I cannot tell you how many times over the course of my career that a patient has said to me “since I turned 40 (or 50 or 60) I just cannot seem to lose weight.” If you are over 40 and have not had this experience, consider yourself blessed! What follows is the result of my personal quest to find answers to this dilemma, not only for my patients but for myself. It will contain some truths that may be hard to swallow so please don’t shoot the messenger!
When it comes to the aging female body, there is good news and bad news. The bad news is that most us of gain weight as we age. The good news is that such weight gain is not inevitable or irreversible (praise the Lord)! For the pupose of this discussion I will be referring to those years up to, including, and beyond the menopause.
For those of you too young to know much about menopause, a few definitions may be in order. Perimenopause is defined as those years leading up to and including menopause. Menopause is the complete cessation of the menstrual cycle marked by 12 consecutive months without a period. Once this has occurred, a woman is considered to be postmenopausal. During this time the levels of the hormones estrogen and progesterone become erratic and ultimately fall significantly. There is also an entity known as surgical menopause which is more sudden following the removal of both ovaries prior to natural menopause. Such sudden menopause can also result from certain cancer treatments. The average age at which menopause occurs is around 51 but it varies widely from the early 40’s to well into the late 50’s. Thus a woman may spend many years in this state of fluctuating hormone production.
Many women notice that not only is losing weight more difficult during this transition but any weight that is gained has a tendency to accumulate in the abdomen leading to the loss of the “girlish figure” of youth. There are multiple factors that lead to these changes. Once we have a better understanding of the changes that take place during these years and how we can combat them, the more likely we are to maintain our good health and control our weight well into our 60’s and beyond.
Loss if Muscle Mass
During the menopausal transition a woman may lose as much as half a pound of muscle mass per year. This has the effect of decreasing the metabolism. So even if you eat exactly as you did in your twenties and do not increase your physical activity, the aging body does not burn that fuel as well and the excess will result in weight gain. A sedentary lifestyle is one of the biggest factors in midlife weight gain.
Fat is an Alternate Source of Estrogen
Once the ovaries stop making estrogen, the fat cells become the major alternative source of estrogen production. The fat cells are able to convert precursor hormones secreted by the adrenal glands into estrogen. The estrogen produced by the fat cells is a double edged sword. The estrogen that comes from excess fat can lessen some of the symptoms of menopause but obesity is a major risk factor for breast and endometrial cancer. So while the body is trying to hold on to fat cells as a source of estrogen, too much fat can be dangerous.
One of the cardinal symptoms of menopause is the dreaded night sweat. Many women are awakened nightly drenched in sweat to the point of having to get up and change night clothes and/or bed linen. Others suffer from insomnia likely related to milder vasomotor symptoms and other factors. As we discussed in a previous blog post, sufficient sleep is essential to good health. It is while we are sleeping that the hunger and fullness hormones reset and our insulin levels fall. When sleep is out of kilter, so are those hormones making us more likely to store fat. In addition, poor sleep increases the temptation to snack at night, crave high calorie comfort foods and take in excess calories.
There are numerous changes during midlife to which a woman may have to adjust. Changing roles in the lives of loved ones, (including children and parents), illness, job changes, divorce and death of a loved one can all lead us to turn to food for comfort. These stressors can also increase our blood of levels of the stress hormone cortisol which encourages our bodies to store belly fat. As alluded to a previous blog post, we must find alternatives to eating to handle the stresses in our lives.
Women who are very active (as I was) may find themselves gaining weight due to the effect of many years of eating a diet high in processed carbohydrates like bread, potatoes, sugar and chips and other junk foods. Even those high protein bars, low fat foods and commercially prepared smoothies are usually full of sugar! Those of us who have been chronic dieters relying on such foods to help us lose weight have set ourselves up for a world of trouble! A lifetime of high carbohydrate intake leads to increased insulin levels. Eventually the insulin stops performing as well to lower blood sugar and we become insulin resistant. This encourages our bodies to store the excess sugar as fat! In addition to poor nutrition, declining levels of estrogen during menopause has been linked to insulin resistance in susceptible women. It is estimated that at least 40-50 percent of postmenopausal women have insulin resistance which leads not only to weight gain but to an increased risk of diabetes, heart disease, hypertension, stroke and dementia.
Solutions to Menopausal Weight Gain
1. Fight back against the slowed metabolism and muscle loss with exercise. While we have already established that exercise contributes only modestly to weight loss, it is very beneficial to preventing weight gain. Both aerobic exercise like brisk walking, cycling and running as well as strength training are no longer optional but necessary to maintaining a healthy weight during the perimenopausal and post menopausal years. Regular exercise is also a great stress reliever and provides an alternative to stress eating! The key to success with exercise is consistency. Find activities you truly enjoy and enlist the support of others to hold you accountable.
2. Learn what your triggers are for the night sweats and hot flashes that interfere with sleep. These vary from person to person. Some of the likely culprits are caffeine, alcohol, spicy foods, and sugars. If your night sweats are severe, you might want to speak to your doctor about medications and or other lifestyle changes to minimize them.
3. Consider adopting a LCHF (low carb/healthy fat) eating pattern (see last month’s blog post). A diet that minimizes processed carbohydrates and has moderate protein and increased healthy fats reduces insulin levels leading to less fat storage. Another way to reduce insulin levels is with time restricted eating. This can be as simple as eliminating late night eating by vowing not to eat within 2-3 hours of bedtime. If you go at least 12 hours without eating and get your morning exercise while still fasting, you will teach your body to burn your stored body fat to fuel your exercise, thus enhancing weight loss.
On a personal note, I went through menopause in my mid 40’s and struggled mightily with managing my weight throughout my 50’s. Even as an avid walker then interval runner I continued to struggle with my weight, hypertension and prediabetes. In the past year, even though I am now 64, I have been able to make remarkable improvements in my health by making the changes I have suggested to you. Be encouraged! It is never too late to take control of your health!!!
““Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit.”
3 John 1:2 NLT