Insulin Resistance in Peri-menopause and beyond
Peri-Menopause is the lead up to menopause- which is classified as 12 months from the last date of menstruation. From around the age of 38-40 women may start to experience some peri-menopause symptoms, although it can be earlier - sometimes as young as 35. Often initially symptoms are subtle, so they are passed off as PMS, tiredness, stressed etc..but as we get into our forties symptoms may become more noticeable.
Insulin resistance is a hormonal condition that is characterised by chronically elevated levels of insulin, and can be a major driver of peri and post-menopausal symptoms, increasing the risk of weight gain, cardiovascular risk - including high blood pressure, high cholesterhol, fluctuations to moods, tiredness, insomnia, headaches, brain fog, joint pain, periodontal and vasomotor symptoms such as extra sweating, hot flushes, night sweats.
Insulin resistance symptoms
Symptoms can be varied, but include:
High blood pressure
Hungry all the time, and/or tired after meals
Cravings for sweet food
Weight gain, especially around the belly (aka “the roll”)
Reduced ability to loose weight
Fatty liver
Skin tags, dark patches/discolouration of skin particularly under the neck and around the arms - this can often be a velvet/purple texture (acanthosis nigricans)
Acne
Testing for insulin resistance
Blood pathology testing can be useful to assist in evaluating if insulin resistance is present. Whilst HbA1c/insulin markers are very helpful, they should not be used on their own to diagnose insulin resistance. Other pathology tests to take into consideration include:
HbA1c and/or fasting insulin
Lipid studies that include Triglycerides
Liver function
CRP inflammation marker
Iron studies
HOMA-IR index
Causes of Insulin resistance
Excess androgens: This is often seen in women with polycystic ovarian syndrome (PCOS), as increased androgen levels impair glucose metabolism, which leads to insulin signalling pathways being altered. An increase in visceral adiposity is also reported. These can both lead to impaired glucose uptake and reduced insulin sensitivity.
Autoimmune thyroid conditions such as Hashimoto’s disease and Graves’ disease: Due to altered under and over-production of thyroid hormones. In Hashimoto’s disease there is often central adiposity and dyslipidema present which can lead to insulin resistance. In Graves’ disease there is often impaired glucose tolerance due to excess thyroid hormone production leading to insulin resistance.
Increased iron, in particular increased transferrin levels: Women of a reproductive age are sheltered from insulin resistance during the reproductive years due to higher oestrogen levels and low iron. High oestrogen supports mitochondrial function and assists in reducing intestinal permeability, and low iron due to menstruation shelters women from insulin resistance and heart disease. Higher iron puts in particular post-menopausal women at risk, especially if they take oestrogen therapy because oestrogen raises iron by suppressing the hormone hepcidin (this is produced by the liver that plays a part in iron absorption), but as there is no regular menstruation the iron can accumulate in the tissues of the body. Increased transferrin levels are associated with insulin resistance in this population.
Mitochondrial dysfunction: Glucose and lipid metabolism are largely dependent on mitochondria (the “powerhouse” of the cell) to generate energy in the cells, and as such regulate a healthy insulin response. Genetic and environmental factors such as diet and lifestyle, ageing, obesity, stress, inflammation and immune function (infections) can compromise mitochondrial function. Interventions that improve mitochondrial function may contribute to improving insulin sensitivity/reduce insulin resistance.
Fasted training - In the morning when we wake, we have naturally high cortisol levels (this is part of what helps us wake up), which should then naturally decrease during the day. By consuming some food or breakfast prior to a training session (protein or carbohydrates, depending on if it is cardio or strength based), it helps to decrease our cortisol levels, which then assists with improving metabolic outcomes, including reducing insulin resistance (cortisol increases blood sugar). Women’s bodies are more sensitive to cortisol, so training on an empty stomach in the morning, and even worse, continuing to then fast until lunch time, is going to be particularly detrimental to metabolic health. It is not uncommon for women at this time of life to start to eat less and exercise more, often following the pattern I have just mentioned, and are continually left frustrated to be doing both of these often with no or limited results! If you are going to intermittent fast to assist with metabolic flexibility, it is best to do it at the other end of the day i.e. eat an early meal (3-4pm), then fast until the morning when you have either have breakfast, or a small snack when you arise in the morning, especially around training. Food before and after training will also assist in recovery. Also FYI - coffee in the morning does not count as your fuel before training, as on an empty stomach it can also increase cortisol, so for this reason should be consumed ideally after breakfast around morning tea time.
Stress and poor sleep habits: These can lead to an increase in our stress hormone cortisol. When this is increased our ability to fat burn is suppressed. Often in life we are unable to reduce the load we are carrying whether it be work, children, family etc, but establishing healthy sleep patterns can be of benefit to assist with nervous system adaptation to the stresses of life, as well as hugely support immune system and hormonal function. Aim for 7-8 hours per night. Lack of sleep and high stress leading to high cortisol will also impact blood glucose, and plays a part in how well (or not) it responds to food when these factors are dysregulated.
