Women are moving into a state of insulin resistance — or “syndrome X” — at an alarming rate and most of them have no idea it’s happening. These women join more than 80 million Americans already experiencing insulin resistance, a condition that develops when your body makes insulin just fine but cannot use it properly. Even with a quarter of the American population estimated to have insulin resistance, it’s likely that the incidence among perimenopausal women is even higher. Many women may actually be further along the spectrum into pre-diabetes.
Insulin resistance is a syndrome at the very center of many chronic and serious health problems, including diabetes, obesity, heart disease and polycystic ovary syndrome or PCOS. Insulin is one of your “major” hormones and it has a cascading effect on the rest of your hormones, including the “minor” hormones estrogen, progesterone and testosterone. Imbalances among these “sex” hormones can be the source of many perimenopause symptoms. The bottom line is, unless your insulin metabolism is balanced and functioning well, it’s going to be nearly impossible to reduce your hot flashes, lose weight or relieve your other symptoms.
When they are in balance with each other, all your hormones are able to do their jobs right and you feel healthy. Insulin and other major hormones like cortisol have everything to do with how you feel every day and how well your body works. Restoring balance to all your hormones is essential for true health, and insulin should be at the top of the list.
You can take control of insulin resistance and recover the balance you need to feel good and have a healthy body. You just need the right information.
Insulin resistance amps up your risk for developing chronic disease
On top of contributing directly to obesity, diabetes and PCOS, insulin resistance appears to underlie many other dreaded health problems like hypertension (high blood pressure), high cholesterol, breast cancer and endometrial cancer. It has also been implicated in Alzheimer’s disease.
Insulin resistance also lurks beneath two of the most common complaints we hear at Women's Health Network: fatigue and weight gain. Women notice these symptoms as they approach menopause mostly because their bodies can no longer tolerate the amount of carbohydrates they’ve been consuming. This results in weight gain, especially around the middle, along with afternoon blahs, sugar crashes and carbohydrate cravings. All of these are early insulin resistance symptoms.
How insulin works in your body
Once it hits your digestive system, everything you eat — fats, proteins and carbohydrates — is reduced to micronutrients, proteins and glucose. Your body uses the proteins and nutrients for cellular metabolism, immune function, and cell replacement. The glucose is powerfully important — it is your body’s basic fuel, carried by the bloodstream to the individual cells.
The specific demands for fuel vary, but your brain requires blood sugar to remain stable at all times. This is where insulin comes in because it brings the cells the energy they need without changing your blood sugar. As insulin signals the cells to absorb glucose from the bloodstream, your body monitors the food you’ve digested, along with blood sugar levels and cell demands. Then insulin is released in precise amounts and your body can be described as “insulin sensitive” — that’s what you want.
How insulin sensitivity is lost
When our metabolism evolved eons ago our diets included fewer — and more complex — carbohydrates. But today most calories come in the form of simple carbohydrates — sugars that quickly enter the bloodstream as glucose. The body has to release high levels of insulin to keep glucose in the bloodstream from spiraling out of control. Over time, the cells simply can’t keep up. They stop responding to the insulin signal and the body becomes “insulin resistant.”
Now, the body is forced to release even more insulin because it cannot let blood sugar get too high. Having excess insulin in the bloodstream is called hyperinsulinemia, though the body can’t endure prolonged high levels of insulin, which disrupt cellular metabolism and spread inflammation. When the body is unable to keep blood glucose under control, diabetes occurs though it is only the most obvious disease caused by insulin resistance. Along the way, there are many serious negative health effects before full-blown diabetes takes hold.
Menopause plus syndrome X equals symptoms
For women, it’s crucial to understand how insulin resistance disrupts fat metabolism. When cells won’t soak up the extra glucose, the liver has to deal with it by converting it into fat. Since fat cells are loaded with glucose receptors, this is a never-ending cycle. If you are insulin-resistant and gaining weight, your cells are actually “starved” for glucose — even with all that excess glucose, the cells still don’t get enough.
You will feel exhausted all the time and turn to those trouble-causing carbohydrate-heavy foods for fast energy. Your extra fat cells are also little estrogen factories which allow any weight gain to feed the estrogen dominance that causes so many symptoms during the early stages of perimenopause.
Syndrome X symptoms usually hit well before menopause, though you might not notice them at first. With syndrome X in full swing, a woman’s health can deteriorate rapidly during menopause as estrogen levels fall. Any existing digestive issues balloon into more serious problems in response to the depletion of the body’s natural defenses against inflammation, including estrogen.
