Midlife Curveballs: Belly Fat and Insulin Resistance
It's as if a switch had been flipped. Over the course of a year, my cholesterol shot up, my HbA1c edged higher, and my jeans became tighter. But my diet and lifestyle remained unchanged. What changed?
'They’ve mixed up my blood sample with someone else’s!' I exclaimed in shock as I went through my labs with my doctor.
I had always prided myself on my pristine annual bloodwork. I knew what to eat, had my workout routines on autopilot, kept toxins and stress at bay like a ninja, and had a sleep sanctuary that could put royalty to shame.
But then I turned 45.
It turns out there is science to show that humans dramatically age finin 2 spurts: in our mid-40s, and early 60s.1 “We’re not just changing gradually over time.” said Prof. Michael Snyder, a geneticist and director of the Center for Genomics and Personalized Medicine at Stanford University and senior author of the study. “It turns out the mid-40s is a time of dramatic change, as is the early 60s.”
Even when you’re doing everything right, your body can still throw you a curveball, and yes - this can start in your mid 30s - and yes, there are things you can do to future-proof yourself for a softer landing. Let’s dive in.
The unfair truth about perimenopause and menopause.
Menopause is defined as the absence of menstrual periods for 12 months, making it a diagnosis often confirmed in hindsight. Doctors watch and wait to see if those periods come back before officially slapping on the ‘menopause’ label.
But in the 5-10 years leading up to menopause, aka 'perimenopause', a phase spanning years where hormones fluctuate wildly and estrogen and progesterone begin to trend downwards, our bodies can change. This brings a whole host of subtle symptoms that most women (and their doctors) don’t even realize are hormone-related. As a result, many end up just putting up with them, not making the connection to these hormonal shifts.
Why? Largely because perimenopause and menopause are poorly covered in medical training, and research dedicated to this stage of life is seriously lacking. Luckily, things are changing. Women are becoming more informed, educated, and demanding better care.
When I mention menopause, the one symptom everyone immediately thinks of is ‘hot flashes’ (or 'flushes' for my UK friends). But there are some under-talked-about, yet all-too-common, symptoms that can rear their ugly heads during perimenopause and menopause:
Anxiety
Insomnia
Mood changes
Brain fog/inattention (Could it be the lead being released from our bones?)2 We know that the lead accumulated over time is stored in bones, and I’ve certainly worked with many women in peri-/menopause presenting with high lead levels due to increased bone loss (another reason supporting our detox organs is SO crucial).
Last but not least: transitions in metabolic health, which manifest as increasing belly fat, stubborn weight gain, insulin resistance (higher fasting glucose, higher HbA1c), higher blood pressure, and rising cholesterol.
So, if you’ve been doing everything right but suddenly things start to feel a bit out of your control, know that you are not alone, and it’s not your fault. Your body is changing, and I wish someone had sat me down in my 30s to equip me with the tools I’m about to share today. Better late than never, right? And if you’re already well into menopause, these tips apply to you too.
What is Insulin resistance, and why is everyone talking about it?
When we eat, the glucose (sugar) in our blood rises. This triggers the release of the hormone insulin, which acts like a key to unlock doors on our cells, allowing glucose to enter. This process helps bring blood sugar levels down.
However, if you’re insulin resistant, insulin no longer opens those doors effectively.
As a result, blood sugar stays elevated after a meal, which can lead to type 2 diabetes if left unmanaged.
High blood sugar also triggers inflammation, increases the risk of cardiovascular disease (the #1 killer of Americans), Alzheimer's, and cancer. Additionally, elevated insulin levels contribute to increased fat storage, particularly around major organs—think fatty liver and visceral (belly) fat.
Why do we gain belly fat in perimenopause?
Well, I just gave you a hint—insulin resistance plays a role. But the truth is, we don’t fully know yet. It’s likely a combination of several factors:
Lower estrogen - which plays a big role in insulin/blood sugar and cortisol, all of which contribute to belly fat.3 4
Loss of muscle mass - this begins in our 30s, believe it or not.5 By the time we are in perimenopause, most women have lost significant muscle mass - lower muscle mass means poorer blood sugar control and more insulin resistance.
Change in gut microbiome - Lower microbiome diversity (types of friendly bacteria in our gut) is hypothesized to lower estrogen. Our gut microbiome, like muscle mass, holds the key to our metabolic health and calorie processing. Poor gut health has been linked to insulin resistance.6
Poor sleep - Lower levels of estrogen and progesterone can seriously disrupt sleep, which is also linked to insulin resistance and increased appetite.7
Declining mitochondrial health with age due to environmental stressors like toxicants (e.g., BPA, phthalates, PFAs, heavy metals), poor diet, and stress. These little powerhouses convert food into ATP (energy) and play a critical role in fat burning. When mitochondrial health declines, it underpins insulin resistance and poor blood sugar control.
This explains why women in their late 30s and 40s become more susceptible to developing insulin resistance, and why I’m SO excited about this. The good news? Many of these factors are modifiable, presenting a unique opportunity for us to reduce our chances of developing pre-diabetes, diabetes, cancer, heart disease, dementia, and more.
Science-based tools that can help
Before we go into solutions, I know lots of you will ask me what set of labs I usually get every year, and this will be a good place to share it because if you don’t test, you won’t know, and you will be guessing.
Here’s the panel I usually get (and by no means am I saying you should get these - your labs should be decided on in consultation with your doctor and depends on your insurance coverage):