The Truth About Insulin Resistance Treatment, Foods, and Labs in Perimenopause

Dr. Brighten: Shockingly, up to 80% of women develop some degree of insulin resistance during perimenopause and menopause, even if they're not overweight. And this is according to the Endocrine Society. So we're gonna be getting into this today on the Dr. Brayton Show. I'm gonna give you labs lab values, how to identify the symptoms of blood sugar imbalance, insulin resistance.

But I really need this point to sink in. Insulin resistance does not only affect people who are obese, those who look overweight, you can't just look at somebody and know they have metabolic issues.

That's why the lab testing we're gonna talk about today is so, so crucial. You're definitely gonna want to take notes on this one. I also need you to know that hormonal shifts alone, not just lifestyle choices, can drive metabolic changes.

So if we're not talking about hormonal health in women's health, we're failing to give complete and holistic care. Now, your lifestyle choices can [00:01:00] influence your hormones, but there are hormonal changes that happen. Perimenopause, menopause phase, the. Are outside of our control that we've gotta talk about.

Insulin dysregulation or resistance can also be silently rewiring your metabolism, making it harder to lose weight, wrecking your sleep if you know, you know, draining your energy, increasing your risk for Alzheimer's heart disease, and even certain cancers, and you might not even know it's happening.

That's why we have to talk about symptoms today and specific things that you should be on the lookout for. So I'll definitely teach you how to identify the symptoms, and I'm gonna give you what labs to ask your doctor for. I know I've said that a few times, but it's just really important that this screening is being done.

And unfortunately, many doctors are like, well, if there's not a problem, like, you know, it's not overt diabetes, like, why would we test these things? Because prevention. Because I'd rather [00:02:00] know that you have insulin issues starting before those insulin issues are full-blown diabetes. So in today's episode, we're getting into the hormones other than insulin, which is a hormone that can drive insulin resistance, blood sugar imbalances.

And as always, I will be providing you with actionable advice on what can help. And you've been listening to the Dr. Brighton show, then you know that my style is to give you actionable advice, usually as soon as I tell you about problems. So you can do something about it. You can take ownership of your health and you don't feel overwhelmed.

And I want you to understand that if you're in perimenopause and you're like diet and lifestyle, diet and exercise, like it always used to work and it's not working anymore. That's pretty common. That's a common experience and that doesn't mean you're doing anything wrong or that you're bad. It means we need to change the strategy.

Now, if you feel like you're doing everything right, but weight is still an [00:03:00] issue or you are tired, moody craving sugar at 3:00 PM waking up at 3:00 AM hungry, hangry sometimes. Then you need this episode,

 Anybody who's dealing with insulin resistance or blood sugar issues is going to benefit from this episode.

And to make this easier, I've created a free resource called the Perimenopause Weight Loss Action Plan. It includes a symptom tracker so you can start spotting and logging patterns for sleep, mood, energy, and cravings. It also has the exercise and nutrition tips that you need, along with 21 anti-inflammatory recipes.

You can grab that at dr brighton.com/plan.

It is totally free. It compliments what you're learning in this show. And again, that's dr brighton.com/plan. If you are a subscriber, thank you so much. If you have not yet subscribed, please consider it or like, or leave us a comment. I know these [00:04:00] are little action steps. They have a tremendous impact on the success of this show.

Even leaving us a quick review helps make this information more accessible to others and helps center women's voices in the women's health space.

I'm forever grateful for all of the love and support that you show. . So with that said, let's dive into why perimenopause triggers insulin resistance. And we're gonna start with like, kind of like going under the hood, I guess if you listened to my episode on perimenopause, which I will link for you, then you're familiar with what is going on with the hormones during this time, and I'll put that in the show notes.

You can always find [email protected]. But so that we're all on the same page, I'm going to briefly explain this and redundancy of information is how we learn and retain it. So if you've heard this before, don't tune out.

out.

Okay, so as we move through perimenopause, estrogen, progesterone start to [00:05:00] decline, but not in a steady, graceful way, may fluctuate unpredictably.

Estrogen in particular, has an insulin sensitizing effects. It enhances glucose uptake in your skeletal muscles. It improves insulin signaling, and it helps maintain metabolic flexibility. Like you eat something and your blood sugar doesn't go crazy. Now, studies have shown that estrogen deficiency in perimenopause and post-menopausal women is associated with significant increase in insulin resistance.

Estrogen hormone replacement therapy has been shown to improve insulin sensitivity and reduce visceral fat in several trials. Now, visceral fat is the deep abdominal fat around your organs, which I will go into more later in the episode. Now as estrogen drops muscle tissue becomes less responsive to insulin.

