Sugar and Perimenopause: What You Need to Know

Making dietary changes, such as cutting down on added sugar and opting for whole unprocessed foods, can help stabilize your blood sugar and manage perimenopause symptoms.

“During perimenopause, estrogen, which is protective, walks out the door. Progesterone also makes a quick exit, and testosterone begins to wane,” says Maya Feller, RD, founder and lead dietitian at Maya Feller Nutrition in New York. Estrogen plays an important role in regulating blood sugar and insulin sensitivity.

Symptoms of unstable blood sugar can mimic those commonly seen in perimenopause or worsen those caused by perimenopause itself:

• Hot Flashes Research suggests that unstable blood sugar levels can trigger or worsen hot flashes. A study that looked at the relationship between high blood sugar and hot flashes in more than 3,000 women found that higher blood sugar levels correlated with more frequent hot flashes.

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   Another study found that premenopausal or early perimenopausal women with persistent hot flashes and night sweats had a 50 percent increased risk of diabetes.

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   “Hot flashes and night sweats that occur with these hormonal fluctuations can lead to fatigue, less exercise, and more unhealthy food cravings, creating this unhealthy cycle,” says Mindy Goldman, MD, the director of the gynecology program for cancer survivors and at-risk women at the University of California, San Francisco.
• Mood Swings and Anxiety Emotions can become volatile during perimenopause, but unstable blood sugar can acutely exacerbate symptoms or mimic them.

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• Fatigue Generalized fatigue is a common symptom during perimenopause, but a lack of sugar being efficiently used by the body can also lead to low energy.

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• Brain Fog or Memory Issues These symptoms are believed to be caused by hormonal fluctuations, which can affect brain function. Blood sugar fluctuations can also cause similar symptoms, as the brain relies on blood sugar for energy.

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• Abdominal Fat Weight gain around the midsection is common during perimenopause, but higher sugar intake also increases visceral fat, says Dr. Goldman. “This is associated with increased insulin resistance and more inflammation, and it increases risks for cardiovascular disease,” she says.
• Sleep Disturbances Issues such as difficulty falling asleep or staying asleep often occur during perimenopause. Poor sleep can also complicate blood sugar control.

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• Joint Pain Some women may experience joint pain in perimenopause as a result of declining estrogen levels. “It is also thought that diets high in processed sugars increase inflammatory cytokines, which might worsen joint pain that is often seen during perimenopause and menopause,” says Goldman.
• Frequent Urination and Excess Thirst If blood sugar is high, the body will flush out excess amounts, leading to increased urination. This may cause dehydration and subsequent thirst.

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“Overall, the average American consumes an excessive amount of added sugar, and much of it is found in sauces, dressings, breads, and hand-to-mouth snacks,” says Feller.

So how much is too much? “For most women, the sweet spot is about 6 teaspoons, or 25 grams a day or roughly 100 calories,” says Lena Beal, RDN, a cardiovascular dietitian at Piedmont Atlanta Hospital and a spokesperson for the Academy of Nutrition and Dietetics. “The real issue is when added sugars displace nutrient-dense food, which can contribute to inflammation, weight gain, and higher risk for heart disease and type 2 diabetes.”

Several major health organizations have issued recommendations for reducing sugar, and although the numbers are in the same ballpark, there are slight differences between them.

• The Dietary Guidelines for Americans, jointly issued by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services, recommend that adults limit added sugars to less than 10 percent of their total daily calories. For example, if you consume 2,000 calories a day, added sugars should account for not more than 200 calories (about 12 teaspoons).

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• The American Heart Association’s recommendations are a little more stringent, since its focus is heart health. It suggests that added sugar account for no more than 6 percent of your daily calories, about 100 calories a day.

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• The World Health Organization recommends reducing all sugars, both added and sugar naturally found in foods such as honey and fruit juice, to less than 10 percent of your total daily calories.

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   However, this recommendation doesn’t apply to the natural sugars found in fresh fruits, vegetables, and milk, as those have no evidence of harmful effects.

Reducing your sugar intake can be challenging because much of the sugar we consume is hidden within processed foods. As a result, you may not even realize how much sugar you’re actually eating. Beal recommends starting small and focusing on swaps, not sacrifice.

“Sugar isn't bad. The key is keeping it in check while prioritizing whole, minimally processed foods that nourish your body,” she says.

Here are some practical tips to help you cut down on your sugar intake:

• Learn the Lingo Sugar comes in many forms and goes by many names, including brown rice syrup, corn syrup, molasses, coconut sugar, honey, date syrup, dextrose, barley malt, and agave. Familiarize yourself with the different forms.
• Identify Hidden Sugars Look for added sugars on nutrition labels of the foods and beverages you purchase. “I encourage people to become informed consumers and learn to read nutrition labels,” says Feller. “The added sugars are listed on all packaged goods.” Some products to scrutinize more closely include condiments, sauces and marinades, cereals, and flavored yogurt.
• Cut Back on Added Sugars Try cutting the amount of sugar you regularly add to beverages or food. “When cooking at home, making swaps such as using whole fruit in place of added sugar can significantly reduce the total sugar content,” says Feller. She also recommends cutting the amount of sugar any recipe calls for in half.
• Taper Gradually “Reduce how much sugar you add to coffee or cereal each week to help your taste buds recalibrate, says Beal. She also suggests “flavoring smarter,” by using cinnamon, vanilla, citrus zest, or berries for sweetness without sugar.
• Cut Down on Sugary Beverages Rethink your drinks. “Water, seltzer with fruit slices, or unsweetened tea can cut sugar intake dramatically,” says Beal
• Choose Whole Foods As much as possible, eat whole foods that are minimally processed and unrefined. These foods are packed with nutrients and free from added sugar.

What About Artificial Sweeteners?

• Acesulfame potassium
• Advantame
• Aspartame
• Neotame
• Saccharin
• Sucralose

“Low- and no-calorie sweeteners are a good alternative for people who are looking for sweet taste without added sugars,” says Feller. “It’s really a case of personal preference. Many of my patients prefer monk fruit or stevia.”

Beal agrees and notes that these alternatives can help women reduce added sugar, especially when transitioning away from sugary beverages or desserts.

The FDA and other health agencies around the world consider artificial sweeteners to be safe for use among the general population. However, some research suggests that when you use artificial sweeteners every day and over a long period of time, there may be a higher risk of stroke and heart disease.

“My advice is to use them sparingly — as a bridge and not a crutch,” says Beal. “If you rely heavily on sweeteners, you may still crave sweet tastes. For the best long-term results, focus on retraining your palate with naturally sweet whole foods like fruit, sweet potatoes, and dairy.”

• Declining levels of estrogen and progesterone can lead to fluctuations in blood sugar levels.
• Symptoms of blood sugar fluctuations can mimic those commonly seen in perimenopause and may also worsen existing perimenopause symptoms.
• A high sugar intake can impact blood sugar levels, which may worsen perimenopausal symptoms such as hot flashes, mood swings, and fatigue.
• Cutting back on added sugar and opting for foods in whole and minimally processed forms can help stabilize blood sugar.