What is Metabolic Syndrome (MetS)?
I remember the conference in New York distinctly.
It was 1995, the year my daughter was born. It was my first time away from her.
However, attending the conference was an opportunity that I didn’t want to miss. I was presenting at an American health and exercise conference and for the first time ever, there were specialist presentations on medical concerns associated with exercise prescription.
Sitting in one of these sessions, it was the first time that I had heard a name given to the cocktail of conditions that I was seeing in overweight middle-aged women coming into the gym.
When taking their physical and healthy history as part of their pre-screening, many of them described abdominal and breast weight gain, high blood pressure, pre-diabetes (insulin resistance) and high cholesterol.
Here I was, for the first time ever, hearing that these conditions were collectively known as Metabolic Syndrome [MetS], or as it is more popularly known, Syndrome X.
Nearly 30 years later, I continue to remember this conference … because as I went into menopause, the same health changes happened to me.
The menopause transition is now known to be a catalyst for the development of Metabolic Syndrome and a condition called Insulin Resistance. [Mumusoglu & Yildiz, 2019].
Of concern for women putting on a lot of weight, is that MetS precedes Type 2 Diabetes and cardiovascular risk as they move from menopause into post-menopause.
But wait, there’s now more! New research also suggests that MetS is linked to the progression of osteoarthritis. (Charton, 2025; Dickson et al, 2019)
Metabolic syndrome (MetS), is associated with central obesity and characterised by:
- elevated waist circumference (over 84cm for women)
- raised fasting plasma glucose concentration
- raised triglycerides
- reduced high-density lipoproteins
- and/or hypertension.
All of these factors may also be implicated in the development of Osteoarthritis. According to researchers, this can occur via a wide range of metabolic alterations.
Most noticeably, the way that MetS affects macrophages (white cells that remove debris) and chondrocytes (specialised cells that maintain cartilage).
Hyper-glycaemia (high blood sugar) is also a problem for sore joints – something I’ve noticed in many of my clients too – when they begin their lifestyle-change journey to remove sugar and unhealthy fats, their joint pain tends to reduce too.
This is related to Advanced Glycation End-Products (AGEs), which are produced when sugars bind to proteins and fats.
These AGEs are well known in ageing and longevity health research, because they are known to contribute to many diseases of ageing due to the fact that they bind to receptors on the surface of the macrophages and increase the rate of oxidative stress and inflammatory changes in cells.
With an eye on the future health of clients as they navigate menopause, the management of insulin and blood sugar levels is one of the hallmarks of managing metabolic syndrome – and I share some tips about how to do this below.
If your clients are overweight or obese, tired, feeling sluggish, have developed foggy brain, aching muscles and sore joints, then changing hormones in menopause may not be to blame. Instead the focus may need to be on managing Metabolic Syndrome instead.
Obesity superimposed on menopause and ageing, drastically increases chronic low-grade inflammation (a condition called ‘inflammaging’), and inflammaging is now seen as an important link between obesity, insulin resistance, and age-associated diseases. [Frasca et al, 2017].
This is why, understanding the role of insulin is important and I go into this in more depth in the Certified Menopause Weight Loss Coach Course.
For now however, helping your clients with control of insulin release from the pancreas, helps to control their energy levels, moods, hot flushes, sore joints and their weight.
If your clients aren’t sure about their glucose levels, then the next time they get their bloods checked, they can talk to their Doctor about an HbA1c blood test done (as well as triglycerides and your cholesterol levels). HbA1c is a diabetes test and measures average plasma glucose concentration.
How does Insulin work?
To better understand insulin resistance, it helps to have an understanding of the two hormones that are released by the pancreas when we eat.
These two hormones, insulin and glucagon, interact to help manage our blood sugar levels or blood glucose levels. If both these hormones are out of balance, our blood sugar/glucose levels become unstable.
This can lead to energy peaks and dips throughout the day, worsening mood swings and unstable weight gain.
The pancreas manages Insulin production and release in response to blood sugar levels. It is the most ‘forgotten’ organ that I know, yet it’s importance and function is crucial to helping clients lose weight.
When foods that are highly sweet or they are ultra-processed foods, such as many junk-foods, are eaten, this causes glucose levels in the blood to increase.
In order for the body to manage these higher blood glucose levels and remove them, insulin is released from the pancreas.
The normal role of insulin is to carry sugar or glucose to nearly every cell around your body. This includes your brain, muscle and liver cells.
Insulin carries glucose. It is your energy storage hormone.
When you eat something such as white bread or white rice, or a cookie or honey, 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 our brain, muscle and liver cells ready to supply energy for activity and metabolism. Sometimes however, this process gets out of order. This may be from:
- eating the wrong types of food,
- eating too much or too little food,
- drinking a lot of alcohol,
- having a sedentary lifestyle with very little activity,
- having too much exercise/sports as with athletes training and competing,
- carrying too much body-fat,
- the ageing of our pancreas during menopause, which is the organ responsible for releasing insulin and glucagon (it’s opposing hormone).
- the ageing of our muscles and liver (this reduces the efficiency of glucose storage into cells)
All of these factors can cause the pancreas and the liver to become inflamed and therefore, cause our blood sugar levels to get out of balance, either going too high, or too low.
When blood sugar levels are too high, the ageing pancreas works harder than ever to release insulin. If insulin is released too rapidly or too regularly, in response to increased blood sugar levels, then our cells and tissues can’t cope. Nor can we.
Hot flushes may become worse (because insulin helps to regulate temperature), and with the swings and dips in our blood sugar levels, just like hungry children, our moods can also change quickly.
