Weight gain, blood glucose and the menopause

At some point most of us will have seen articles in magazines about how to ‘speed up’ or ‘rev up’ our metabolism to burn more calories and lose weight, so it’s understandable that when we talk about metabolism, we think about weight loss. We may also have realised how much easier it seemed when we were younger to maintain our weight than it is now, during the menopausal years weight gain is a major concern for many women.

It’s true that the metabolism is responsible for weight management, it does this by maintaining blood glucose balance through the process of digesting and utilising carbohydrates which are broken down and used for energy or stored as needed. However, when it comes to the metabolism, there is much more to it than weight loss or gain, which will be discussed in this article.

What is glucose?

Glucose is a simple sugar found in carbohydrate foods such as bread, pasta, grains, dairy, fruit and vegetables. Blood glucose is the concentration of sugar in our blood and is managed by a hormone produced by the pancreas called insulin, which signals glucose to be immediately available for energy or reserved for later use.

If we consume more carbohydrates or sugar than we need for our energy requirements, the pancreas must work overtime and eventually, our cells can become de-sensitised to the effects of insulin, leading to a ‘dysregulation’ of the metabolism and a condition called ‘insulin resistance’. Left unchecked excess blood glucose can lead to obesity, diabetes and cardiovascular disease, and for women entering menopausal years, changes in energy metabolism due to a reduction in oestrogen can affect our cells’ ability to respond to insulin and put us at further risk.

Blood glucose and the menopause

The menopause is a time of major metabolic upheaval and affects every single cell in our body with significant impact on long term health [1]. Therefore, while weight management is important, to optimise overall health during the menopause, we must consider the metabolism in it’s true sense – which is the ability to convert the food we eat into available energy to run all bodily processes. This includes creating our cells’ energy currency – adenosine triphosphate (ATP), driving the thyroid, supporting gut health and brain function.

The recalibration of the brain

Critically, glucose is also the primary source of fuel for the human brain. However, unique to women, as we enter the perimenopause, from our late 30s onwards, glucose metabolism in the brain drops and we need to be able to switch to a different type of fuel made up of ketones and fatty acids, and the mitochondria (our cells energy powerhouses) in every single one of our cells must adapt.

During the transition from perimenopause to menopause, women experience both chronological and endocrinological ageing, with the effect of a total recalibration in the way that brain and body work [2].

You may have seen the second documentary on the menopause with Davina McCall, in which neuroscientists Dr Lisa Mosconi and Dr Roberta Brinton presented their findings on the brain during menopause and the changes which occur as we lose oestrogen [3] [4].

Oestrogen and glucose metabolism

Oestrogen facilitates the body’s ability to use glucose as fuel within the mitochondria, and as it drops, triggers a natural decline in glucose metabolism, prompting an adaptive reaction switching our fuel gauge from glucose to ketones and fatty acids which are produced by the liver and can be used as an energy source.

The problem is, we can only do this if our cells remain responsive to insulin, and as we move into our 40s and 50s, this becomes more difficult to manage.

Abdominal fat and insulin levels

Fluctuating hormones and a decline in muscle tissue leads to a shift in our physical appearance – from the typically female distribution of body fat around the hips and buttocks to a more android shape, with weight gain around the abdomen [5].

Abdominal fat is linked with higher insulin levels, high blood glucose and a pre-disposition for diabetes.  Research tells us that the menopause should be a period of increased ‘diabetes vigilance’ and that many common symptoms, such as a change in body weight, frequent urination, fatigue, weakness, irritability, thirst, increased appetite, and sexual dysfunction may be directly linked to a ‘carbohydrate disorder’ [6] – a reduced ability to manage glucose in the blood, rather than hormonal changes.

Insulin resistance

This becomes even more of an issue if our cells are not ‘metabolically flexible’ and able to use both glucose as well as ketones for energy. Any degree of insulin resistance will have a negative impact on the brain, if ketones are not readily available our cells may resort to utilising myelin for energy, which is the protective coating on our nerve cells. Hence the majority, around 80% [7] of peri and menopausal symptoms come under the neurological banner – anxiety, night sweats, insomnia, migraines, reduced ability to cope with stress, the ability to regulate body temperature, depression, insomnia, and cognitive dysfunction [8].

The effect of hormonal changes

If we do not pay attention to blood glucose before we reach menopause years, we may be faced with bigger challenges as a fluctuation in oestrogen and a drop in progesterone take their toll.

