It was 1995 and I remember the conference in New York distinctly. It was the year my daughter was born and it was my first time away from her to travel to an academic health conference. I think many of us remember the nervousness as we leave our babies for the first time. But it was an opportunity that I didn’t want to miss. I was presenting at an American health and fitness conference and for the first time, there were specialist presentations on medical concerns associated with exercise.
As I sat listening to the fascinating sessions, I heard the term ‘Metabolic Syndrome’. It was the first time that I had heard a name given to the cocktail of conditions that I was seeing in women coming into the gym, who were overweight. As I sat talking to them doing the health screening questionnaires at the time, many would describe high blood pressure, insulin resistance and high cholesterol. At the time, I never knew that these ‘big-3 health issues’ were now, for the first time, being described as a syndrome … metabolic syndrome or as it is more popularly known, Syndrome X. Goodness knows how many women I was seeing back then, who were also menopausal. We didn’t even think about menopause back in those days.
Over 25 years later, I think about menopause, Metabolic Syndrome and Insulin Resistance nearly every day.
It’s something I talk about for women on my programmes who are overweight and have changing blood pressure and cholesterol levels. But the most important thing I talk about is their need to manage a condition called insulin-resistance and the choices that they need to make as busy women with families to feed and a lot going on in their lives.
The management of insulin and blood sugar levels is one of the hallmarks of managing metabolic syndrome. It’s the difference between pizza and broccoli. If you are overweight or obese, tired, feeling sluggish, have developed foggy brain, aching muscles and perhaps you always feel grumpy, then please don’t necessarily blame your changing hormones in menopause – blame your changing insulin levels and loss of muscle tissue instead.
If any of these symptoms sound familiar, then I want to tell you about insulin and why it is so crucial to manage the secretion of insulin from our ageing pancreas in response to blood sugar levels, so you don’t become insulin-resistant. As our hormonal environment is changing during our menopause transition, our insulin production and secretion changes too. So with better control of insulin surges from our pancreas, we help to control our energy levels, moods, hot flushes and our weight. Unstable insulin production in the pancreas can create inflammatory changes in our body as we move into post-menopause. This is because when insulin production is unstable, blood levels of glucose can become too high, which can lead to Type 2 diabetes.
If you aren’t sure about your glucose levels, then the next time you get your bloods checked, then please make sure that you get your HbA1c blood test done (as well as your triglycerides and your cholesterol levels). HbA1c is a diabetes test and measures your average plasma glucose concentration.
What does Insulin do in the body?
To better understand insulin resistance, it helps to have an understanding of the two hormones that are released by your pancreas when we eat and how these two hormones, insulin and glucagon, interact to help manage our blood sugar levels or blood glucose levels. Insulin is produced when blood glucose levels are high. But if blood glucose levels are too low, then the opposing hormone, glucagon, is released to boost blood sugar levels. If both these hormones become un-balanced then our blood sugar/glucose levels become unstable. Our energy peaks and dips, our moods are all over the place and so too, is our weight management.
Glucose is a simple sugar and is also known as blood sugar. Flowing through your bloodstream, it is the principle fuel of all of your body cells, especially your brain. Insulin is the hormone made by a gland called the pancreas, and it carries glucose or escorts it, from the blood into cells, where it is burned for energy.
Insulin carries sugar/glucose. It is your energy storage hormone. When you eat something such as bread or rice, or a cookie, your blood glucose (sugar) rises. This signals the pancreas to release an amount of insulin necessary to carry the available glucose to the brain, the liver and muscles as well as other cells. There is no energy storage in our muscles or liver cells without insulin. Nor is there glucose which travels to the brain without insulin. It is a crucial hormone which holds the key to unlocking the door to glucose being stored in the liver, muscles and in fat cells.
In normal situations, insulin moves glucose into muscle and liver cells ready to supply energy for activity and metabolism. Sometimes however, when we eat the wrong types of food, or we eat too much or too little food, or we don’t do enough exercise, or because we have become oestrogen dominant during our menopause transition, or simply because our pancreas is ageing, our insulin levels not very well regulated.
This can cause the pancreas and the liver to become inflamed. When this happens and if we are eating a diet high in processed carbohydrates and sugar and we aren’t sleeping, or putting on weight, then our pancreatic hormones become out of balance as well. When this happens, our blood sugar levels can get out of balance, becoming too high (or too low). If our blood sugar levels are too high, then this means that the ageing pancreas is working harder than ever to release insulin. If insulin is released too rapidly or too regularly, in response to increased blood sugar levels, thenour cells and tissues can’t cope.
Hence, if abnormally high blood glucose levels occur, this can trigger an increase in insulin to remove the glucose from the bloodstream. If it happens too often, the body’s cells can ignore high insulin levels and thus, the cells become ‘resistant’ to the effect of the hormone, insulin. Over time, insulin resistance allows blood glucose levels to rise and stay high. Our blood sugars become erratic, as do our moods, our weight and our hot flushes and night sweats. Welcome to one of the main underlying issues with your symptoms in menopause.
Why too much Insulin is a potential problem in menopause.
