Insulin Resistance. What’s Estrogen Got to do with it?

Sex hormones and Insulin Resistance

What is insulin resistance?

Insulin resistance occurs when there are persistently high levels of the pancreatic hormone insulin in the body. This is caused by persistently high levels of glucose (sugar). Insulin is the hormone that stimulates cells to take up (take in) glucose. When there is too much glucose in the system, over time the pancreas becomes overworked sending out insulin to manage the glucose, and eventually, there is resistance by cells to insulin which will affect the ability of the cell to take up glucose. With insulin resistance, insulin is not the root of the problem; the problem lies with metabolic dysfunction.

Other names for insulin resistance: are hyperinsulinemia and prediabetes.  These can lead to Type 2 Diabetes.

The role of sex hormones

Insulin is not the only hormone that can impact metabolic health. Other endocrine hormones also play a role in the balance of hormones and metabolic health.

Sex (steroid) hormones- testosterone, progesterone, and estrogen all have important roles in metabolic health. When these hormones are out of balance (too high or too low), they can increase the risk of insulin resistance, as well as other metabolic dysfunctions.

High levels of Testosterone can worsen insulin resistance, and insulin resistance can increase levels of testosterone (not a good feedback loop). Women with PCOS who have high levels of androgens (testosterone) are prone to insulin resistance.

Estrogen has an effect on glucose metabolism through its actions within the brain (hypothalamus) which controls food intake, energy expenditure, and white adipose tissue distribution. Throughout the body, estrogen plays a role in glucose utilization in skeletal muscle, liver, adipose tissue, and immune cells are also part of insulin sensitivity1.

Progesterone- the counterpart (or chaperone) to estrogen also plays a role in insulin resistance. High levels of progesterone can have a negative impact on glucose metabolism as it has been found to be related to increased levels of serum glucose,  increased insulin resistance, and elevated insulin release from the pancreas2.  This can be seen in many women with gestational diabetes. 

Perimenopause to post-menopause- increased risk of insulin resistance

During perimenopause, the fluctuations of the hormones progesterone and estrogen can increase the risk of metabolic dysfunction, including insulin resistance.  Women who are post-menopause are still at increased risk for insulin resistance due to decreased estrogen.

As estrogen declines, the brain as well as other organs and tissues will be challenged in maintaining their work in managing metabolic homeostasis. Estrogen is used by the brain to manage adipose tissue as well as blood sugar regulation.  In addition, the change in estrogen affects the distribution of adipose tissue, which places women in similar adiposity to males- more abdominal fat.

It should be noted, women who had a predisposition to hormonal imbalance may already be predisposed to an increased risk of metabolic dysfunction during perimenopause. It is highly encouraged for women to engage in healthy diet and lifestyle practices that can support hormonal balance and metabolic health. 

peri-Menopause and beyond

A holistic approach to hormone health and glucose management

Women who engaged in a healthy diet and lifestyle that supports their personal needs will experience fewer hormone-related disruptions and health challenges.

There are general recommendations to support women during perimenopause that can decrease the risk of insulin resistance and other metabolic dysfunctions. These same recommendations can also help to reduce some of the uncomfortable symptoms women may experience during perimenopause and in some women during post-menopause.

General dietary recommendations

Reduce or eliminate sugar

Sugar is prevalent in the modern or western diet. Not just the added sugars, but also the foods that are easily converted into sugars in the body. This can include pasta, processed grains, high glycemic fruits, and vegetables.  Also, many artificial sweeteners or sugar alternatives can contribute to glucose imbalance through different mechanisms, such as negatively impacting the gut microbiome).

Doing the work to eliminate or reduce sugar intake can be challenging. It can help to know where a lot of the hidden sugars are by reading labels and having a basic knowledge of different names of sugars—sweeteners.

Changing your carbohydrates

What is a carbohydrate? Carbohydrates simply put are biological molecules that are a combination of different types of sugar molecules attached together.  You may have heard of sucrose or maybe Fructose? These are just a couple of the sugar molecules that form a carbohydrate.

Carbohydrates are in ALL plant-based foods. Dairy also has some level of carbohydrates as well due to dairy having lactose (a type of sugar).

Not all carbohydrates have the same level of sugar in them and some can have a stronger impact on glucose and insulin in the body.

During perimenopause, changing carbohydrates can improve glucose management and decrease the risk of insulin resistance.

A typical western or modern diet breakfast includes high levels of carbohydrates. Such as toast, bagels, muffins, pancakes, or smoothies that are high in fruit and other sweeteners.  Swapping bagels, toast, waffles, orange juice (all fruit juices), fruit-loaded smoothies, and flavored coffee drinks in the morning with high protein foods, moderate fat, and low carbohydrate foods can increase glucose stability.

Example breakfast: sautéed dark leafy greens, no-sugar bacon, and egg (poached, basted, scrambled), with a cup of black coffee, herbal tea, or water with a little lemon or ACV.

Lunch and/or Dinner can also be problematic when it comes to carbohydrate overload. Sandwiches, pizza, burgers (with buns), rice bowls or grain bowls, burritos, the list goes on.

Switching carbohydrates from predominately grains (processed or whole), legumes, high sugar fruits, and vegetables, to predominately low carbohydrate foods, such as dark green leafy vegetables, broccoli, cauliflower, cabbage, cucumber, zucchini, and mushrooms, to name a few, will decrease glucose load in the system, and therefore, help support insulin levels.