Your cells don't absorb glucose as [00:06:00] efficiently, and the result is your pancreas goes into overtime pumping out more insulin to compensate for all of this. Then the elevated insulin contributes to increased fat storage, especially visceral adiposity and fat in the deep abdominal section. Okay, so like that all sounds overwhelming, right?

And if I had a magic wand and I can make you not go into menopause, I might consider it. But what can we do when we know that perimenopause transition is inevitable? It's gonna happen. You're gonna go into menopause if we live long enough. This is the natural state of things. So let's talk about what we can be doing.[00:07:00] 

Okay, so firstly we need to build skeletal muscle. If your skeletal muscle is what is gonna help you sensitize to insulin, and then we have these hormonal changes that happen that are gonna make it so the skeletal muscle doesn't function at its best. We want to start building skeletal muscle. And in that perimenopause action plan, dr brain.com/plan.

I talk through how to do that. I will also link to other episodes where we've discussed this in detail. We also wanna track symptoms across our cycle. If we're still regular enough to follow it early mid perimenopause, we may still have regular enough cycles to track, [00:08:00] but if it's not regular, 'cause you're in late stage perimenopause.

Which is totally normal for it to be regular and for your period to disappear for months at a time. We wanna instead focus on tracking daily symptoms regardless of where you're at in your cycle. And we wanna look for patterns for energy, mood, hunger, sleep, and cravings over time. You can keep a journal with you, write things down, or you can do a symptom tracking app.

You know, um, there's some wearables that will allow you to track symptoms or maybe you just put it in your, you know, iPhone notes as an example. Now this is gonna help you identify windows where you might be having blood sugar crashes or insulin. Insulin resistance kind of symptoms are flaring even without a predictable menstrual rhythm.

It is normal to get hungrier before our period because of [00:09:00] progesterone and insulin, but we wanna look for extremes. So if you're noticing increased hunger, brain fog, mood swings, energy crashes in the second half of your cycle, that could be linked to fluctuating estrogen and rising insulin levels. So start logging your symptoms, energy levels, cravings.

We wanna try to identify the pattern and I will talk to you specifically about symptoms of insulin resistance so you can understand that even more. So now that you understand a little bit about like perimenopause hormones that can leave you to susceptible to blood sugar dysregulation and, you know, developing insulin resistance, let's now talk through the signs of insulin resistance that everyone should be aware of.

We should be teaching this in like sixth grade health class of like, be aware of these signs because you're gonna wanna see your doctor if they're coming up. Common signs and symptoms of insulin [00:10:00] resistance can show up years before you have a diagnosis of diabetes. So this can look like belly fat that won't budge even with diet and exercise.

And it's super annoying 'cause your doctor might be like, eat less and move more. And you're like, I can't eat any less and move anymore. It's still sticky. Why is it there? If you're having extreme cravings for sugar or carbs, especially in the evening or afternoon. It's like consuming your thoughts. You're like, I have to eat these things.

That could be a sign if you eat and then you notice energy crashes after meals, especially a carb laden meal like two to three hours later, that can be a sign. Brain fog and difficulty concentrating is not just 'cause you've entered your forties and you're too old. I don't care what your doctor says.

Forties is not old. Sixties is not old. No time is it old to just say brain fog and difficulty concentrating is normal. Okay, that is not. And insulin issues. Blood sugar [00:11:00] dysregulation can be one issue. One issue that's driving that. Now, if you have increased hunger, you're hungry all the time, even after you eat.

We may need to restructure your food or we may need to look at your blood sugar. Like I said before, if you're having difficulty sleeping, you're waking like two to 4:00 AM and you feel hot and hungry and irritable, that could be due to your blood sugar. If you notice you have skin tags on your neck, your underarms, so skin tags showing up or darkened patches of skin.

Those can be signs of insulin resistance if your cholesterol is changing and it's not for the better, even if you're not overweight, if your high blood pressure is elevated. We want to look at insulin hemoglobin A1C glucose, what could be going on with your blood sugar. And then of course, if you have a history of polycystic ovarian syndrome, I.

Or even if you haven't been [00:12:00] diagnosed and you have had a history of irregular periods, hirsutism, hair growth where you don't want it, like chin, chest, abdomen, you're losing hair on your head. Um, if you've had like, you know, periods that go missing and then they're extremely heavy. If you've had infertility, if you have that history or you currently have that going on, we definitely wanna check your blood sugar.

So what do I mean when I say check your blood sugar? Okay, let's get into the specifics of the labs. So even if you're not ready for a full workup, even having some of these done can help catch early pattern. Your Dr. May jump to like fasting glucose and some of these other labs. I wanna talk about some that aren't always as common, but are super helpful. So, a fasting insulin, ideally we wanna see that less than eight. Um, I, I like to see it more like less than five. If insulin is starting to go up, that means insulin.