Alcohol: Dont shoot the messenger! Alcohol is often high in sugar, and will also contribute to dysbiosis within the gut and modification of the microbiota, all of which are going to contribute to insulin resistance. Consuming 15-30g of alcohol per day - the equivelent of 1-2 standard drinks, can increase your risk of breast cancer by 30-50%. And overall, the relative risk of breast cancer is increased by 7% for each additional 10 grams of alcohol consumed per day. Alcohol has been linked to not only breast cancer, but also oesophageal, pancreatic, liver, stomach and colorectal cancers. South Korea and Ireland from 2026 will be mandating warning labels to be placed on all alcoholic beverages with regards to cancer risk. It is a class one carcinogen - it shares the same category as asbestos, arsenic, smoking, and a number of other toxic chemicals and substances. Im just going to leave that one there.
Some medications such as antibiotics, paracetamol and statins may increase the risk of insulin resistance.
Treatment and prevention of Insulin Resistance
AVOID
Pre-packaged foods. These foods are mostly calorie dense and nutrient deficient, so ideally should be minimised as much as possible to assist with addressing insulin resistance. If you could do one thing only for your health and take out all pre-packaged food from your diet you will be heavily reducing your intake of the food sources listed below, which will not only assist with managing insulin resistance, but also aid in reducing inflammation, promote healthy cell function, enhance detoxification and reduce your risk of chronic disease including auto-immune conditions and cancer.
High fructose corn-syrup: Is made from glucose and fructose, and is a liquid sweetener made from corn starch and used in pre-packaged foods. Other ways can be written on labels include HFCS, glucose syrup, fruit fructose, glucose-fructose syrup. You will find in foods such as lollies, soft drinks, muesli bars (even the ones you find in the “health food” section), flavoured yoghurts, condiments and sauces, snack foods, ice cream and pre-made desserts, jams and preserves, breakfast cereals, some bread items, and most pre-packaged foods.
Linoleic acid seed oils: Whilst linoleic acid (ALA) is an essential omega 6 polyunsaturated fatty acid, which means the body can not produce it and it needs to be obtained from the diet, when the omega 6: omega 3 ratio is too high it will contribute to increasing inflammation due to cellular disruption, and dysbiosis, promoting insulin resistance. Linoleic acid is present in oils such as corn, canola, soybean, sunflower/safflower, cottonseed, grapeseed, rice bran, peanut. It can be found in a huge range of foods: dairy free milks, cereals, margarines, dips, dressings, most pre-packaged foods and meals. You may think “it is only a small amount in each product”, but if you consume pre-packaged throughout each day this adds up! If your diet is of quality you will get the omega 6 intake you require from natural sources such as nuts, seeds, eggs, milk and meat.
Refined starches and carbohydrates: These are grains that have been heavily processed to remove one or more parts of the grain (generally the bran, germ or endosperm) to give it properties that are appealing when making pre-packaged foods such as extending the shelf life and giving food a softer and/or chewier texture. This process also removes nutrients such as B vitamins, fibre and healthy fats, which is one of the reasons refined carbohydrates will contribute to insulin resistance. Foods high in refined carbohydrates include white bread, white flour, white pasta and white rice, and can be found in most pre-packaged foods, pastries, cakes, muffins, cereals and other breakfast foods, white flour and crackers, pizza dough. Try to include a variety of whole-grains in the diet, both in meals and cooking, such as: quinoa, barley, oats, amaranth, millet, buckwheat. When consuming grains with meals try to keep it to no more than 1/2 cup per meal, and increase the non-starchy vegetable serving amount.
Alcohol: Aim for at least 4-5 alcohol free days, and avoid binge drinking. Clear spirits such as gin, vodka and tequila are generally lower in sugar than other alcoholic beverages such as wine, champagne, and beer, provided they are not mixed with soft drinks - opt for soda water and fresh lemon or lime ideally.
INCLUDE
A diet that contains plenty of fruits and vegetables daily, good quality protein (from vegetarian sources as well as meat), whole-grains, nut and seeds. Each meal should ideally comprise of 1-2 cups of non-starchy vegetables, a palm-size portion of protein (unless you have increased protein requirements), a small amount of both healthy fats and complex carbohydrates that can be grain based, or starch based- i.e. sweet potato, corn, pumpkin. Home cooked and prepared meals are key.
Weight lifting: Moving/lifting weights regularly increases skeletal muscle mass, and the more muscle mass you have means the more mitochondria you have. Mitochondria are often referred to as the “powerhouse of the cells”, and are the little “furnaces” burning off the food (fuel) we consume. Ideally you should be doing 2-3 strength training sessions per week by the time you reach forty, unless you have increased demand for moving weights (i.e. osteoporosis, sarcopenia). Research shows for treatment of type two diabetes, when participating in regular, weekly strength training, there was a decrease in markers of insulin resistance.
Initially whilst you work on diet and lifestyle modifications supplementation can assist with management of insulin resistance. Occasionally with some conditions supplementation may be used long term.
References:
PMID: 33995849
PMID: 32821534
PMID: 34285440
PMID: 18309108
PMID: 17211497
PMID: 25539479
PMID: 24265860
https://gremjournal.com/wp-content/uploads/2024/02/086-091.pdf
Important note: This information is provided for educational purposes only and is not intended to diagnose, treat, or substitute for medical advice. Always consult your health care provider regarding any health concerns you have.