promoting my Transform Me weight loss programme to women in post-menopause. I love helping them understand that turning around our liver and gut health are more important than exercise as we work towards improved health as we age. So, too is sleeping all night.
My own weight soared as I moved through my early 50s. I had no idea why this was at the time, because I was doing vigorous exercise and eating a high-fat and high-protein, Keto diet which was promoted to me at the time. But the weight wasn’t shifting. In fact, I felt heavy, bloated and unhappy with the fact that I couldn’t exercise the way I used to.
What I wasn’t doing however, was following the scientific evidence for women in menopause and how, when women are overweight or obese at this life-stage, there are numerous changes going on in our organs, including our liver and muscles.
As my July promotion ends and women explore new ways of ‘being’ at this life-stage, I look forward to bringing them that research. We are a generation of women who have been forgotten in the mid-life lifestyle-change research and my passion is to change this. Every one of our menopause symptoms (including depression, hot flushes, weight gain (or weight loss) and sore joints, are our body’s way of telling us that we need to change and adjust our lifestyle, to firstly, remove the inflammation that’s been accumulating for years and secondly, to then move forward with our health as we age. There is too much emphasis on ‘just’ hormonal treatments in menopause, but women who join me in the My Menopause Transformation community soon learn that there is so much more to ‘Women-opause’ than we think.
Australian Institue of Health and Welfare: https://www.aihw.gov.au/reports/diabetes/diabetes/contents/how-many-australians-have-diabetes
Brady CW. (2015). Liver disease in menopause. World J Gastroenterol. Jul 7;21(25):7613-20. doi: 10.3748/wjg.v21.i25.7613. PMID: 26167064; PMCID: PMC4491951.
Kahleova H, Petersen KF, Shulman GI, Alwarith J, Rembert E, Tura A, Hill M, Holubkov R, Barnard ND. (2021). Effect of a Low-Fat Vegan Diet on Body Weight, Insulin Sensitivity, Postprandial Metabolism, and Intramyocellular and Hepatocellular Lipid Levels in Overweight Adults: A Randomized Clinical Trial. JAMA Netw Open. Nov 2;3(11):e2025454.
Khambatta, C. (Podcast). https://www.pcrm.org/news/exam-room-podcast/fat-fruit-sugar-and-diabetes-cyrus-khambatta-phd
Venetsanaki V, Polyzos SA. (2019). Menopause and Non-Alcoholic Fatty Liver Disease: A Review Focusing on Therapeutic Perspectives. Curr Vasc Pharmacol. 17(6):546-555. doi: 10.2174/1570161116666180711121949. PMID: 29992886.