So insulin is like the one that escorts glucose to the cell. It knocks on the door and it's [00:13:00] like, Hey, I vouched for this glucose. Let it in. And that's why we check fasting glucose with a fasting insulin. So if insulin levels are starting to rise, that's already the pancreas saying we have to make more.

'cause the cells are starting to get resistant. They're not listening. Now, hemoglobin A1C, anything above 5.4% may indicate early dysregulation. Hemoglobin A1C is your blood sugar average over the last three months.

 Fasting glucose. . Definitely not over 1 25. Um, the reason why I like hemoglobin A1C better is because some people will have elevated fasting glucose because like, although they fasted and they were on the way to the lab, like maybe someone cut them off in traffic, they had a cortisol release, big stress response, maybe they're scared of needles and that can cause their blood sugar to go up.

So that one is, you know. It's a nice to have, but I never hang my hat on it 'cause I've seen [00:14:00] elevated fasting glucose and then I've seen fasting insulin. That's totally fine. Hemoglobin A1C, that's totally fine. We start looking at all these markers and it's like just your fasting glucose was a problem. So that's just when snapshot and time.

Whereas if you couple it with other labs, you can get a lot more information. Now, outside of just testing glucose parameters, we wanna look at other lab markers that can point towards insulin resistance or blood sugar dysregulation issues. So those are going to include.

Triglycerides and HDL ratio to higher than two to one may signal insulin resistance. And anytime we start having issues with our cholesterol, that always prompts me to also look at thyroid as well. Because as we become hypothyroid, we can see issues with our cholesterol. C-reactive protein or CRP is a marker of inflammation, and that is often elevated in those who have [00:15:00] diabetes.

So here's how CRP ranges break down. So you can have an idea of, you know, what you're looking for in those labs. So less than 0.5 milligrams per liter, that's a sign of very low inflammation. Sometimes it's too low, so lower isn't always better. Sometimes it's like we've got other immune issues going on.

Point five to one. That's more in the optimal range, low cardiovascular and metabolic risk. So the, the key thing is that less than one, uh, 1.0 milligrams per liter. That's, that's ideally what we're looking for. When it's above one to three, that's syndicating mild inflammation, maybe early metabolic dysfunction.

And when it's climbing above three, high inflammation associated with higher risk of cardiovascular disease, insulin resistance, chronic disease, we might have autoimmunity taking place. So this is a helpful lamb because as you become inflamed, the cell walls can [00:16:00] become rigid. They don't accept the docking of hormones as easily, so the hormonal receptors can't accept the hormones.

And so that could be a driver of what's happening with insulin resistance issues. , Now, if you haven't heard of Homa ir.

ir,

That stands for Homeostatic Model Assessment of Insulin Resistance. It's a calculated score used to estimate how resistant your body is to insulin even before your fasting glucose or your hemoglobin A1C appear abnormal. So if you know that you have a high family risk and you're starting to have symptoms like this could be a good lab.

Now doctors aren't always ready to order this one. So let's talk about like, when is Homa IR indicated is especially helpful when fasting glucose is still normal, but symptoms suggest dysregulation. So you know, the labs that we're running, they look pretty normal. However, you are having symptoms that makes us go, Hmm, [00:17:00] something is going on.

So if you have unexplained weight gain, especially abdominal fat. If you're experiencing perimenopausal metabolic shifts, so like fatigue, cravings, poor sleep, could be worth investigating, especially in that perimenopause menopausal phase of our life. If you have a family history of type two diabetes, PCS, or polycystic ovarian syndrome or metabolic syndrome, then this could also be worth investigating because genetically there's a predisposition here.

We can certainly overcome those things with nutrition and lifestyle, but we wanna know what kind of risk we're working with. If you are someone who had gestational diabetes or blood sugar instability in pregnancy, if you have that history and you are now, you know, 40, 45, 50 plus. This is a good lab to take a look at.

And if you're wanting to take more of a preventative [00:18:00] perspective on things and, and doing like, you know, basically all you can to prevent a diabetes diagnosis and to prevent chronic disease, it's also a good idea to consider having this lab done. So the homa ir specifically that we've been talking about.

Okay. I wanna go a little more into like the vicious cycle of blood sugar crashes and cravings and give you some more actionable steps because if you have cravings, this is not a moral failing or a willpower issue alone. I mean, sometimes that carton of ice cream is calling you, uh, and it does take some willpower, but we have to also recognize there's underlying physiological disruption in the body that can lead us to have really significant cravings.

When insulin resistance begins, the swings in blood sugar become more pronounced. You might feel energized after eating a carb heavy meal, but then crash two hours later, and then this crash leads to [00:19:00] irritability, sugar, cravings, even anxiety. You can drive anxiety up as well, and that's because of how it interplays with cortisol, epinephrine, norepinephrine, these stress hormones and all of that can further worsen insulin sensitivity.

