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Medscape
3 days ago
- Health
- Medscape
Hyperinsulinemia Linked to Abnormal Uterine Bleeding
Hyperinsulinemia appears to have an early association with common causes of abnormal uterine bleeding (AUB), particularly in women with obesity, a preliminary study in Menopause found. Although preliminary, the study data suggested the opportunity for future research on potential relationships between cardiovascular disease risk factors and gynecologic disease. 'Many studies and organizational bodies have examined and asserted a relationship between polycystic ovarian syndrome (PCOS) and elevated insulin levels,' wrote investigators led by Andrea C. Salcedo, DO, MPH, of the Department of Obstetrics and Gynecology at Loma Linda University in Loma Linda, California. They noted that AUB is the most common reason for benign gynecologic consultation in the United States. Andrea C. Salcedo, DO, MPH 'After over 15 years of clinical practice , I started realizing there were several patterns in women who presented with irregular or heavy periods. Many were self-referred or sent by their primary care providers to see me to evaluate for female hormone problems,' Salcedo told Medscape Medical News . 'The majority were not in perimenopause, but they had similar risk factors for cardiovascular disease, such as obesity, hypertension, and migraine headaches.' Salcedo began to wonder whether healthcare providers are recognizing abnormal periods in reproductive age as a cardiovascular risk and using them to educate women on prevention rather than solely treating them medically or surgically. 'I believe that the theory of the uterus as an 'end organ' that receives inflammation in the same way as the heart and kidneys do in cardiovascular disease helps explain to the patient the reasons for heavy or irregular periods.' The study findings came as no surprise to her: 'They confirmed the patterns I was seeing clinically.' Hyperinsulinemia is associated with smooth blood vessel inflammation in the peripheral circulation. 'What is often under-recognized is that the uterus is made of these same blood vessels.' When the uterus is on the receiving end of inflammation, the blood vessels are damaged and do not function appropriately. The result can be uterine fibroids or heavy periods. The gynecologic expression of this inflammation can vary from person to person, she added. The Study This exploratory cross-sectional analysis of the association between hyperinsulinemia and biomarkers of metabolic syndrome in reproductive-aged women with AUB was designed to motivate future hypothesis-driven research. It was conducted from June 2019 to August 2023 at a single institution's outpatient gynecology clinics. A total of 205 premenopausal women aged 18-54 years were enrolled, including 116 with AUB and 89 control individuals with normal menstrual cycles. Approximately 40% in each group were identified as Hispanic. Participants underwent assessment for fasting insulin and additional markers of metabolic syndrome, including body mass index (BMI), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and waist-to-hip ratio. Among the findings: • Hyperinsulinemia, the main effect of interest, was a significant predictor of AUB, affecting 44.0% of the AUB group vs 33.7% of the control group, with an odds ratio of 3.0 (95% CI, 1.372-6.832; P = .0085). • Hypertension, LDL, HDL, smoking, migraines, and polyps or fibroids were all significantly associated with AUB and identified as confounders. Chronic hypertension was identified in 26% of the AUB group vs 12% of the control group. • Interestingly, including BMI in the model diminished the significance of hyperinsulinemia, suggesting overlapping or mediating pathways, the authors said. • Among metabolic markers, LDL levels were similar between groups, while HDL levels were lower in women with AUB (54.0 vs 60.0 mg/dL). • There was a nonsignificant intergroup difference in triglycerides (82.0 vs 73.5 mg/dL) and total cholesterol levels (169.0 vs 172.5 mg/dL). • Migraines were more prevalent in the AUB group (31.0% vs 11.2%), as were polyps or fibroids (45.7% vs 9.6%). Commenting on the study but not involved in it, Maureen Whelihan, MD, a gynecologist at the Center for Sexual Health and Education and Elite GYN Care of the Palm Beaches in Greenacres, Florida, called the study an interesting one, 'suggesting that before we see the effects of PCOS, a diagnosis of hyperinsulinemia can be made and managed and that hyperinsulinemia has a direct effect on microinflammatory injury to the uterus.' Maureen Whelihan, MD In her practice, women with insulin resistance and PCOS have major infertility issues. 'About 85% are obese and have lipid disorders. While this study indicates we can make a diagnosis earlier by evaluating fasting insulin, the question is, 'then what?'' she said. The ultimate remedy is diet and lifestyle modification. 'The minute patients understand they must eliminate starch and sugar to lower insulin levels and move their body a little, we lose them,' she said. 'They want a quick fix and nothing that requires them to make difficult decisions and drastic modifications. This is the hard part! We can teach them the pathophysiology all day, but they have to commit to a permanent change in the way they approach diet and exercise.' While the study findings are exploratory and preliminary, Salcedo said, they suggest that abnormal periods may have predictive value. 'In many cases, elevated fasting insulin levels, above 10 µU/mL, could be an early sign of cardiovascular and diabetes disease risk.' In this study, elevated insulin levels were associated with AUB, particularly among those with obesity. 'Therefore, when a patient sees her healthcare provider for irregular periods, it could be an excellent opportunity to discuss the known association of menstrual problems with [cardiovascular] risk factors.' Larger, longitudinal studies are needed, however, to confirm the causal mechanisms, Salcedo said.
