A recent study shows a new shocking statistic: only 6.8% of American adults are metabolically healthy. This may be one of the worst health crises of our generation, given how many diseases and health disparities are linked to poor metabolic health. Metabolic health is essential to overall health. This statement is especially true when looking at women's metabolic health during various stages of life. Could a low-carb or ketogenic diet be the answer? Read on as Dr. Kevin Gendreau and I discuss women's metabolic health, whether a low-carb or ketogenic diet is helpful, the risk factors involved, and how women should approach improving their metabolic health.[*][*]
Tell Me About Metabolic Health
At its most basic, metabolism is a series of processes that take place on a cellular level. These processes help convert the food we eat into energy for all bodily functions. Metabolic health is having ideal blood sugar levels, high-density lipoprotein (HDL) cholesterol, triglycerides, blood pressure, and waist circumference without medication use.[*]
Given that blood sugar levels stand out as one of the primary clinical markers of metabolic health, it's essential to be mindful of how to keep it under control. Does your blood glucose remain high after a meal? Is your blood glucose high in the morning? These can be prime indicators that your insulin is not functioning correctly. Insulin is a hormone made by your pancreas that controls the glucose level in your bloodstream and helps your body use carbohydrates for energy.
Insulin is another important marker of metabolic health; most chronic diseases are linked to insulin resistance.[*] In its simplest form, insulin resistance is when cells in the body stop responding to the hormone insulin. Insulin resistance will cause a cascade of metabolic problems and diseases. On the other hand, a metabolically healthy individual's insulin correctly moves sugar out of the bloodstream and into cells for storage. In short, their blood sugar comes down again, with the help of insulin, after eating.
Risk Factors of Poor Metabolic Health
It's important to note that while there are some things you can control to improve your metabolic health, there are things you cannot, such as your age, sex hormones, and family history. Women must be cautious with their metabolic health as they age due to the large hormonal fluctuations of menopause. These differentiating hormone levels pose a risk of a larger waistline, high blood sugar, and low levels of HDL (good) cholesterol.[*] According to the National Heart, Lung, and Blood Institute, the two most important risk factors of poor metabolic health are:
- Excess body fat around the middle and upper parts of the body
- Insulin resistance
Other risk factors for women include:
- High blood pressure
- High blood sugar levels
- High triglyceride levels
- Low levels of HDL (good cholesterol)
- Family history of metabolic dysfunction or type II diabetes
- Sedentary lifestyle
- Poor sleep
- PCOS diagnosis
- High cortisol (the stress hormone)
- Chronic levels of inflammation
While having one (or more) of the above risk factors doesn't automatically mean you are metabolically unhealthy, it does raise the likelihood of metabolic syndrome. Metabolic syndrome is a handful of conditions that collectively increase your risk for serious health problems, such as coronary heart disease, stroke, diabetes, and even certain types of cancer.[*]
Signs and Symptoms of Poor Metabolic Health
The signs and symptoms of metabolic health may look slightly different or manifest differently depending on the individual. Sometimes symptoms may progress very quickly, or they may take years to develop fully. Women may struggle more with these symptoms after pregnancy or throughout menopause.
As a woman, you may be diagnosed with metabolic dysfunction or insulin resistance if you meet any of the following diagnostic criteria:
- Being overweight or, specifically, central obesity (belly fat)
- Waist circumference ≥ 35 inches
- Triglycerides ≥ 150
- HDL (good cholesterol) levels < 50
- Blood pressure ≥ 130/85
- Fasting blood sugar levels ≥ 100
- Fasting insulin levels ≥ 10
Some other signs and symptoms that may indicate poor metabolic health include:
- Skin tags
- Apple-shaped body
- Darkening of the skin around the neck or under the arms (Acanthosis Nigricans)
- Irregular menstruation in women of reproductive age
- Inability to lose weight
- Blood glucose dysregulation
- High waist-to-hip ratio
- High LDL:Triglyceride ratio
Hormones and Metabolic Wellness: Is there a connection?
Women and men differ in varying ways, but one of the most significant contributors to a woman’s health is her hormonal cycle. Unlike men, women have four monthly phases of the menstrual cycle during their reproductive years, and then they experience perimenopause and menopause around age 50. These are significant "health" moments in a female's life as they can often come with unpleasant and undesirable side effects due to large hormonal fluctuations. Other potentially life-altering events in a female's life include conception, birthing, and breastfeeding an infant. Given the significant difference in hormonal changes, metabolic health can look different between men and women. Let's break down how metabolic wellness directly impacts women's health and some conditions that affect women's metabolic health.
Being metabolically healthy is very important for fertility. Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder that is the most common cause of infertility in women. Up to 70 percent of women with PCOS have insulin resistance (although some predict this to be even higher). Metabolic risk factors are associated with significant levels of infertility.[*] Having optimal metabolic health gives the best chance for a healthy mom and baby throughout the pregnancy.
Dr. Kevin says:
“I’ve evaluated hundreds of women with PCOS over the years, and they almost always suffer from elevated blood sugar levels and insulin resistance. A low carbohydrate approach to weight loss can be life-changing for helping women regulate their menstrual cycle and improve fertility.”