Now, if you've heard of HPA dysregulation, that's hypothalamic pituitary adrenal access dysregulation. That's when the brain and the adrenal glands are struggling to do their dance appropriately, and it is very common to see it come up in perimenopause. This can also lead to cravings of carbohydrates and salty foods as well.

So if you are dragging your energy, you wake up in the morning, you're like, I don't feel refreshed. I'm super tired in the afternoon. I try to go to bed, my brain is up, but my body is going to sleep. And you're having all these cravings we could be, you know, turning our attention to What is your stress response like

Now, as we talked about in late perimenopause, menopause, there can be drops of [00:20:00] estrogen, drops in estrogen, can drive drops in serotonin and dopamine, and now we're chasing carbs, sweets, and things that make us feel good. Okay, so what I'm trying to illustrate here is that physiologically, there are things going on with your hormones that can drive your cravings.

Now, we've been talking a lot about insulin, high insulin levels suppress lipolysis, or fat burning and stimulate hunger, promoting hormones like ghrelin. Studies have actually shown that insulin resistance is associated with impaired satiety that is feeling full. Um, and even when you've eaten enough, you may not get the signals to your brain and your brain's like, keep going.

We're hungry. Now all hope is not lost, and you can positively impact all of these hormones by what you put on the end of your fork. So we want to talk about what you can be doing now. And again, I just want you to understand there are hormonal changes you cannot [00:21:00] control, but there are aspects of your life that you can control to positively impact these hormones and your body during the hormonal change.

So number one is we have to implement a protein and fiber first rule, build each meal around roughly 25 to 30 grams of protein and eight to 10 grams of fiber. Now if you're not eating fiber regularly, you're gonna start with like three to five grams of fiber. Um, maybe even total in your day, just depending on where you're at.

I don't want anyone getting constipated and I don't want anybody being like, now I have tummy troubles. Thanks a lot. I. So things to prioritize are gonna be whole food sources like salmon, eggs, lentils, chia seeds, leafy greens. And why we're doing this is because protein promotes hunger signals and blunts what's going on with these insulin issues.

So what kinds of foods do you wanna prioritize? Whole foods. So things like salmon, lean meats, eggs, lentils, chia seeds, leafy greens. And the reason why we wanna focus on protein and fiber is that it blunts the glucose spikes and it promotes that filling that I am satisfied and I am full. Now, you'll hear a lot of people say that if you have insulin issues, you [00:22:00] can have no carbs.

That's not right. Slow burning carbs like those in whole grains and vegetables can help you maintain a healthy blood sugar and work positively with your neurotransmitters, serotonin, and dopamine to give you that feel good vibe. So we don't wanna throw out all carbs. Women do need carbs. And just as a reminder, I do have a free meal plan recipe guide that shows you how to do all of this as part of my perimenopause Weight Loss Action plan.

And it's also gonna include the exercise, stress, sleep tips, um, that we all need to holistically support your weight loss journey. And again, I'll have it in the show notes, but if you're like, give it to me now, it's dr brighton.com, D-R-B-R-I-G-H-T-E n.com/plan, because I know it's well and good for me to say these things, but sometimes you need structure and need to see how can I actually implement this?

Now I wanna change the conversation. We're gonna stay with food, but we're gonna talk, um, about going beyond keto and intermittent [00:23:00] fasting, and a little bit more about carbohydrates. So while keto and intermittent fasting may be trending, they often backfire for perimenopausal women when they're done so extreme.

So why is that? Because prolonged fasting or carb restriction can raise cortisol and that then can lead to like impaired thyroid function, worsened sleep, and ultimately lead to insulin issues coming up. Now, that's not to say there isn't a place for these or that they never work. Actually did a podcast interview with Liz Wolf and she's like, everything works one time.

And I'm like, man, if that's not the truth. But what this is to say is that they don't, they don't work for everyone. And if they don't work for you, that's not a, you're broken, you are the problem here. Now, when it comes to intermittent fasting, there is a great way to do it for women. So if you do wanna try it, the best approach [00:24:00] is to simply close your kitchen.

After dinner and don't open it again until breakfast, which for most people is gonna be like 10, 12, 14 hours. That's not unrealistic. Unrealistic is let's not eat all day, or let's only eat in a six to eight hour window. That's way too extreme on a system that's usually already stressed. Now, if you wake up hungry at night and you're sweaty and you're anxious and you're feeling that panic, then that's a sign that you probably need proteins, uh, like a snack with protein, a little bit of carbs before bed, like having, uh, you know, some peanut butter and apple slices, or maybe having some collagen in some tea.

