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Managing Your Menopause Type^® Educational Class
Session Three - Your Risks of Disease
INSULIN RESISTANCE & DIABETES
Are hormones the answer? What about weight, and the waist-to-hip ratio?
Are hormones the only answer?
A study released in February of 2001 suggests that the risk of developing impaired glucose tolerance increases 6% for each year after menopause^1. Subsequent studies do demonstrate that proper hormone levels (achieved through hormone replacement therapy) may improve blood sugar control in women^2. However, other studies suggest that if the amount of weight gain is the same that insulin sensitivity does not differ between women using hormone replacement therapy, and those not using hormone replacement therapy^3.
So, hormones play some role, but weight gain is involved in the equation as well.
Proper blood glucose and blood insulin function is heavily dependent on the balancing of all three hormones - estrogen, progesterone & testosterone - as discussed on pages 73- 76 of "What Your Menopause Type?"
Recent research also suggests that other hormones can affect glucose and insulin function. Postmenopausal women given 1 mg of melatonin may result in reduces glucose tolerance and reduces insulin sensitivity^4. The implications are that proper glucose and insulin function is a complex phenomenon, which is not going to be understood by a one-size-fits-all approach. here are strong indications that hormones are not the only answer.
What about weight and the waist-to-hip ratio? How does weight affect insulin resistance?
In the late 1980s increased attention was given to the concept that a decreased waist to hip ratio carried lower risk of insulin resistance^5. This meant that women (and men) with a lot of fat within their abdomen (intra-abdominal or visceral fat depots), had a higher risk of developing insulin resistance, glucose intolerance, diabetes and heart disease.
The "apple shaped" type of obesity (truncal obesity) has extra weight stored in the abdomen. The "pear shaped" type of obesity (gluteofemoral obesity) has the weight in the hips and thighs. To determine your Waist-to-Hip Ratio measure your waist (at the smallest area below your rib cage and above your navel) and your hips (at the widest point).
Divide waist measurement by hip measurement to get your waist-to-hip ratio.
A ratio of 1.0 or more is in the danger zone.
For women, a ratio if 0.80 of less is best. For men, a ratio of .90 or less is best.
Subsequent studies have revealed that while the reduced waist-to-hip ratio (WHR) is preferable, it is clear that weight loss, in and of itself, will improve glucose and insulin function, even if the WHR does not improve^6, 7. So, if excess weight is lost, but the proportion
lost in each area results in the same WHR at the lower weight, there will be better glucose and insulin function. WHR does not give the complete picture.
To add further complexity to the question of insulin resistance, it has been noted that some women with earlier age-related onset of obesity have normal glucose metabolism, and their higher accumulation of body fat does not appear to increase their risk of developing diabetes^8. Again, we are seeing that we can not determine risks of dysglycemias simple by looking at weight.
One of the most interesting findings was a study that found that a specific gene may be the cause of insulin resistance in some postmenopausal women no matter what their waist-to-hip ratio, exercise habits or hormone replacement program^9. Therefore, the risk of insulin resistance does appear to involve genetics to some degree, so weight and waist-to-hip ratio are not the entire answer.
The Big Picture
The answer to proper glucose and insulin function will not be found in looking at hormones only, or on body weight only. Proper blood sugar metabolism requires a healthy diet and healthy lifestyle. For instance, we know that chromium plays a significant role in proper function of insulin. However, this goes far beyond chromium supplementation.
Recall that in Chapter 12 of "What Your Menopause Type?" there is a detailed recount of how two dozen vitamins and minerals are absolutely required for the production of hormones. Likewise, there are many nutrients that are absolutely required for proper glucose metabolism.
Only by recognizing the "big picture" that nutrition plays in maintaining proper blood sugar metabolism can we stop the progression of insulin resistance and diabetes.
The extensive Professional Management of Menopause Type^® Seminar is available to healthcare professionals as a component of the Management of Menopause Types® Program. Women are advised to Find a Physician & Choose a Pharmacist that are have been trained in Management of Menopause Type^® Program
What's Next?
Next we will discuss how widespread abnormal blood sugar metabolism conditions are.
	Table of Contents
The Managing Your Menopause Type® Educational Class is provided to the public without charge. This information is provide for education purposes only, and is not intended to prescribe treatment. Consult a physician, pharmacist or other healthcare professional regarding the applicability of any opinions or recommendations with respect to your symptoms or medical condition.
This public education class does not provide physicians, pharmacists or other healthcare professional with the extensive training and ongoing education provided within the Management of Menopause Type^® Program.
The extensive Professional Management of Menopause Type^® Seminar is available to healthcare professionals as a component of the Management of Menopause Types® Program.
Menopause Type^® is a Registered Trademark of YourMenopauseType.com.
© 1999 - 2002 by YourMenopauseType.com.
References:
[1] Wu SI, Chou P, Tsai ST. The impact of years since menopause on the development of impaired glucose tolerance. J Clin Epidemiol. 2001 Feb;54(2):117-20. [PubMed]
[2] Ferrara A, Karter AJ, Ackerson LM, Liu JY, Selby JV. Hormone replacement therapy is associated with better glycemic control in women with type 2 diabetes: The Northern California Kaiser Permanente Diabetes Registry. Diabetes Care. 2001 Jul;24(7):1144-50. [PubMed]
[3] Sites CK, Brochu M, Tchernof A, Poehlman ET. Relationship between hormone replacement therapy use with body fat distribution and insulin sensitivity in obese postmenopausal women. Metabolism. 2001 Jul;50(7):835-40. [PubMed]
[4] Cagnacci A, Arangino S, Renzi A, Paoletti AM, Melis GB, Cagnacci P, Volpe A. Influence of melatonin administration on glucose tolerance and insulin sensitivity of postmenopausal women. Clin Endocrinol (Oxf). 2001 Mar;54(3):339-46. [PubMed]
[5] Peiris AN, Hennes MI, Evans DJ, Wilson CR, Lee MB, Kissebah AH. Relationship of anthropometric measurements of body fat distribution to metabolic profile in premenopausal women. Acta Med Scand Suppl. 1988;723:179-88. [PubMed]
[6] Pascale RW, Wing RR, Blair EH, Harvey JR, Guare JC. The effect of weight loss on change in waist-to-hip ratio in patients with type II diabetes. Int J Obes Relat Metab Disord. 1992 Jan;16(1):59-65. [PubMed]
[7] Barrett-Connor E, Schrott HG, Greendale G, Kritz-Silverstein D, Espeland MA, Stern MP, Bush T, Perlman JA. Factors associated with glucose and insulin levels in healthy postmenopausal women. Diabetes Care. 1996 Apr;19(4):333-40. [PubMed]
[8] Brochu M, Tchernof A, Dionne IJ, Sites CK, Eltabbakh GH, Sims EA, Poehlman ET. What are the physical characteristics associated with a normal metabolic profile despite a high level of obesity in postmenopausal women? J Clin Endocrinol Metab. 2001 Mar;86(3):1020-5. [PubMed]
[9] Brown MD, Shuldiner AR, Ferrell RE, Weiss EP, Korytkowski MT, Zmuda JM, McCole SD, Moore GE, Hagberg JM. FABP2 genotype is associated with insulin sensitivity in older women. Metabolism. 2001 Sep;50(9):1102-5. [PubMed]
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