Hor 47 years old, your cycle has become irregular for a few months. Nothing to worry about, says my gynecologist. But for a while after lunch I’ve been feeling exhausted, tired in a strange way, I really have a lack of energy and I want to sleep. Especially when I eat pasta or rice. The tests are all normal. The doctor told me in passing that maybe hormones had something to do with it, but he didn’t tell me why. Can it really be like this?
The role of estrogens in insulin sensitivity
Yes, it can depend on hormones. And it’s one of the least talked about connections of the entire perimenopausal transition.
In fact, estrogens do not only regulate the cycle. They also regulate insulin sensitivity, i.e. the ability to use glucose efficiently. They do this through various mechanisms, one of the best known concerns the GLUT4a protein that works like a real door in muscle cells that opens and makes enter glucose into the muscle after the meal. Estrogens positively regulate its expression. When their levels drop, or fluctuate irregularly as happens in perimenopause, that door works less well, it doesn’t open when it should, it remains ajar and glucose has more difficulty passing from the blood to the muscle.
Because the energy crash comes after the meal
The consequence is that it takes more insulin to do the same job. Blood sugar rises more rapidly after a meal, then drops. And that descent, especially if abrupt, produces exactly what it describes: loss of energy, tiredness, desire to stop.
In perimenopause this often happens before any tests detect it. Fasting blood sugar may be normal. Also glycated hemoglobin. However, these parameters do not tell what happens in the two hours after the meal, and they do not measure the variability, i.e. the amplitude of the oscillations over the course of the day. However, we must also remember that this is also due to the composition of the intestinal microbiota, as well as direct hormonal changes.
The role of pasta, rice and refined carbohydrates
The fact that symptoms appear mostly after pasta or rice is not surprising. Refined carbohydrates, consumed alone or in unbalanced meals, produce the fastest blood sugar spikes. In a woman with insulin sensitivity already modified hormonally, that oscillation is amplified.
Stress, cortisol and sugar cravings
There is another factor that adds up, often overlooked: cortisol. There perimenopause It frequently brings with it more fragmented sleep and a higher level of chronic stress. Cortisol stimulates the release of glucose from the liver and further worsens the insulin response. It is an effect that is added to the direct hormonal one, and explains why in phases of greater stress the decline in the afternoon becomes more pronounced and the craving for sugar more difficult to manage.
How to better structure meals
In practice, the structure of the meal begins to matter more than before. A breakfast with an adequate protein content stabilizes the glycemic response in the following hours more reliably than a predominantly sweet or carbohydrate-only breakfast.
Lunch, which must always be complete (a little first course, a little second course, fiber and fat) can significantly improve the reported symptoms if consumed in a different order, compared to our habits: first vegetables and proteins, and then carbohydrates. This “little game” slows glucose absorption and attenuates the spike: the literature also documents this in non-diabetic subjects.
Even a ten-minute walk after main meals produces a significant and measurable effect on postprandial blood sugar.
Don’t eliminate carbohydrates, but learn to manage them
It’s not about eliminating pasta and bread. It’s about not overdoing it and understanding how to include them.
And to recognize that that post-meal tiredness can be managed with simple daily choices.
Doctor Federica Almondo
Doctor Federica Almondo.
Specialist in Nutrition Science, trained at the Dietology and Obesity Center of the San Raffaele Hospital in Milan, Doctor Federica Almondo is a point of reference in personalized nutrition, preventive medicine and anti-aging pathways.
After founding and directing Cerva 16 – Nutrition & Anti-aging Center, he is now responsible for the Nutrition and Longevity areas of Image Regenerative Cliniccenter of excellence and international point of reference for Regenerative Medicine and Aesthetic Medicine with offices in Milan and St. Moritz.
It deals with tools such as genetic tests (DNA), assessments of the state of the intestinal microbiota, analysis of oxidative stress, body composition, indirect calorimetry, ANS Analysis to build highly personalized diets with a holistic and scientifically validated approach, suitable for even the most complex needs.
With excellent training and skills ranging from nutrigenetics and nutrigenomics to nutraceutics, metabolomics and epigeneticsAlmondo is also recognized for her work on intestinal health, menopause, chronic stress management and optimization of psycho-physical energy. Particular attention to ketogenic therapya nutritional approach now totally validated by scientific literature such as effective intervention in many complex pathologiesincluding type 2 diabetes, PCOS, fibromyalgia and lipedema and much more.
