The Essential Question Every Midlife Woman Should Ask When Health Takes a Turn
Going deeper to find answers
Chloe,* a 51-year-old fit midlife woman, had taken care of her health most of her life. So, when her doctor told her she had insulin resistance, it rocked her to her core.
Her doctor sent her to an endocrinologist who was ready to start medication to help Chloe. When she asked why this happened to her, the endocrinologist said it was because of her age and hormonal changes.
Chloe was in late perimenopause, after all. Hesitantly, she got on forums and started researching about insulin resistance. Some women suggested she start hormone therapy. Others encouraged her to go low carb. She heard a lot of “increase protein” and “try this or that supplement.”
But nothing. I repeat nothing, was helping her understand why this was happening until she asked a question every midlife woman needs to ask.
*names and details have been changed to protect privacy
Specialists know how to treat
Having specialized in the endocrine system, this doctor knew all about its functioning and different treatments. He had seen lots of patients and excelled at deciding which drug works best.
Knowing how to treat something is not the same as knowing what caused it, because that often takes them outside their speciality.
Chloe still didn’t understand how someone with her health habits could now be insulin resistant.
What’s sad is that there are thousands of Chloe’s in the world, not understanding all that is happening to their body.
Midlife women are at a disadvantage because midlife is not a well-defined life stage beyond the end of the reproductive years (aka menopause). And most doctors know little about menopause either.
We often receive vague explanations. “You’re getting older. Menopause doesn’t help. It’s probably genetic.”
The question midlife women should ask
When midlife women find themselves in this spot—unsure why their health is taking a turn — there is a question that so often can help them find an answer. And it is the One Health Principle (OHP).
We know that increases in inflammation/oxidative stress (what I will call Infla-Stress) cause a decline in nitric oxide (more about how this affects insulin resistance in a bit).
To get answers, the best question Chloe can ask is: Where is the Infla-Stress coming from?
Most will jump to say it’s her hormones because she’s late in perimenopause. But again, these are still vague answers. Because not every perimenopausal woman gets insulin resistance.
We’ve got to go deeper to all the known causes of Infla-Stress around the time of midlife. But first, a little deep knowledge about insulin resistance.
The why behind insulin resistance
We hear a lot about insulin resistance at midlife, and how it causes weight gain and hunger. But it is much more than that.
Insulin resistance is when our cells become less sensitive to insulin, so the body secretes more insulin to keep blood sugars stable.
It’s like pre-pre diabetes because blood sugar tends to stay normal, but insulin increases.
It’s also a sign of endothelial dysfunction that often takes root at midlife. In fact, most of the chronic disease women face starts with endothelial dysfunction. This is when the cells of blood vessels start working less well.
I’ve said it before, but it bears repeating. Endothelial dysfunction is a decline in nitric oxide (NO), a potent vasodilator. This causes even more of an increase in Infla-Stress and damage to the lining of blood vessels.
Why is there a link?
Insulin is a hormone that boosts the uptake of glucose into muscle, adipose tissue and the liver, but it’s also considered a vascular hormone.
Because when it attaches to insulin receptors, it stimulates the release of nitric oxide to increase blood flow to skeletal muscle and other tissues. This accounts for almost half of insulin-stimulated update of glucose in skeletal muscle.
Most importantly, it relaxes resistance arteries in the microcirculation, which is where the glucose exchange occurs.
When a woman has decreased NO bioavailability, it makes it tougher for insulin to stimulate enough NO to help blood vessels relax. So, it often takes more insulin to get the job done.
This disruption of the OHP, which reduces NO, plays a vital role.
For instance, exercise increases insulin sensitivity because it increases NO. But as we learned in the last post, this can be compromised in midlife women.
Getting your biomarkers checked
This is where biomarkers can give us clues where the Infla-Stress is coming from. Chloe had a uric acid level of 5.8. Anything under 6 was considered normal to her doctor.
But luckily, Chloe had inside knowledge to help her see that this might be problematic.
Uric acid used to only be associated with gout as it causes the deposition of urate crystals into the joints and kidneys. But we’ve known that researchers have linked elevated uric acid, or hyperuricemia, to conditions like diabetes since the 1800s and to metabolic syndrome in the early 1900s!
Evidence continues to mount linking high uric acid to metabolic disorders such as cardiovascular disease, metabolic disease, non-alcoholic fatty liver disease and dyslipidemia. There is now an established a link between high uric acid, insulin resistance, and type 2 diabetes.
Initially, it was considered a consequence of such issues, but more research reveals a causative role.
How on earth do high uric acid levels cause problems like insulin resistance?
High levels of uric acid have a negative effect on our adipose tissue (body fat), increasing oxidative stress and reducing adiponectin levels. This leads to NO depletion and endothelial dysfunction.
Because estrogen helps clear urate from the blood, when women experience lower levels of estrogen, they do this less effectively.
This is why uric acid increases as women transition through menopause. And a recent study gives us clues on at what point uric acid can negatively impact health.
A study with midlife women
Researchers from Brazil wanted to understand at what point serum uric acid levels had negative metabolic effects in midlife women. They selected 672 women between ages of 40 and 65 and took blood, measured blood pressure, and performed anthropometric measures like body weight and waist-hip ratio.
The mean uric acid level was 4.9, ranging from 2.0 to 11.6. The researchers pinpointed levels above 4.8 as being linked with adverse metabolic parameters.
More specifically, women with UA >4.8 had higher fasting blood glucose, insulin, blood pressure and HOMA-IR, and were on more meds to help their blood sugar.
The researchers conclude:
The normal reference range for serum UA in women is 1.5 to 6.0 mg/dl. This range was established based on UA levels in individuals without clinical evidence of gout. However, it is well established that UA is central to several metabolic processes beyond articular issues. The worldwide increase in circulating UA highlights the need to re-evaluate this reference range.
These findings are consistent with other studies showing that somewhat elevated, though still normal, levels pose issues, especially among women.
Finding the WHY will set you free
Chloe was ecstatic to pinpoint what was behind her insulin resistance. She realized it may be because her diet shifted to more animal protein, less plant-based protein, and no dairy.
Uric acid is the final product of purine metabolism. A diet high in animal products and low in plant-based foods probably raised her uric acid, and lower estrogen levels may have hindered its removal.
She could add in foods that help lower uric acid including plant foods, dairy (calcium), and vitamin C, and lower animal sources of protein.
We don’t have a lot of research on lowering uric acid and health outcomes, but studies have shown that the uric-acid lowering medication allopurinol decreases insulin resistance.
Midlife is the time to act. If you’re doing everything right but still feel unwell or have metabolic problems, identify and address the underlying cause of your Infla-Stress, and share your concerns with your healthcare provider.
Uric acid is one of many things it could be. I’ll be posting about other hidden factors affecting midlife women.
I find it unbelievable that significant factors like uric acid are ignored, considering their significant health implications.
Nipping them in midlife is no big deal. But living a lifetime not knowing, while the damage keeps spreading, isn’t fair to anyone.
Midlife women deserve more than that! Agree?
The information on this site is not meant to replace medical advice but educate women about changes that occur at midlife.
Oh my goodness this was such a helpful article. I really wish we saw more such as these. I’m gonna go back through my most recent labs to see if I have that tested. You did not mention this, but if this is related to a decrease in estrogen, would hormone therapy address it?
Yet ANOTHER fantastic newsletter, Maryann! I always thoroughly appreciate what you do for us midlife women!!!