During perimenopause, progesterone is the first hormone that drops, and the reason for irregular and heavier periods. Low progesterone destabilises the hypothalamus-pituitary-adrenal (HPA) axis leading to sleep disturbances, erratic eating, the potential for weight gain, and may lead to feelings of anxiety. Progesterone also has an immune modulating, anti-inflammatory effect and during periods in a woman’s life cycle where it suddenly declines such as post-partum and late-stage perimenopause, creates a window of vulnerability for autoimmune conditions. In the latter stages of the menopause, women are in a permanent state of low oestrogen, this impairs the conversion of glucose into energy in the cells’ mitochondria, causing a temporary energy crisis.

Diet and lifestyle guidelines

 So, what can women do to help balance blood glucose during the menopause?  Here are our top 11 tips:

1. Choose natural foods and avoid processed or refined foods, steer clear of anything with more than 5 ingredients on the packet.
2. Take time over your meals – engage with your food and aim for 20 chews per mouthful.
3. Try to stick to three meals a day – no snacking.
4. Your plate should be 65% plant based, made up of vegetables, herbs, wholegrains and fruits, 25% protein – meat, fish, eggs, tofu and pulses, 10-15% fats – oils, butter, nuts and seeds.
5. Protein at every meal slows the release of sugar from food into the blood, eat a few mouthfuls before starting anything else.
6. Phytoestrogens (compounds found in plants) such as soya, flaxseed, lentils, chickpeas and red clover can help to balance hormones.
7. Include cruciferous vegetables such as broccoli, cauliflower, cabbage, kale, pak choi, and brussels sprouts.
8. Opt for an eating schedule that allows a fasting window, for example finish your evening meal by 7pm, fasting for 14 hours with breakfast around 9-10am. Water, herbal tea and black coffee are fine. Intermittent fasting repairs and encourages the creation of new mitochondria and promotes a healthy metabolism.
9. Gut health – a healthy microbiome helps to detoxify oestrogen and support the mitochondria, while dysbiosis has been shown to disrupt insulin receptors which may be factor in weight gain [9].
10. Try to sleep for 7-8 hours to ‘re-charge’ mitochondria. Disrupted sleep patterns will upregulate cortisol and increase fat storage, inhibit muscle gains from exercise and increase hunger and cravings for sugar and starchy carbohydrates. A lack of sleep will also decrease leptin (satiety hormone) and increase ghrelin (hunger hormone), glucose and insulin levels.
11. Aim to move every day for at least 30 mins incorporating resistance exercise, yoga or Pilates.

 What about supplements?

There are a number of supplements that women can take to support blood glucose levels, these are:

1. Berberine, Alpha lipoc acid (ALA) and curcumin – can help to upregulate an enzyme called AMPK which works to stabilise cellular energy, activating glucose and fatty acid uptake.
2. Myo-inositol – studies show can lower triglycerides and increase sensitivity of cells to insulin.
3. Milk thistle – has been shown to reduce fasting blood glucose and insulin.
4. Magnesium glycinate – calms the brain, reducing anxiety, encouraging sleep and promote insulin sensitivity.
5. Taurine – an amino acid that works well with magnesium, calming the brain, promoting energy metabolism, neurogenesis and protecting neurons.

Better understand your body

Certain tests can give us an indication of our metabolic flexibility, by looking at liver enzymes, fasting glucose and fasting insulin. While hormone tests can give insights into changes that occuring during perimenopause and menopause.

1. MyFORM® – helps you get a deeper understanding of your hormone fluctuations across your entire menstrual cycle.  This is particularly useful for women in perimenopause as their levels of FSH, LH, oestrogen and progesterone change – but not in a linear fashion.  Some days hormone fluctuations will be normal, other days they won’t – which is why mapping hormones across your entire cycle rather than a single day is more insightful. If results show high FSH and LH levels and low oestrogen and progesterone – combined with symptoms – it’s indicative of perimenopause.  It also provides an ovarian responsiveness score, telling you how well your ovaries are responding to the control hormones FSH and LH. As women enter perimenopause their ovaries become less responsive to these hormones, so a low score is also indicative of perimenopause.
2. Baseline Plus – this is a great all round health check, which also measures key markers that affect metabolism and includes liver function, HbA1c which is the gold standard for testing blood glucose and checking for pre-diabetes.  It also includes a heart health check by measuring cholesterol and triglycerides. Finally, it also checks key nutrients to see how well your diet is supporting your health and wellbeing.
3. Menopause Health – this is a great test for women who have reached menopause or are post-menopause.  It checks key hormones, along with heart health, thyroid function, energy and bone health.

Author: Becky Graham, registered Nutritionist MBANT, qualified from the renowned Institute for Optimum Nutrition (ION) in Richmond.