These like little light snacks can help. Now, when it comes to keto, that's pretty restrictive, and in truth, it's not always necessary. So let's talk about a way to work with carbs in your diet without completely cutting them out. So this is a strategy that works for my patients who are in [00:25:00] perimenopause and menopause, and it's something I just like call, like gentle carb cycling.

And it is not vilifying carbs or pushing them out. If you saw my interview with Dr. Stephanie Tima, we talked about how important taking in carbohydrates is to build skeletal muscle. What's the first thing I told you we gotta do in this podcast? And we gotta build skeletal muscle. We gotta get stronger.

We, we gotta build the little glucose sponge that we have. So we definitely want to be bringing in carbohydrates, but there's a way to actually cycle this outside of your menstrual cycle that will help you in terms of your blood sugar management and something else. I'm gonna get into that, but first something else I wanna say that I teach, I've, I've been teaching this in lectures for like several years to doctors, uh, other healthcare practitioners, to the general public is something called the sous pushup.

If you've never heard of this [00:26:00] before, um, it's a really brilliant exercise. So the sous is a deep calf muscle that I call a greedy glucose goblin because it'll really suck up your glucose and what you do, and you can do this like on road trips, you can do this at the dinner table. Um, you, you can do this sitting at your desk.

You might be doing this right now, so your feet are flat on the floor. Okay? This is the heel of my foot, and I'm gonna lift it up and I'm gonna drop it abruptly and lift it up and drop it abruptly. And you wanna do like one second every one second. You're lifting your heels and you're dropping 'em, lifting 'em and dropping 'em.

That's one way after meals that we can actually start sucking up the glucose from our bloodstream and help support our blood sugar. And you only have to do it for about a minute. Another thing that has been really effective in the research. Is doing apple cider vinegar shots with your meals? [00:27:00] Um, I just think about Dr.

Stacy, the dentist that I add on here. I've had a few dentists on here. I will link to their, um, their conversations that we've had, but they would be not happy with me if I didn't tell you to dilute it. So definitely dilute it. But that has been shown in research to help with people's glucose levels. In fact, there have been studies where they take like the worst of the worst diabetics, um, in terms of like really poor blood sugar control.

And they're like, let's not that these people are the worst. Okay, so someone is saying, but then they're like, let's feed 'em the absolute worst meal you could give someone for that. Um, and they find the apple cider vinegar even helped with their blood sugar at that time. Okay, so let's get back into the conversation about that gentle carb cycling and what you could be thinking about with your meals.

Okay, so on our active days, our exercise days, our heavy training days, we're gonna include slow digesting carbs like quinoa, lentils, root vegetables like , carrots, parsnips, uh, sweet [00:28:00] potatoes, potatoes in general, um, potatoes that you cook, put in the fridge overnight. And now we got resistant starch 'cause we're gonna eat them cold on rest and recovery days, we're gonna reduce the carbohydrates slightly and increase the protein and nons starchy vegetables.

So now we're looking at like broccoli, cauliflower, Brussels sprouts, leafy greens like spinach, charred, getting more of those in. We want to aim for balanced macronutrients, not extremes, because your hormones crave stability. So. When we're training hard and heavy, we're going to do more of those slow burning carbohydrates.

And on the days that we're not exercising, we're not skipping carbs, Now, if you've already identified that you're having those blood sugar challenges that we talked about a little bit ago, or you're having signs of insulin resistance that we already discussed at the start of this, you're gonna need to make strength training a must in your routine. And when you're [00:29:00] making strength training a must, please remember, you have to be fueling with enough protein and you still need to be keeping those carbohydrates going.

And I have an entire episode on perimenopause weight loss that will link to, so you can listen to that where I cover exercise. So I'm not gonna go any deeper there, but I've brought it up a few times because. It matters greatly. Okay, now a question I always get is like, are there supplements that can help?

And yes, supplements can help. I wanna do a supplement spotlight on supporting insulin sensitivity, , but real talk, you gotta do the nutrition and lifestyle and don't believe any supplements. It's like you'll have instant weight loss. So let's talk about some specific nutrients that can support your metabolism and help with your insulin sensitivity.

Top of mind is always chromium, chromium, picco lineate specifically hundred to 200 micrograms daily is usually the sweet spot that enhances insulin signaling and it [00:30:00] supports glucose uptake in the cells. It's also been shown to reduce sugar cravings. If you haven't heard of creatine, creatine five grams a day.

That can be really helpful for supporting your exercise and giving you maybe some more oomph in the gym. Um, and that's something that isn't directly about insulin, but it's about the skeletal muscle that we need. Mitol is another great one, 2000 milligrams or two grams daily that, um, sometimes it's four grams daily.