Women experience a fluctuation of hormones each month, which can directly impact metabolic health. Specifically, changes in estrogen and progesterone hormones affect glucose metabolism and insulin sensitivity. Generally speaking, estrogen encourages insulin sensitivity, while progesterone promotes insulin resistance.
Why does this happen? Research indicates that glucose concentrations tend to be higher in the luteal phase (pre-ovulation phase) compared to the follicular phase (post-ovulation phase). Higher progesterone levels decrease insulin sensitivity, which prevents insulin from properly clearing glucose from the bloodstream, thus producing higher blood sugar levels.[*] As such, women may experience higher blood sugar levels at certain times of the month.
During perimenopause/menopause, significantly decreased estrogen levels and increased circulating androgens may lead to metabolic diseases and weight gain.
Dr. Kevin says:
“I work as a board-certified weight loss physician, and the majority of my patients are post-menopausal women. Weight gain is all about hormones and biology—not willpower. Anybody who advises you to simply “eat less,” doesn’t understand the complexities of the human body. Weight loss happens when you focus on the types of foods you eat instead of just the quantity of foods you eat.”
Skin tags, acne, hidradenitis suppurativa, androgenetic alopecia, acanthosis nigricans, and atopic dermatitis are all skin diseases connected to poor metabolic health and metabolic syndrome. Although many of the exact pathways to this remain unclear, it's thought that chronic inflammation and insulin resistance play a prominent role.[*] Many of these conditions may be resolved or greatly improved as metabolic health improves.
How Can Women Improve Metabolic Health?
Change Your Diet:
Following a low-carb or Keto diet may dramatically improve blood sugar regulation. Focus on consuming:
It is also important to avoid sugar and limit carbs to help maintain a stable blood glucose level. A higher intake of protein and healthy fats will keep you fuller for longer, which in turn will help lower sugar cravings. Make sure to also add in anti-inflammatory foods like fatty fish, olive oil, dark chocolate, berries, green tea, peppers, and turmeric.
Carb manager provides tons of fantastic recipes to help women conquer their metabolic health.[*]
Dr. Kevin says:
“Your dietary focus should always be protein, healthy fats, and fiber. Try to limit processed carbohydrates and refined sugars if you want to improve your metabolic health.”
Incorporating resistance training, bodyweight exercises, or strength training is vital. Women need to build muscle, but they must do so strategically. Women should avoid overtraining, as this can cause issues with cortisol, leading to fatigue, increased blood glucose levels, reduced performance, and weight gain (particularly around the midsection).
Dr. Kevin says:
“Start with just two 15-minute sessions of strength training per week, and you’ll begin to see results in no time!”
Sleep and Stress Management:
There's a correlation between a lack of sleep and higher cortisol (stress hormone) and ghrelin (hunger hormone) levels. Lack of sleep will also cause elevated blood glucose levels. Get 7-8 hours of shut-eye and keep a routine sleep schedule.
Sleep hygiene may include:
- Turning off devices 3 hours before bed
- Wearing blue light-blocking glasses
- Eating earlier
- Practicing breath work
- Recognizing stressful thinking
Higher cortisol levels can cause anxiety, decreased immunity, weight gain, lack of focus, and depression.[*]
Avoid Endocrine Disruptors:
Endocrine Disrupting Chemicals interfere with the way women's hormones work. In some cases, EDCs trick our body into thinking they're hormones, while others block natural hormones from doing their job! EDCs include flame retardants, phthalates, bisphenol A, and PFA's. These chemicals are often found in water bottles, furniture, clothing, perfumes, candles, cleaning products, pesticides, tap water, and so much more.[*]
Lose Weight If Needed
While it is possible to be metabolically healthy being overweight or obese, the statistics and risk of eventual problems are not in your favor. Those at an unhealthy weight are at increased risk for many severe diseases and health conditions, from diabetes to cancer. Losing 5-10% of your body weight may produce massive metabolic benefits. Many people will see improvements in blood glucose, blood pressure, and even cholesterol with just a 5-10% body weight reduction.[*]
Dr. Kevin says:
“Over the years, I have helped many patients reverse type II diabetes, cure fatty liver disease, lower cholesterol, and improve blood pressure with a modest 10% weight reduction on a low carbohydrate diet. These improvements can occur without the help of medication or bariatric surgery. Our diet impacts our metabolic health in profound ways.”
Having read through this article, you know metabolic health isn't ONE thing; it's a series of things that make up overall health. Now that you have a pretty good idea of whether you are metabolically healthy or unhealthy, keeping yourself accountable for maintaining or improving your metabolic wellness is essential. Here are some action steps:
Log your food and manage your macros using the Carb Manager app. Logging your food often reveals how much you're actually eating and the quality of food you choose. Accountability is key. Knowledge is power.
#2 Make Small Changes
Little things like being aware of your blood glucose levels and tracking your weight can be beneficial to keep your finger on the pulse of metabolic health. Carb Manager makes it easy to track these metrics and sync with health devices such as Keto Mojo and other wellness apps.
#3 Continue to Educate Yourself
Don't stop here! The more you know about your hormones and metabolic health, the more equipped you'll be to make the right lifestyle choices to better your overall health. Carb Manager has numerous articles on eating Keto, women’s health, intermittent fasting, and much more.
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