 As women enter the transformative phase of menopause, they often find themselves grappling with unexpected health challenges. One significant aspect that deserves attention is the connection between menopause and insulin resistance, is this causing excess weight gain, especially around the tummy? Let's explore insulin resistance during this time. What is insulin resistance? Insulin resistance or impaired insulin sensitivity is when the body becomes intolerant to insulin, making the hormone less effective. Insulin is often said to be like a key in the body, unlocking doors, and insulin resistance is like having dud keys! What is Insulin’s role in the body? Insulin is an important hormone within the body as it helps the body to use glucose for energy. When foods containing carbohydrates are consumed, they are broken down by the body into glucose and released into the bloodstream. The hormone insulin is signalled to be released by the beta cells of the pancreas, enters the bloodstream, and helps glucose to move out of the blood and into the cells/tissues of the liver, muscle, and adipose tissue where it can be used for energy later on (insulin is like the key that opens the cell doors and allows glucose to enter).5 In addition to helping regulate blood glucose levels, insulin also plays a part in other essential processes within the body including the synthesis of lipids and regulation of enzymatic activity. What causes Insulin Resistance The factors that promote the development of insulin resistance include altered insulin signalling, high levels of insulin in the body, high lipid (fat) levels in the body, and obesity.2 There are several risk factors for insulin resistance, these being if you:
How is Insulin Resistance Diagnosed Generally, individuals do not show any symptoms of insulin resistance. If your GP believes that you are at risk of insulin resistance, they may request a blood test to investigate further. How does Insulin Resistance relate to menopause? Research has shown that menopause is a potential risk factor for developing insulin resistance, regardless of age, and most likely due to the reduction in estrogen in the body. Some clinical studies have shown that post-menopausal women are more susceptible to developing dyslipidaemia (high lipid levels), an increase in body weight (assessed by Body Mass Index and waist circumference), and impaired glucose tolerance than premenopausal women.8 Even in the absence of a change in body weight, cross-sectional studies indicate that as women approach postmenopause, their abdomen fat increases. The drop in estrogen, which instructs fat to be stored in the hips and thighs, is connected to this rise in the deposition of belly fat. Visceral (between the visceral organs) and subcutaneous (under the skin) fat are two types of abdominal fat. Because visceral abdominal obesity is also linked to dyslipidaemia, insulin resistance, and hypertension, it independently increases the risk for cardiovascular disease (CVD).10 Estrogen replacement therapy has been shown to significantly reduce the risk of metabolic syndrome, in contrast to metabolic disturbances, such as insulin resistance, tending to increase with the onset of menopause.2 It has therefore been summarized that estrogen plays a protective role in the development of insulin resistance and its related health effects. What can you do to improve insulin resistance? Several risk factors for metabolic syndrome and insulin resistance are lifestyle-related, including a high sugar intake, a high-fat diet, being overweight or obese, and being physically inactive. These are controllable risk factors, and a healthy lifestyle can have a positive impact on these, including reduced insulin resistance. Weight Management Significant improvements in insulin sensitivity can be achieved through weight reduction in the overweight and obese population. Adaptations that occur with a combination of improved nutrition and exercise are the most effective methods in achieving sustainable weight loss and improvements to insulin resistance.7 Nutrition Carbohydrates are crucial to the body and are our main form of energy, however, inappropriate intake of carbohydrates can lead to poor health outcomes. Guidelines informing nutritional changes and recommendations for the dietary management of insulin resistance are to:
If you have been diagnosed with insulin resistance, an Accredited Practicing Dietitian is the right person to guide you with a nutrition program suitable to your needs. Exercise As stated above, exercise can form part of a weight loss program if needed, however, the benefits of exercise to insulin sensitivity and reduced insulin resistance are independent of weight loss:- meaning that you can achieve improvements in insulin resistance by exercise alone 8. In addition to improving insulin resistance, females can also experience the following through regular exercise:
A systemized review in 2017 examining the effect of programmed exercise on insulin sensitivity in postmenopausal women found that regular exercising for 3 to 4 months significantly lowered insulin levels, body mass index, waist circumference, and percentage body fat mass in postmenopausal women.1 How much and what type of exercise? The Australian Physical Activity Guidelines recommend that individuals undertake a minimum of 150 minutes of moderate-intensity cardiovascular exercise (5 days or more per week of 30 to 60 minutes) or 75 minutes of vigorous-intensity cardiovascular each week, in addition to 2 resistance training sessions weekly (on non-consecutive days). This is the absolute minimum amount recommended, with greater improvements in insulin resistance, weight reduction, and reduction in risk of death from cardiac conditions being obtained with increased levels of cardiovascular exercise up to 300 minutes/week (of moderate-intensity cardiovascular exercise.) 4 Research has shown that regular exercisers who demonstrate high levels of physical activity exhibit high levels of insulin sensitivity/insulin action. If these exercisers then cease exercise training, they then show a decrease in insulin action, demonstrating that regular exercise is required to sustain improvements in insulin sensitivity. 7 All forms of exercise training including aerobic, interval, and resistance training, with or without body composition changes/weight loss have been shown to improve insulin sensitivity and metabolic syndrome factors such as HDL cholesterol, triglycerides, blood glucose and blood pressure, cancer risk, type 2 diabetes risk and cardiovascular disease risk reduction.9 And, even in females whose insulin sensitivity was found to be reduced in early post menopause, following 3 months of high-intensity exercise training, they were able to increase their peripheral insulin sensitivity, skeletal muscle insulin-stimulated glucose uptake, and skeletal muscle mass to the same extent as premenopausal women.8 What are forms of cardiovascular exercise?
What is resistance training? Resistance training is when a limb is moved through a range of movement against resistance. This may include initially using body weight (such as a squat) and progressing to using heavier resistances such as dumbbells, kettlebells, barbells, and resistance machines. Exercise of our skeletal muscles should occur at every stage of life, but after menopause, resistance training becomes even more crucial for women because of the quick reduction in bone density, muscle mass, and joint health that occurs as women age. GETTING HELP An optimal exercise prescription should be individualised and prescribed by an Accredited Exercise Physiologist (AEP) following a complete health screening and assessment by the AEP. The exercise program will then be tailored to the individual and include aerobic training and resistance training, in addition to balance and pelvic floor training if appropriate. Lisa Parkinson Accredited Exercise Physiologist and Credentialed Diabetes Educator References
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