We see this a lot in women with PCOS. It really helps with their insulin. So my ACETOL acts as a secondary messenger in insulin signaling pathways and improves ovarian function, mood, metabolic patterns, thyroid health, and , if you don't know, roughly 70% of those with PCOS have insulin resistance.

And this particular supplement has been studied a lot in PCOS women now Green T [00:31:00] extract, that can be anywhere from a hundred to 500 milligrams per day. And that is something that you get caffeine free . So green tea can help with fat oxidation, improve insulin sensitivity, reduce oxidative stress. , It does have a lot of benefits, but it's not like weight loss for the caffeine benefits.

The other one that's kind of surprising that you should consider are lactobacillus species like lactobacillus rosis. So probiotics, some of the research is as low as like 10 to 20 billion CFUA day showing, uh, that it can be helpful in terms of supporting a healthy microbiome. Can support healthy glucose metabolism, help with inflammation.

So probiotics, we definitely wanna eat our fiber, our prebiotics, but studies have shown that probiotic supplementation. Can help with body composition. In fact, one study, women who took probiotic supplement, specifically the strain, lactobacillus prognosis, [00:32:00] lost 50% more weight over a three month period of time than women who took the placebo.

So that's really interesting. Um, in terms of the research and in terms of the power of your microbiome. So if you're like, well, this is kind of like a lot of supplements. It is, and we're gonna talk about more supplements as we talk about cortisol. But you really only want to look at these, uh, choose a few that you wanna discuss with your healthcare provider and try to, in that discussion, come to a conclusion of what might be most beneficial for you.

And understanding that sometimes stacking things can have a synergistic effect. So combining myo acetol with green tea extract and uh, chromium may help with cravings. Uh, your focus, your energy, your fat metabolism. And so sometimes it's better to do a combination product than it is to just do one-off supplements, and it's often cheaper that way as well.

So, I told you we're gonna talk about adrenal health. We're [00:33:00] talk about stress. Let's talk about the role of cortisol and stress in insulin resistance. ' cause this is super important in perimenopause. It's important all the time, but we see it get really problematic starting in perimenopause and continuing into menopause.

You know, understanding the relationship between cortisol stress and insulin resistance is critical and it cannot be ignored. And so if your doctor is like just Stressless and you're like, well, what the heck does that mean? Or what does it matter? Let's talk about it. Cortisol is your primary stress hormone.

It plays an important role in blood sugar regulation, but when cortisol is chronically elevated, it disrupts insulin signaling. And why is it chronically elevated? Because we have an evolutionary mismatch in terms of what our body responds to as stress in the environment, and then the environment just being like so loaded with so many stressors.

Now as estrogen, progesterone decline, this is what's really lame. Your body becomes more sensitive to stress and progesterone, as we've talked about in other episodes, I'll [00:34:00] link to those, has a calming anti-anxiety effect. It helps buffer cortisol. So we're starting to lose our progesterone. We're starting to be at the mercy of stress.

Progesterone levels fall in perimenopause, and now we feel like we have no resiliency to stress. That's not a you issue, that's a hormone issue. And on top of all of that, the fluctuating estrogen can dysregulate that hypothalamic pituitary adrenal axis, HPA axis we talked about before, increasing cortisol production and disrupting your body's ability to manage stress.

So this is why you might be losing your mind in perimenopause and menopause. You feel so irritable with people, it's the changing hormones. And if you're neurodivergent, I will link to the episodes on that because you've got another layer going on there. Now here's why all of this matters.

Cortisol promotes gluconeogenesis, and that's the generation of new [00:35:00] glucose in the liver. Chronically elevated cortisol leads to higher blood sugar levels. You see where I'm going with this. High cortisol impairs insulin receptor sensitivity as well, making it harder for glucose to enter cells.

So insulin's like knock, knock and the cells like whatever, whatever. I don't care. Plus cortisol regulates inflammation. So if we've got inflammation going up now we've got like a double whammy there. Cortisol also encourages abdominal fat storage. It actually gets, it gets hated on so much 'cause like cortisol belly.

So especially visceral fat, it can be contributing to, which is already increasing in the perimenopausal woman due to the lowering estrogen. Estrogen dictates where we store fat, but hips and thighs. When it's when it's right. And then as it decreases, here comes the visceral fat and chronic stress is also gonna worsen your sleep.

I don't even need to tell you that, you know that, but [00:36:00] that's going to further elevate Cortisol, increase cravings for sugar and processed carbs. Like all the stuff that tastes really good. That's not because like you have lack of willpowers, 'cause your hormones are like, please, we just wanna feel good, make us feel good.

So in perimenopause, your body's stress response is more easily activated, less easily shut off, and that makes stress management. Absolutely foundational for managing insulin resistance. So how are we gonna do this? How are we gonna get this done? Because we can't just stop stress from coming. We have to practice stress reduction techniques.