Daily Mail
12-05-2025
- Health
- Daily Mail
EXCLUSIVE Food expert says you should ditch fiber
A food expert has made the claim that the public have been 'indoctrinated' to eat the wrong foods, and should be following an all-meat diet. Retired academic Bart Kay spent decades working across 10 universities around the world, specializing in the fields of human nutrition, cardiovascular pathophysiology and exercise physiology. He has published a number of scientific papers and was a consultant to the famed New Zealand All Blacks rugby union team, the Australian Defence Force, the New Zealand Army and NRL referees' association. Professor Kay claimed the carnivore diet was superior and even argued fiber should be cut out because no actual 'evidence' existed that it was beneficial. His beliefs fly in the face of longstanding advice that a diet should consist of an equal balance of red meat, fruits, vegetables and carbohydrates. Dietitians Australia president Dr Fiona Willer warned the carnivore diet was not 'healthy' and that fiber was beneficial as it was proven to lower the risk of developing certain diseases and cancers. Professor Kay told labelled fruits and vegetables 'plants' and went as far as to call them 'toxins'. 'Plant material is not helpful in any way to us as a source of food or nutrient. In fact, it's the exact opposite, it's anti-nutrient, it's toxin, it's irritant,' he said. 'Plants basically don't want to be eaten and the only way they can fight back is chemically, which they do, and the wool has been pulled over our eyes for generations to think we should eat a diet rich in plants and we shouldn't.' The carnivore diet includes meat, fish, and other animal products like eggs and some dairy. It excludes all other foods, including fruits, vegetables, legumes, grains, nuts, and seeds. Professor Kay claimed that the public has been 'indoctrinated' and led to 'believe their entire lives that they must eat the rainbow'. 'When I say the correct diet for a human being is hyper-carnivore, with as little plant material as possible, that's my opinion based on my significant understanding of human physiology, human nutrition science and cardiovascular pathophysiology,' he said. Professor Kay added the average person could go even more extreme and live on what's called the 'Lion Diet' which consists of only red meat, salt and water. 'As long as they eat enough fat with the red meat,' he said. 'The closer you can get to 100 per cent carnivore and zero plant material the better.' Professor Kay also took aim at fiber, labelling it a 'health myth'. 'The exact amount of evidence anywhere that proves that fiber is beneficial for human health, or any hard health outcomes of any kind, is none whatsoever. It does not exist,' he claimed. 'It's astonishing that we have this narrative that's accepted without question by almost everyone in the industry that says fibre is great. 'Fiber keeps you regular, no it doesn't. If anything, fiber tends to be associated with idiopathic constipation.' Professor Kay has been on a carnivore diet for nearly 10 years and despite consuming virtually no fiber, he claimed he has a regular bowel movement once a day. Dr Fiona Willer rejected Professor Kay's claims. 'The carnivore diet is certainly not aligned with the best evidence of a healthy diet, certainly for long-term health outcomes,' Dr Willer claimed. 'There are ways we can reduce our health risks and bump up longevity, but the carnivore diet doesn't tick those boxes. 'Meat itself is fine but the issue is in exclusion of all other kinds of foods.' Dr Willer slammed the anti-fiber rhetoric, saying fiber intake was associated with many health benefits and was 'healthy for our bowel bacteria'. 'We know that eating enough fiber is associated with a lower risk of heart disease and diabetes and bowel cancer as well,' she said.