Women near menopause are particularly prone to insulin resistance due to metabolic changes related to fluctuations in adrenal and thyroid hormonal secretions. In fact, the decrease of certain hormones, like estradiol, may trigger a resistance to insulin in women who never experienced it before. Certain blood pressure medications can mask symptoms without treating the underlying problem. And many, many women unwittingly make their symptoms worse by desperately trying to lose weight on low-fat, high-carbohydrate diets.
Can you tell if you have insulin resistance?
Anyone can become insulin resistant — even if you are thin. Since we have endless access to refined carbohydrates — white bread, sugar, bagels, pasta, potatoes, sodas, processed foods with added fructose — most of us are probably resistant to insulin to some degree. The chain reaction kicks in as you eat more processed and refined food because you need more insulin to metabolize it all. The more insulin in your blood, the less responsive your cells become to that key hormone. As you age, continual exposure erodes tolerance for refined carbohydrates and steadily reduces sensitivity to insulin.
If you have high cholesterol, high triglycerides, or hypertension, you should get checked for insulin resistance, regardless of your weight or age. If you have high blood pressure, it is likely that you are also suffering from insulin resistance, though blood pressure medication will not cure insulin resistance.
Insulin resistance signals to look for
You are at the highest risk for developing insulin resistance if you have a family history of type 2 diabetes or if you have suffered from gestational diabetes, hypertension, or are very overweight. Women with apple-shaped bodies, or those who tend to gain weight mostly around their abdomen, show less tolerance for insulin.
To assess your risk, measure yourself around the smallest part of your waist (don’t hold in your stomach!) and the biggest part of your hips. Divide the waist measurement by the hip measurement. A ratio bigger than 0.8 for women (or 1.0 for men) indicates that your abdomen is obese and you are at risk for developing insulin resistance.
If you have an abnormal amount of fat or cholesterol in your blood, or dyslipidemia, especially if you have low HDL levels and high triglycerides, you may be insulin resistant. Another sign to look for is a skin change called acanthosis nigricans — velvety, wart-like darkened skin patches on the neck and armpits — that indicates insulin resistance in over 90% of the women who experience it.
Insulin and glucose levels are very easily influenced by simple but lasting changes in lifestyle, exercise, diet and supplementation. If you are diagnosed with insulin resistance, there is a lot you can do to reverse its course and the sooner you address it the better.
Restoring balance to insulin
To evaluate insulin resistance, you can have a blood test for glucose and insulin levels after fasting for 12 hours and then again two hours after a meal (preferably a high-carbohydrate meal). On fasting tests, it's best if glucose levels are no higher than 75–80, though many informed practitioners like to see insulin at around 5; higher levels indicate a risk of insulin resistance. Increased triglycerides can help confirm a diagnosis within this context.
If the triglycerides amount to about half of the cholesterol number, it indicates proper metabolism of fat. For example, if total cholesterol is 200, then triglycerides should be 100. You should also take into account your lifestyle, diet and exercise patterns, as well as stress factors because they can all be changed. Talk to your primary care provider about being tested if you think you may be at risk, though you may have to bring it to his or her attention.
Counter insulin resistance with the right food and lifestyle
Build a diet that consists primarily of lean meats and other proteins, high-fiber grains, vegetables and legumes, leafy greens, and fruit to help balance insulin levels. If you’re already insulin resistant, we recommend always eating breakfast, lunch, dinner, and two snacks.
- Manage carbs: each meal should have no more than 15 grams of carbohydrates in the form of vegetables and fruits (eliminating “white” food such as bread, pasta, and sugar) and some lean protein. Each snack should contain only 7 grams of similar carbohydrates.
- Get healthy fats, or those rich in essential fatty acids (EFAs), as these are very important in an insulin-resistance diet. Find EFAs in avocados, cold-water fish like salmon and tuna, flax seed, and eggs or choose a good quality supplement.
- Choose a pharmaceutical-grade nutritional supplement to help decrease carbohydrate and sugar cravings and normalize hormonal function, especially if you are perimenopausal or menopausal. Our Hormonal Health Packages can supply key nutrition as you work to restore insulin sensitivity.
- Get regular exercise of 30 minutes or more per day, 3–5 times a week to help regulate metabolic function and support hormonal balance.
- Decrease stress to help shrink the strain on the adrenal glands and keep your insulin levels in check.
Finally, quit smoking, moderate alcohol intake, and get enough sleep to help with any blood chemistry surges. Insulin is so important to your overall health that when its metabolism goes wrong, everything else is thrown off. We believe that women with menopause symptoms must reverse any insulin resistance first before being able to find relief from those symptoms. Overcoming insulin resistance is a challenge, but it can be done, and we can help.