Insulin Resistance in Perimenopause
Many, if not most, of my perimenopausal/menopausal patients mention their weight. Or that lovely little pooch below their navel that’s increased in recent years. A select few bring up their concern about insulin resistance, but that’s what’s going on.
Insulin resistance, using an imperfect metaphor, happens when a cell can’t easily ‘unlock’ when the insulin-key tries to unlock it to allow glucose into the cell. That resistance to unlocking causes more and more insulin to be produced (more keys to try) which is detrimental to the body as a whole. And insulin resistance increases physiologically and biologically in perimenopause for a multitude of reasons. [see Insulin Resistance in Perimenopause Part 1.]
The parts of this puzzle I discuss with patients include: supporting sleep, muscle mass, supporting stress responses, stabilizing blood sugar, responsible and deliberate calorie restriction and exercise. Let’s start with sleep, remember that?
Supporting Sleep
Research shows that sleeping about 6 hours per night for 4-6 weeks impairs insulin sensitivity1, and in postmenopausal women even four nights of reduced sleep caused a 12-20% drop in insulin sensitivity on gold-standard testing. Those results were higher fasting insulin and higher HOMA-IR (an insulin resistance marker) and those results showed an increase in insulin resistance even without any weight gain2.
As a naturopathic doctor, to support sleep I recommend decreasing caffeine intake, utilizing herbs like hops, valerian root, and others. L-Theanine is a great amino acid that works well for helping with sleep. Melatonin can also work, I’ve seen mixed results – sometimes people get intense dreams after taking melatonin.
Muscle Mass
I’m usually talking about muscles in regards to bone health, having strong muscles pulling on our bones keeps them healthy and less prone to osteoporosis. However, there’s also a role here in insulin resistance. Lower muscle mass is associated with increased insulin resistance in perimenopausal and postmenopausal women.3
Because our muscles are one of the primary places our body uses glucose, as we have less muscle we have more glucose circulating. There’s also declining levels of growth hormone and insulin-like growth factor 1 after menopause, and both of those hormones are important for maintaining muscle mass and strength.
There’s also another portion of this that’s important: sarcopenic obesity. Sarcopenic obesity is the combination of low muscle mass and high body fat. That combination of decreased muscle mass and increased visceral fat affected 41% of postmenopausal women, indicating a strong predictor of insulin resistance.4,5
I recommend talking with a trainer for a personalized, targeted resistance training routine. Try to build your muscles three times a week, that could be in the gym or even lifting five year olds (anyone else hauling kindergartners home from the park?).
Stress
Reduce your stress. Hah! Those of us in the sandwich generation have parented through a pandemic, multiple “unprecedented world events”, de-escalated an aging parent ready to give their bank info to a phishing scheme, and had to re-learn long division!
We know that chronic stress increases hormones like cortisol which signals the liver to release glucose into the body while simultaneously suppressing muscles and fat cells from taking up the glucose.6 Testing cortisol is part of treating stress in my patients. If they have very high cortisol then I’m prescribing different supplements than if they have low cortisol. B vitamins and Vitamin C are really beneficial in cases of adrenal fatigue, and herbs like Rhodiola and Eleuthero.
Blood sugar stability
Because insulin resistance is worsened with swings in blood sugar levels working to stabilize blood sugar is part of this conversation.7 One of my favorite ways of addressing this is using a Continuous Glucose Monitor (CGM) for a few weeks. You can see on the data how exactly that bowl of ice cream at 10pm impacted your sleep, that morning you skipped breakfast, and the actual physical impact of a stressful meeting.
A note on diet and exercise
The final piece of this balancing act is calorie restriction and high impact exercise. Both of those are important, but both are also only effective in moderation. Dieting your way out of this or committing to another class of Orange Theory aren’t looking at the entire picture.
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Dr. Jennifer Potter, ND
Naturopathic Doctor San Jose
408-356-1364
Dr. Jennifer Potter, ND provides natural healthcare solutions for families and individuals, focusing on perimenopause/menopause, autoimmune conditions, fatigue, and immune support. She is deeply committed to her patient’s well being, prioritizes patient education and combines natural and conventional therapies to deliver personalized care. Outside of her practice, she enjoys time with her two kids, reading fiction, and crocheting.
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Resources
1 Chronic Insufficient Sleep in Women Impairs Insulin Sensitivity Independent of Adiposity Changes: Results of a Randomized Trial. Diabetes Care. 2023. Zuraikat FM, Laferrère B, Cheng B, et al.
2 Effect of Sleep Restriction on Insulin Sensitivity and Energy Metabolism in Postmenopausal Women: A Randomized Crossover Trial. Obesity. 2023. Singh P, Beyl RA, Stephens JM, et al.
3 Menopause: A Cardiometabolic Transition. Nappi RE, Chedraui P, Lambrinoudaki I, Simoncini T. The Lancet. Diabetes & Endocrinology. 2022;10(6):442-456. doi:10.1016/S2213-8587(22)00076-6.
4Association of Muscle Mass Measured by D3-Creatine (D3Cr), Sarcopenic Obesity, and Insulin-Glucose Homeostasis in Postmenopausal Women. Banack HR, LaMonte MJ, Manson JE, et al. PloS One. 2022;17(12):e0278723. doi:10.1371/journal.pone.0278723.
5 Ectopic Lipid Deposition Is Associated With Insulin Resistance in Postmenopausal Women. Abildgaard J, Danielsen ER, Dorph E, et al. The Journal of Clinical Endocrinology and Metabolism. 2018;103(9):3394-3404. doi:10.1210/jc.2018-00554.
6 Chronic Stress and Diabetes Mellitus: Interwoven Pathologies. Sharma VK, Singh TG. Current Diabetes Reviews. 2020;16(6):546-556. doi:10.2174/1573399815666191111152248.
7 Menopause and Diabetes. Cerdas Pérez S. Climacteric : The Journal of the International Menopause Society. 2023;26(3):216-221. doi:10.1080/13697137.2023.2184252.
