We've have been taught to focus on cholesterol levels in mid life. Fair enough, heart health, particularly in women is not talked about enough and it kills more of us than breast cancer. But cholesterol is just one marker to look out for. The shift in metabolism that comes with menopause, highlights something that is just as, if not more important. It affects your heart health as well as how you feel day to day. Read on to find out what this metric is and for some practical actions you can take today help lower your risk.
The glucose rollercoaster
Every time you eat, behind the scenes, your body is working hard to keep the sugar that is released from your foods, at stable levels in your blood. There will always be some fluctuations in sugar levels but you want to avoid spikes and crashes. The medical term for these fluctuations is called glucose variability. If your blood sugar levels through the day look more like a rollercoaster, you have poor glucose variability. Emerging research suggests this is a highly significant independent risk factor for heart problems.
At menopause, there is a metabolic shift towards significantly worse glucose variability. A big study from ZOE, shows that if you are postmenopausal, you are 42% more likely to get glucose spikes after a meal. It also means your blood sugar levels spend less time in the ideal, stable "healthy zone" throughout the day. If you haven’t hit menopause yet, now’s the time to prevent this from happening and if you are post menopausal, you can take back control!
The link between glucose variability and heart disease
So, you may be wondering what’s the blood sugar rollercoaster got to do with your heart health? When your blood sugar spikes it triggers inflammation. You can’t feel that inflammation, but behind the scenes, it’s slowly damaging the delicate lining of your blood vessels. Damaged linings in the vessels attract the build up of plaque, which narrows the blood vessels. Over time, they become stiffer and less able to do their job. Cardiovascular disease begins.
NHS Tests
Tests such as HbA1C and fasting glucose levels, are definitely useful. However, they show smoothed out averages and spot checks. They are not tracking hour by hour blood sugar fluctuations. For this you need a continuous glucose monitor (CGM). More on this below. Having said this, it is definitely important and worthwhile to have these tests which you can get on the NHS:
HbA1C - a measure of your average blood sugar levels over a 3 month period. An HbA1C result at the higher end of normal is a sign you need to take action now.
Fasting Glucose - if it is creeping up each time your test, even though it's within the normal range, again a sign that you need to take action.
C-reactive protein (hs-CRP) - if this is raised, it's a sign of inflammation. Blood sugar swings drive inflammation.
Triglycerides - if they are going up, whilst HDL (good cholesterol) is going down, this warrants a look at insulin resistance
The big benefit of a continuous glucose monitor (CGM)
The above NHS tests give smoothed out readings and spot checks. They won't show spikes and drops. A continuous glucose monitor (CGM) can track your blood sugar in real time over a period of two weeks. You'll be able to see clearly which particular foods, exercise or stress corresponded to peaks and drops in your blood sugar. Information is power - you can then make adjustments to your diet and lifestyle, which will level out your blood sugar levels and bring a whole host of health benefits.
Recent clinical studies have shown that when overweight women used CGMs as well as having diet education, they lost significantly more body weight, body fat percentage and belly fat.
Who needs a CGM?
If you experience any of these symptoms (note they can have other causes - always check in with your GP), try wearing a CGM. After just 2 weeks you'll have plenty of data, specific to you, to show which foods and lifestyle habits are affecting you.
- An afternoon slump when you crave a nap
- Feeling mentally cloudy after a meal
- Feeling sleepy straight after a meal
- Piling on fat around your middle, despite trying to eat carefully
- Intense cravings for sweet foods or carbs
- Hanger if you miss a meal or go a long time in between meals
- Waking suddenly in the middle of the night
Further Help
When it comes to CGMs, interpreting the data correctly is key. See my other blog here for more information. I am currently working with low cost CGMs that allow me as your practitioner to directly view your data and advise you on diet changes. Please contact me for more info penny@nutritionistlondon.co.uk or book a free call here