Increase fat and protein

There is a strong myth that fat is the cause of many metabolic dysregulations and dysfunction. Unfortunately, research that was used a few decades ago was grossly biased and inaccurate (researchers engaged in bias when presenting study findings). Thankfully, the reevaluation of the research exposed the bias in the research, which led to an analysis of dietary fat research as well as new research. This has brought forward today the insight that fat is not the culprit. Fat offers many health benefits. In relation to hormones- steroid hormones, such as estrogen, progesterone, testosterone, and cortisol, all require cholesterol, which is a component of fat!

Increasing dietary fat, from appropriate sources, can support not only hormones, but also brain health, immune system regulation, cellular health, and skin health (to name a few).  Many women find when they incorporate foods that are good sources of fat, they have better moods, skin, balanced hormones, and fewer food cravings.

What are good sources of fat?  Wild/pastured meats (fish, poultry, etc), whole nuts, and seeds (some nut and seed oils are good too). Ghee, butter, avocado oil, and extra virgin olive oil are also good sources of fat (verify the brand you purchase is not adulterated and is authentic).

Supplemental fats/oils that can support hormonal balance: flax seed, borage, black current seed, evening primrose, EPA/DHA- fish oils.

Side note: those important vitamins A, D, E, and K- are fat-soluble vitamins. They need fat in the diet for the body to absorb and utilize them.

Protein is another macronutrient that many women do not get enough of.  Protein is made of a combination of different amino acids. There are 20 different amino acids that can be used to build a protein. Of these 20, 9 are essential. What this means, the body can’t create these on its own, it needs them from outside sources—food.

When we talk about ‘complete’ proteins, this means that the food that is complete has all 9 essential amino acids. All animal proteins are complete proteins. There are a few plant proteins that have the 9 essential amino acids. Someone who is engaging in a vegan diet can through food combinations build up the 9 essential amino acids through different plant foods.

How much protein do women need? This is bio-individual and will change due to different conditions, such as the stage of the menstrual cycle, pregnancy, illness, stress, and age.  As we get older, our need for protein will increase to offset the loss of muscle that occurs. On average, women will need at least 45g of protein per meal.  Keep in mind, this is a complete protein.

Good sources of protein include wild/pastured meats, eggs, some dairy (if tolerated), legumes, grains, nuts, and seeds.

Supplemental protein: powders, etc.  Whey and egg white protein powders are a complete protein. Some plant-based protein powders will be designed to offer complete protein as well. Collagen can also be used as a protein supplement; however, it is not a complete protein.

Side note: keep in mind that plant-based proteins from whole foods or protein powders will have carbohydrates in them, therefore, if glucose management is a challenge, working on creating a balance between protein needs and carbohydrates will be needed.

Lifestyle

During perimenopause through to post-menopause lifestyle will have an impact on metabolic health—glucose management and insulin resistance.

Stress management and movement are two key factors here.

Stress

Stress can increase cortisol, which increases glucose in the system. When the body is under stress it will go into fight or flight mode, which requires quick movement. To run away quickly or fight, the body will need energy, and the body knows glucose is the easiest and quickest energy source. To create the glucose the body needs to deal with whatever the source is of stress (the body doesn’t know if it is a tiger chasing you down or a boss that wants a report soon), it will trigger biological mechanisms to create glucose either from the liver or from muscle. This will increase glucose in the system, which can be too much for insulin to handle, especially if insulin is already overloaded with the level of glucose that is coming in from daily intake of foods high in glucose/carbohydrates.

During perimenopause, the reduction in the calming hormone progesterone can impact the ability to manage stress as tolerance levels fluctuate.

 What to do?

Engaging in stress management therapy can help the body maintain a homeostasis balance, reduce cortisol levels, and help the body manage glucose as needed.

Stress management therapy can include the following; this is not an inclusive list:

Yoga, meditation, functional breathing, low impact movement/exercise, adaptogenic foods/herbs, vagal nerve toning.

Supplements: adaptogenic herbs such as Rhodiola, ashwagandha, holy basil, also lemon balm, lavender (L. angustifolia), and chamomile, can be beneficial. A few nutrient supplements such as magnesium bis-glycinate, vitamin D, L-theanine, and a B-complex can also be supportive.

Side note: before taking ANY supplements, talk with your health support professional. Some supplements are contraindicated with certain health conditions, medications, food or other supplements.

Movement

Movement offers many benefits to health, including supporting bone health, and muscle health, and encouraging muscles to utilize glucose. The key for women during perimenopause and menopause is healthy balance- not too much, and not too little.

Under-exercising, which can fall into the category of sedentary, can lead to many health issues both mentally and physically. Too little movement can increase metabolic dysfunction, and inflammation challenge moods and emotions. As we age, our muscle mass declines and adding this to lack of movement we decrease our vibrancy and health.

Over-exercising may seem to be a great way to use up any excess glucose; however, this can backfire on women by increasing the stress hormone cortisol. As noted about stress, this can impact hormonal balance, including glucose.

In terms of what type of movement is best, it will depend on the individual and their physical ability. To support muscle health and strength, as well as bone health- weight-bearing (strength building) exercise is highly recommended, especially for women in perimenopause and post menopause3

Balancing nutrition/Diet with lifestyle during perimenopause and beyond will not only reduce the risk of insulin resistance, but also support metabolic health and healthy aging—vibrant, beautiful, and strong!