[Angela Foster] (0:14 - 1:12)
When you look at visceral fat developing, if you have visceral fat, it seems that you're now more prone to insulin resistance, but if you have insulin resistance, it seems to drive visceral fat. So do we know like what is driving it? Because I guess if I look at myself, I've been, just as an example, I've been monitoring my data using DEXA scans.

And so across the kind of perimenopause transition, and I've seen a very minuscule rise, I didn't, and it's still below the radar, the level of visceral fat, but it's hard to isolate these things because I exercise daily. And so that I think makes a difference. And then I try and eat as many of the types of foods that you're eating.

And all of those things, right, are also lowering inflammation, improving blood glucose control. So do we know like, is there a thing that's kind of the starting point of causing this and then the others are coming off the back of it? Or is it just this whole kind of metabolic issue that's all going on at the same time?

[Sarah Berry] (1:13 - 6:44)
So that's a good question. And it's a hard question. It's a bit like the chicken and egg.

We don't know which comes first. We do know that there is a biodirectionality. We do know that if you increase your visceral adiposity, then you increase your, you know, chances of insulin resistance due to particular hormones and chemicals that are released from your adipose tissue.

We know that if you are insulin resistance, then in turn, that also therefore means that we're not metabolising food in the same way. We're not processing our blood lipids, our cholesterol in the same way, because insulin has a role on lots of, with lots of other hormones as well. And so all of that can then contribute as well to weight gain.

So it's kind of this circular process. And I think what I often say to people during the menopause transition is, you know, to remember that it's a really challenging time in terms of you've got all of these symptoms going on. You know, we see in our own data, and we've got collected this data in hundreds of thousands of women, that although we typically talk about heart flushes, actually the most prevalent symptoms are anxiety, mood swings, depression, brain fog, poor sleep.

And if you're feeling pretty damn fed up and you're not sleeping, how motivated are you to eat well? How motivated are you to do physical activity? So you've got all of that going on, plus the fact that this loss of oestrogen is directly causing as well, this increase in, or this change in where your fat is deposited.

We know that. We know that oestrogen in simple terms directs the fat to your hips. We know if you lose oestrogen in simple terms, it then is more predisposed to going around your belly.

So you've got the direct action of insulin increasing your adiposity around your belly. You've got the indirect effects of the fact that, you know, 85% of people report poor sleep, 80% say they feel anxious, depressed, fed up, low mood, and so therefore less likely to want to partake in physical activity or even eat well. And then we also know that during the menopause transition, it can impact factors like your hunger signals.

We hear so many people saying, I'm eating the same that I always had, but I'm so much more hungry. We know that it impacts also how you metabolise food. So again, we've published some research from our ZOE predict studies where we looked at about 600 women and we looked at those who were pre or post menopausal.

We gave these women exactly the same breakfast with exactly the same amount of carbohydrate. It was a very high carbohydrate meal. Those who were post-menopausal had a significantly higher postprandial glucose response, meaning that they had a significantly greater short-term change in their circulating blood sugar levels compared to the pre-menopausal women.

We then took this a step further because we know menopause is an age-related disease. So how can, or age-related events, sorry, that was an error. We know that menopause is an age-related event.

So what we did was we then with our cohort took an age-matched group of pre and post-menopausal women. So we had an equal amount of people of the same age who were pre and those who were post menopause. And we still found that dependent on not your age, but your menopause status, there was this poorer metabolic response to consuming carbohydrates in post-menopausal women compared to pre-menopausal women.

We know that this can go on to cause bigger glucose dips. So bigger dips in that circulating blood sugar two to four hours after consuming a high carbohydrate meal. And again, we know from our own research that those dips in circulating blood glucose or blood sugar cause people to consume more, sets them off on this kind of rollercoaster.

And so if people have this dip, our research shows they consume about 320 calories more over the day compared to if they don't have that dip. So you've kind of got all of these factors working against you. And then it's at a time where so many women are saying, being so hard on themselves.

Now I'm not saying, okay, sit back, eat what you want. Don't be physically active. Yes, absolutely.

It's one of the most important times to be physically active. But I do think as well that we need to be really aware of how, unfortunately, nature is working against us. And I don't mean to paint a doom and gloom picture, but I think it's important to be aware of this because as a 49-year-old woman, when I see these pictures of Jennifer Lopez, Halle Berry, with their most perfect washboard belly and perfect figures, it can be hard to think, wow, how can I live up to that?

Now I can't because I have kids, I have jobs. And also I want to enjoy my life. I want to enjoy my food.

I don't want to be on a treadmill all day long and only eating carrot sticks. And so I just think it's really important that we recognise that our bodies are changing. And that is a natural part of what happens as we age, as we go through the menopause transition.

Plus we have all of these other factors that are kind of working against us. But yeah, absolutely. Let's still try and be physically active.

And it is a point in time as well to be even more mindful than before about what food we're eating.

[Angela Foster] (6:44 - 9:00)
And to make the changes that we can, as you say, right, because women are under a formidable amount of stress. It's interesting because we have a quiz that we started about a couple of months ago, I would say, coming up to. And so far, we've had around 1,500 women take it.

And over 40% of them report this increase in abdominal fat. But they also, as you say, report things like brain fog and also, you know, increased anxiety and just almost like the inability to be able to sort of foresee what they want in their future with the same clarity. Right.

I think there's so much going on that we actually just need to show a bit more kindness to ourselves and support each other. And that's where I think kind of communities come in, friendships, right? Mums at the school gate that you're talking about, right?

We can support each other through this transition because we're all going to go through it. I hope today's episode inspired you on your journey to vibrant health and high performance. Make sure you check out the show notes for a summary of all the important links to everything we talked about.

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Angela is joined by Sarah Berry to talk about the complex relationship between visceral fat and insulin resistance, particularly during the menopause transition. They discuss how these two factors influence each other in a cyclical manner, making it challenging to pinpoint a clear starting point for weight gain and metabolic issues. They highlight the various symptoms women experience during menopause, such as anxiety, mood swings, and poor sleep, which can hinder motivation for healthy eating and physical activity

WHAT YOU’LL LEARN

• There is a complex relationship between visceral fat and insulin resistance, where each can exacerbate the other, creating a circular process that complicates weight management during menopause.
• Common symptoms during the menopause transition include anxiety, mood swings, depression, brain fog, and poor sleep, which can negatively impact motivation for healthy eating and physical activity. 
• The loss of oestrogen during menopause leads to changes in fat distribution, shifting fat storage from the hips to the abdomen, which is associated with increased visceral fat. 
• Postmenopausal women experience poorer metabolic responses to carbohydrates, leading to higher blood sugar levels and increased hunger, which can result in consuming more calories throughout the day. 
• Women need to show kindness to themselves and support each other through the menopause transition, as many experience similar challenges and changes in their bodies.