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Managing Your Menopause Type®
Educational Class |
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Session Three - Your Risks of Disease |
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INSULIN RESISTANCE & DIABETES |
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Are hormones the answer? What about weight, and the
waist-to-hip ratio? |
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Are hormones the only answer? |
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A study released in February of
2001 suggests that the risk of developing impaired glucose tolerance
increases 6% for each year after menopause1. Subsequent
studies do demonstrate that proper hormone levels (achieved through hormone
replacement therapy) may improve blood sugar control in women2.
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 therapy3.
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So, hormones play some role, but
weight gain is involved in the equation as well. |
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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?" |
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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 sensitivity4. 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. |
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What about weight
and the waist-to-hip ratio? How does weight affect insulin resistance? |
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In the late 1980s increased attention was given to the concept
that a decreased waist to hip ratio carried lower risk of insulin resistance5.
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. |
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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. |
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Divide waist measurement by hip
measurement to get your waist-to-hip ratio. |
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A ratio of 1.0 or more is in the
danger zone. |
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For women, a ratio if 0.80 of less is best. For men, a
ratio of .90 or less is best. |
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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 improve6, 7. So, if excess
weight is lost, but the proportion |
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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. |
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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 diabetes8.
Again, we are seeing that we can not determine risks of dysglycemias simple
by looking at weight. |
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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 program9. 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. |
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The Big Picture |
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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. |
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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. |
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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. |
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What's
Next? |
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Next we will discuss how widespread abnormal blood
sugar metabolism conditions are. |
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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. |
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References: |
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[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] |
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[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] |
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[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] |
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[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. |
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[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] |
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[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] |
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[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] |
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[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] |
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[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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