Daily deep breathing. I have an episode on vagal nerve stimulation, uh, meditation, 10 minutes of grounding movement, um, just being with people that you love and make you happy. These little acts can help lower cortisol levels. Saying nice things to yourself can help lower cortisol levels, improving [00:37:00] sleep quality.

Just one night of forced sleep can raise cortisol and impair insulin sensitivity. So we need to look at our bedtime routine. I have episodes all about sleep. I'll link to those as well. And we might wanna include adaptogenic herbs. So like ashwagandha, rhodiola, a caucus, uh, holy basil. These kind of adaptogens help your adrenal glands adapt more to the stress that you're under.

So I want you to understand that managing cortisol is just as critical as managing your carbs when it comes to insulin resistance. And that cutting carbs too much can cause cortisol problems, which then causes insulin problems and sleep problems. So it's very nuanced and don't believe the hype out there that it's like there's a one size fits all and it's super restrictive.

Now, I've mentioned visceral fat a few times in this episode, but I wanna talk a little bit more about it. Uh, [00:38:00] because there's a lot of misinformation about visceral fat. Now, all, , visceral fat is belly fat, but not all belly fat is visceral fat. Visceral fat is the fat stored deep inside your abdominal cavity.

It surrounds your internal organs like your liver, intestines, pancreas. And unlike the subcutaneous fat that's just under the skin, so that's the belly fat we can grab. Visceral fat is metabolically active, meaning it's not just sitting there. Being annoying, stretching out your pant size, like it's actively releasing hormones and inflammatory molecules into your bloodstream.

And so that's why I like to check that C-reactive protein, that marker of inflammation. So what's the major problem with visceral fat? Okay, because this is not an aesthetic thing. Visceral fat releases pro-inflammatory cytokines like TNF alpha interleukin six, which interfere with insulin signaling pathways and contribute to low [00:39:00] grade inflammation.

Estrogen is anti-inflammatory. Estrogens regulated our immune system. Now we're losing estrogen, we're storing visceral fat. We're gonna have inflammation that's gonna lead to brain fog, it's gonna lead to mood issues, it can lead to joint pain. So this is a systemic issue. Visceral fat also increases the release of free fatty acids into the liver promoting hepatic insulin resistance and driving non-alcoholic fatty liver disease.

A condition now very common among women in their midlife, even those who are not significantly overweight. Remember what I said at the top of this? You can't just look at someone and know their metabolic health. Even if someone's overweight, they may have subcutaneous fat, they don't have the visceral fat, and I can run their markers and it's like things are not looking so bad there.

Now, visceral fat, as they said, it's, associated with an elevated c-reactive protein, which is a marker of systemic inflammation. So if it is something that , you are filling some of [00:40:00] those inflammatory symptoms. Like I said, back it up. Go listen to what we look for for CRP. Get that done, and let's make sure that you are less than one.

Now visceral fat significantly increases the risk of cardiometabolic diseases. Type two diabetes, hypertension, dyslipidemia, like elevated triglycerides and LDL atherosclerosis, which is plaques in your heart, coronary heart disease, heart disease, and heart attacks. This is the number one killer of women, beats out breast cancer.

So visceral fat. Again, it's not about aesthetics. It's a biological signal that your metabolism needs deeper support. And because of this episode, you now have the tools to start giving yourself exactly that. Can HRT help? Yes. If you are a candidate for estrogen hormone replacement therapy, and we start that sooner than later, that can help.

However, it will never be enough. We have to also get our fiber up [00:41:00] limit, the amount of added sugar, not fruit, but sugar and we need to be tracking our waist to hip circumference because if that's increasing, even if you're not overweight, that can be a sign that your visceral fat is increasing.

And you don't, by the way, need to rely on BMI to track hip to waist ratio. That's actually a better marker than BMI.

I could totally rant forever on how dumb BMI is because it was like made by a mathematician for like white men. Um, and it doesn't take into account the differences of women. And so it really isn't that useful when we're talking about metabolic health compared to the waist to hip ratio. Now, what other things can you be focusing on?

So definitely reducing cortisol by reducing stress that's gonna help with your visceral fat. Prioritizing strength training to build metabolically active muscle. This is, I feel like I've, I've beaten that one. Supporting insulin sensitivity through both nutrition and [00:42:00] targeted supplementation. So definitely looking at your fiber, your fat, your protein intake, balancing those macros out.

And I want you to keep in mind that it does matter what you put at the end of your fork. What you do not have to be perfect every single day. Okay? And when we talk about added fat, or excuse me, added sugar, I want you to be thinking about reading labels. Looking at what you're taking in, and if you are someone who's like, 25 grams is my Mac, and I would rather have a cookie today, and I'm gonna skip this yogurt over here, or the sugary beverage so that I can have that cookie, like there's not a problem with that.

