Thursday, April 23, 2020

Retrospective #432: “I’ve never had a hot flash”

My editor said, “I’ve never had a hot flash,” in a comment to me on a linked article she sent me. Her full quote: “So thanks to Bernstein, I’ve never had a hot flash. I just thought it was luck!” She added, “…interesting, how it is always insulin and glucose control.” The article, “Vasomotor Symptoms and Insulin Resistance in the Study of Women’s Health Across the Nation,” appeared in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.
Quoting from the abstract: “Vasomotor symptoms (VMS) are classic symptoms of the menopausal transition, experience by up to 70% of women living in the United States.”  “VMS have important…implications because women reporting VMS consistently show poorer sleep quality, more negative mood, and impaired quality of life.”
The report drew on annual blood draws and questionnaires over 8 years from 3,075 women aged 42-52 at entry who participated in the Women’s Health study. Hot flashes/sweats were examined in relation to two metabolic factors used to define type 2 diabetes: glucose and the homeostasis model assessment (HOMA).
The study made adjustments for BMI (associated with Insulin Resistance), CVD risk factors, medications and hormonal status. It found that, “compared to no flashes, hot flashes were associated with a higher HOMA” and “were similar for night sweats.” “Findings were statistically significant, yet modest in magnitude, for glucose.”
Beyond the scope of this study, but of interest to the researchers, was the association of the link between menopausal hot flashes/night sweats (VMS) and cardiovascular disease (CVD). “The mechanisms underlying these associations are unclear, due to the incomplete understanding of the physiology of hot flashes,” the report says. The investigators then explored the relation between VMS and CVD from the two well-known studies: Women’s Health Initiative hormone therapy trial and the Heart and Estrogen Replacement Study.
These studies “showed an elevated risk for clinical CVD with hormone use among older women with moderate to severe VMS at baseline relative to women with no/mild VMS.” In addition, “In the Study of Women’s Health Across the Nations, VMS was associated with higher subclinical CVD.” But the findings were mixed. Other work has “examined the associations between VMS and CVD risk factors such as blood pressure.” But until now…
This study was well designed, testing the hypothesis with controls for race/ethnicity, CVD risk factors, body mass index (BMI), the reproductive hormones E2 and FSH, and menopausal stage. The take away for me was the association with BMI, which as mentioned correlates with Insulin Resistance. The researches here noted that:
The association “did not persist” after adjustment for BMI. In other words: “You lose the weight, you lose the risk.”
The report concludes, “Considering BMI in relation between Insulin Resistance and VMS is particularly important given that higher BMI is a potent risk factor for Insulin Resistance and is associated with greater VMS reporting in perimenopausal and early postmenopausal women.” So, eat Low Carb and get svelte, like my editor, while there’s still time.
Or, if you’re already postmenopausal, ponder another statement from the study with respect to cognitive impairment.
This citation “postulates alterations in glucose transport across the blood-brain barrier as a trigger for VMS.”
Since glucose is the main brain fuel, and ketones are brain fuel only while eating Very Low Carb or during fasting when blood insulin levels are low and body fat breaks down for energy, a decline in “glucose transport across the blood-brain barrier” leading to VMS could be problematic. Could KETONES substitute for GLUCOSE in this way?
As my editor observed, “…it’s always insulin and glucose control.” Would following Bernstein’s 6-12-12 or another Very Low Carb regimen (≤30 grams of carbohydrates a day) enable you to say, “I’ve never had a hot flash” or, if you’re one of my older readers, I’ve never exhibited any sign of cognitive impairment!

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