Too much insulin attaching to blood glucose, can be taken to fat cells instead. If we have quite a sedentary life and we aren’t doing a lot of exercise, then our cells aren’t using up the excess glucose. For many women who have sore joints or are exhausted from not sleeping during their menopause transition, it’s very easy to become more sedentary. Especially if we have jobs that demand our time. I know that the heavier I got and the more my joints became sore, I didn’t feel like exercising, nor did I have the time, however, if we become more sedentary, our muscles don’t take up the glucose and turn it over.
The term ‘insulin-resistance’ comes from the fact that our cells become resistant to insulin arriving to deposit glucose into them. Over time, this sedentary lifestyle combined with menopause hormonal changes and a diet that isn’t conducive to our age and stage of life, can cause metabolic chaos. In fact, it can lead to Metabolic Syndrome … just as I heard about back in 1995, when the Doctor presenting the session spoke about the changing cardiac and metabolic health of our mother’s generation in post-menopause. As a young ’30-something’ year old at the time, I had no inkling that the same thing might happen to me and many women who come on my programmes are the same.
Another contribution to the chaos of insulin resistance is also the result of a condition called sarcopenia. This occurs in part, because as we lose the role of oestrogen, we also lose the power fibres in our muscles. If you’ve noticed your loss of muscle tone, then this is why. As we lose muscle density, then this opens up the environment for fat cells to expand as insulin carries glucose to fat cells instead. This is why as we move from peri-menopause to post-menopause, our lowering oestrogen can promote insulin-resistance in some susceptible women.
When women become insulin resistant, their liver, muscle and fat cells do not respond to the normal role of insulin properly. This situation can build up over years due to a diet that is high in carbohydrates (especially processed carbs) but can also become accelerated in peri-menopause when oestrogen levels fall and inflammatory changes in cells occur. This includes our pancreas. When the cells do not respond to insulin, they don’t allow sugars from the blood stream to enter into them. So, the normal processes for insulin to be taken up by cells is ‘blunted’. This is the what causes ‘insulin-resistance’ which can occur on it’s own, but is always included in Syndrome X, or Metabolic Syndrome. The key underpinning of Syndrome X is insulin resistance.
When cells don’t allow insulin to do its job, what happens is that sugars from the foods you eat, including carbohydrates, as well as sugar released from the liver, builds up in your blood-stream.
Sugar [glucose] in the bloodstream sends a signal to the pancreas to step up its insulin production in an attempt to maintain a normal blood sugar level. But because the liver, muscle and fat cells are resistant to insulin doing its job, the result is a by-pass of the normal processes and the sugar moves directly to fat cells. In menopausal women, the types of enzymes for storing fat move this fat into storage areas under the diaphragm and into the stomach regions. It is frustrating and confusing.
For some women, peri-menopause is the time when fat storage in these areas increases, but for other women, they may already be over-weight and insulin resistant when entering menopause. The risk for these women is high for developing Type 2 diabetes as well as other changes implicated in heart disease such as high blood pressure and high low-density cholesterol. Clinically, you will have entered the zone which medical experts call, Metabolic Syndrome or alternatively, Syndrome X. This is the title bestowed on the cocktail of health problems relating to over-weight and obesity that can beset women during menopause.
3 things you can do to manage Insulin Resistance:
- Know that nutrition is your best medicine. As such, you need to understand that the evidence behind the Mediterranean Diet for women in menopause to manage weight has been evolving for years. This is the type of dietary approach that I take in the MyMT™ programmes.
2. Go for (mainly) low glycemic index carbohydrates. If you have been following my newsletters for a while, then you will have heard me discuss the low glycemic index. Pioneered by Professor Jenny Brand-Miller from Australia, this rating scale helps us to find carbohydrates that don’t spike insulin levels. I have lists in your MyMT™ programme all ready and waiting for you.
3. Improve Joint Health so you can move more freely and get active again. Did you know that your joints have oestrogen receptors in them? That means when we move through menopause, the reduction of oestrogen affects our joints as well. If you have sore joints, then please explore the ‘Restore your Joyful Joints’ stand-alone module I have for you. Because if your joints are aching and preventing you from being active, then you are more at risk of developing insulin resistance and/or metabolic syndrome. In this powerful module, you will discover that there is a nutrient found in olive oil that replaces the loss of oestrogen in our tendons and that when we move through menopause, our collagen turnover is slowed as well. This is why changing our nutrition to meet the specific changes to our health that occur during menopause is so important to do.
When we begin to develop health changes, it’s hard to remember that we can turn this around and feel great again. It’s the same with insulin resistance – you can reduce and reverse insulin resistance and/or metabolic syndrome. If you don’t get on top of managing insulin levels then not only do you acquire more inflammation and weight, but you age more quickly too. So, get on top of your insulin management ladies for your weight management, and if you are busy and want to feel supported then join me on the MyMT™ Transform Me weight loss programme when you can.
Manco, M. ,Nolfe, G. , Calvani, M., Natali, A., Nolan, J., Ferrannini, E., Mingrone, G. (2006). Menopause, insulin resistance and risk factors for cardiovascular disease. Menopause, 13 (5), 809-817
Patni, R., & Mahajan, A. (2018). The metabolic syndrome and menopause. Journal of Mid-life Health, 9(3), 111–112.
Weickert M. O. (2012). Nutritional modulation of insulin resistance. Scientifica, 2012, 424780.