The problem is when we're having excess added sugar coming in, now keep in mind, perimenopause is not the time to punish your body. It's a time to nourish it and take care of it differently. Insulin resistance is not [00:43:00] just about blood sugar, it's about inflammation, hormonal shits stress, how your brain and metabolism are responding to all of it, and you deserve to understand what's happening.

Get the right labs and have the tools to respond with compassion, but also a strategy for your body. And if you're someone who's like, okay, but I need a little more help, perimenopause weight loss action plan, I made it for you. It's a free science backed guide that's gonna walk you through practical hormone friendly strategies to support your metabolism, reduce your cravings, feel like yourself again and again.

You can grab that at dr brighton.com/plan. I'll put it in the show notes for you.

And if you are someone who is listening to this and you have someone in your life that you're like, yeah, all of these symptoms that you talked about. Or maybe they have risk factors like [00:44:00] TCOS, they have a family history of diabetes, they've struggled with infertility.

I ask that you pass this show over to them so you can go ahead and just hit share. If you're listening to this right now, leave me a comment, leave me a review wherever you're listening to this podcast,

I wanna do something we haven't done yet on this show, and let's take some, ask Dr. Brighton questions and answer your questions that you've sent to me. So these are actually coming from social media that I invited you to ask questions. And this one comes from Marilee. She says, this is my second month without a period.

Am I in menopause? No. And let me take a moment to explain more. Okay. So firstly, no. What is menopause? Menopause is 12 consecutive months, no period, so two months. We can't call that menopause. We need you to have a one year anniversary of no period, and then we call it menopause, but there's a little more to it.

You also have to be over age 45 for us to just call it menopause. Otherwise, [00:45:00] we have to ask more questions. That doesn't mean you can't go into menopause earlier. Maybe that's your family history. Maybe you've had exposure, and certainly if you've had an ectomy where they take out your ovaries, then you're definitely in menopause.

However, before age 45, I need to ask questions. Is this primary ovarian insufficiency? Is this hypothyroidism? Is this functional? Hypothalamic amenorrhea? Are you over-training and undereating? I have to ask more questions to make sure I do my due diligence and your doctor should too. We don't just call it menopause because that's easier for us.

We ask questions because some of these issues. That can cause you to lose your period earlier than 45. So if that's before your time, they can cause other issues in your body, like compromising bone health, compromising cardiovascular health. So we want to always go deeper.

all right. This question comes from the Morgan Brood and she asks, as a perimenopausal woman, can I still get pregnant during this season of my life? Let's talk [00:46:00] about it. Yes. Be careful. Okay, friend. So what is happening with perimenopause is that we are running out of eggs and there's, here's what I want you to understand, . So with perimenopause, we were running out of eggs and the quality of the eggs is not so good. So if you're like, I want to get pregnant, I don't want you to be like, oh, it's gonna be so easy, she said I could get pregnant in perimenopause.

I will link in the show notes to an article that I wrote all about perimenopause and pregnancy. And if you'd like, uh, an episode on it, you can just let me know. Leave me a comment in the review section on Apple, iTunes, wherever you're listening to this. So it is possible to get pregnant and it can sometimes be tricky because.

You start ovulating irregularly. So you are having unprotected sex and you don't know when you're actually gonna ovulate, or you're like, I haven't had a period in like six months, so I'm probably fine. And then, whoops, you ovulated. And the sperm was good quality, the egg was good quality, the uterus was ready to go, and now you are pregnant.

[00:47:00] So if you don't wanna become pregnant, you need to be using some kind of birth control. Now, as I said, you know, a quality is compromised as we age, so then it's possible that you become pregnant and then you have a miscarriage because there's much higher rates of miscarriage. As we enter into our forties, it is much harder to become pregnant.

So the average person, they're gonna have like a 20% chance of becoming pregnant every cycle. With perimenopause, that drops significantly, and each year it drops even more as we go into our forties because. Not only are we not ovulating as regularly, but the a quality is not there and the risk of miscarriage is much higher.

So, uh, just take heed that yes, it is possible to become pregnant. And if you do want to become pregnant, that is the goal. Immediately meet with a reproductive endocrinologist. Do not waste time with your PCP or your ob gyn. Don't waste time. They will [00:48:00] waste your time. Get to the expert who is going to thoroughly work you up, tell you what your odds are, and tell you what you need to be doing right away.

 

And that for some reason is a controversial statement still, but you ain't got time to waste when you're in barrier menopause if you want to have a baby. And I will link to some of the fertility episodes that we have done that talk a lot more about the nuance on this. Okay? So until next time, take care of your hormones and they'll take care of you.