Why too much insulin is a problem in menopause.
Too much glucose in the blood can be problematic to women during menopause, because insulin also carries it to fat cells.
Insulin regulates the uptake of dietary fats and glucose from simple carbohydrates into fat cells, especially if women have a large meal, or are sedentary (our liver and muscles use up glucose during exercise), or they are experiencing insomnia.
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.
I understand how women feel – the worse my sleep was, the worse my joints and muscles felt, and I didn’t have the energy for exercising, nor did I have the time.
My weight gain and breast tissue increase was also a hindrance to being able to enjoy more vigorous, higher-impact exercise. Something I had done for years.
This is where lack of exercise and insomnia can be problematic to overweight women contributing to a condition called insulin-resistance.
The term ‘insulin-resistance’ comes from the knowledge that cells can become resistant to insulin arriving to deposit glucose into them.
If 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 in our pancreas and liver.
Insulin Resistance may 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. Many women who come on my programmes are the same.
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, sugars from the foods eaten, including simple carbohydrates, as well as sugar released from the liver, build up in the 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, glucose may then move into storage areas under the diaphragm and into the stomach regions.
Tips for Managing Insulin Resistance
- Know that nutrition and adherence to it, is your client’s 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.
- Selenium is known to reduce inflammation in the ageing pancreas. The pancreas, represents a metabolically-active organ and many overweight women also suffer from a fatty pancreas as well as a fatty liver (Non-alcoholic Fatty Liver Disease). A healthy pancreas is essential for the uptake and breakdown of essential nutritional components. Because it changes its morphology and function with age, anti-inflammatory foods are an important component of your client’s diet, especially selenium-rich foods, such as Brazil nuts.
3. Introduce clients to low glycemic index carbohydrates if this is possible within your Scope of Practice. Pioneered by Professor Jenny Brand-Miller from Australia, the glycemic index and glycemic-load rating scale helps to consider carbohydrates that don’t spike insulin levels. I have lists in the Menopause Weight Loss Coach Programme too.
4. Improve Joint Health so your clients can move more freely and get active again. If your client’s have sore, aching joints and this is preventing them from being active, then this elevates their risk of developing insulin resistance and/or metabolic syndrome.
In the powerful JOINT HEALTH COURSE, you will discover that there is a nutrient found in olive oil that replaces the loss of oestrogen in tendons. This is why supporting them with nutritional change to meet the specific joint health changes that occur during menopause is so important to share with them.
When women develop health changes in their menopause and post-menopause years, it’s hard for them to consider that they have the ability to turn this around using evidenced lifestyle solutions.
It’s the same with insulin resistance – women can reduce and reverse insulin resistance and/or metabolic syndrome.
This is where your role is crucial to their health journey. And for those of you who have joined me on the Practitioner training, or any of the other courses, it’s my privilege to draw your attention to this important stage of your client’s life, whether they choose to go on HRT or not!
Dr Wendy Sweet (PhD) Member: Australasian Society of Lifestyle Medicine.
References:
Carr MC. The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab. 2003 Jun;88(6):2404-11.
Charton, Alix et al. (2025). Metabolic syndrome is associated with more pain in hand osteoarthritis: results from the DIGICOD cohort. Osteoarthritis and Cartilage, Volume 32, S43 – S44
Dickson, B.M., Roelofs, A.J., Rochford, J.J. et al. The burden of metabolic syndrome on osteoarthritic joints. Arthritis Res Ther 21, 289 (2019). https://doi.org/10.1186/s13075-019-2081-x
Frasca D, Blomberg BB, Paganelli R. Aging, Obesity, and Inflammatory Age-Related Diseases. Front Immunol. 2017 Dec 7;8:1745.
Godoy-Matos AF, Silva Júnior WS, Valerio CM. NAFLD as a continuum: from obesity to metabolic syndrome and diabetes. Diabetol Metab Syndr. 2020 Jul 14;12:60.
Ko SH, Kim HS. Menopause-Associated Lipid Metabolic Disorders and Foods Beneficial for Postmenopausal Women. Nutrients. 2020 Jan 13;12(1):202.
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
Martín-Peláez, S., Fito, M., & Castaner, O. (2020). Mediterranean Diet Effects on Type 2 Diabetes Prevention, Disease Progression, and Related Mechanisms. A Review. Nutrients, 12(8), 2236. https://doi.org/10.3390/nu12082236
Metabolic Syndrome and Related Disorders.Oct 2022.429-439.
Mumusoglu S, Yildiz BO. Metabolic Syndrome During Menopause. Curr Vasc Pharmacol. 2019;17(6):595-603.
Patni, R., & Mahajan, A. (2018). The metabolic syndrome and menopause. Journal of Mid-life Health, 9(3), 111–112.
Stachowiak G, Pertyński T, Pertyńska-Marczewska M. Metabolic disorders in menopause. Prz Menopauzalny. 2015 Mar;14(1):59-64. doi: 10.5114/pm.2015.50000.
Wang, Q., Ferreira, D.L.S., Nelson, S.M. et al. Metabolic characterization of menopause: cross-sectional and longitudinal evidence. BMC Med 16, 17 (2018). https://doi.org/10.1186/s12916-018-1008-8
Wei, G., Lu, K., Umar, M. et al. Risk of metabolic abnormalities in osteoarthritis: a new perspective to understand its pathological mechanisms. Bone Res 11, 63 (2023). https://doi.org/10.1038/s41413-023-00301-9
Weickert M. O. (2012). Nutritional modulation of insulin resistance. Scientifica, 2012, 424780.
