What foods should I be eating to stop gaining weight? A cousin navigating the mysteries of peri-menopause just posted this plea on my Facebook page, but it is a familiar lament. Prior to menopause our hormones shift and influence everything from mood and libido to vitality and metabolism. While the medical community identifies menopause as a discreet event–the cessation of monthly bleeding– the experience is something else. Symptoms of the changing hormonal landscape can endure over time. Some women notice the first changes in their 40’s, yet their the last period may not occur for another 10 years. They gain weight, fight to get enough sleep, and miss their usual energy and stamina. What is going on, and probably more critically–what can you do about it?
TREATMENT OPTIONS FOR MENOPAUSE
Last week Medscape published, Treatment Options for Menopause, a piece that I found rather unhelpful– mostly for everything it didn’t say. The authors explain that a reduction in serum estrogen and androgen levels drive the most obvious symptoms of menopause: hot flashes, weight gain, mood swings, vaginal atrophy and dryness, and sleep disturbances. The article highlights medication options, with a good amount of attention on the Women’s Health Study (WHS) findings. But check out the comments. There were problems with the landmark research. I’ve had nurses tell me they just made stuff up when they filled out the questionnaire. The study design was just not that rigorous, and current data is just not adequate. The researchers conclude that hormone replacement therapy works best to quiet menopausal symptoms, especially if you don’t have to take the progesterone. Current recommendations direct women to use as little HRT as possible for as short a time period as possible.
I bristled when I scanned additional research. Too many considered the menopause rather minor inconvenience, noting that symptoms usually don’t last longer that one year. But I woke up repeatedly in a torrid sweat every night (and yet know others who never really experienced anything more than a glow.) I knew that anyone with the nerve to minimize the problem didn’t have any idea how debilitating symptoms could be. After waking 10-12 times a night and changing bedclothes 2-3 times before the light of dawn, I then had the privilege of struggling with the metabolic fall out all day long, exhausted and craving sugar. Really? I am just suppose to grin and bear this for a year?
MENOPAUSE: BIGGEST CHALLENGES
The change brings plenty of challenges. Periods are no longer predictable, nor are the symptoms. I remember one especially frustrated colleague lamenting that there is something seriously wrong when she experiences heavy bleeding,cramps and hot flashes– all at the same time. But even difficult symptoms can be less frustrating when they are familiar. Many women tell me that when they stop bleeding each month, its as if they lose their biological compass. For decades my brain would filter any cramping, bloating, change in appetite, mood swing or other symptom through my menstrual calendar. Only in hindsight did I realize there was a bit of relief when I shrugged and muttered, “Of course, I’ll probably start tomorrow.”
Weight gain was especially frustrating during the peri-menopausal years for me. I already eat pretty clean and I’m very active and actively used both diet and exercise to counter the metabolic impact of menopause. Physical movement improves symptoms in in several ways. First activity improves insulin sensitivity in your muscle cells, making it easier to for your body to burn fat for fuel. Second, movement helps to reduce stress, which also influences energy metabolism. Hot flashes often parallel surges in the flight or flight hormones as well as cortisol, a hormone your body secretes in times of chronic stress. So I bumped up my exercise to include 60-90 minutes most days of the week. Thankfully, that was relatively easy as my bike commute to work takes about 20-25 minutes each way.
I also ate cleaner. Menopause is an insulin resistant state driven by hormonal shifts much like puberty and pregnancy. It is easier to gain weight–both fat and water weight– during these conditions. Increased secretion of insulin drives the metabolic mess and eating excessive carbs drives even greater insulin secretion–which all too often results in craving for even more sugar and starch.
When insulin secretion increases, many women experience greater water and sodium re-absorption, hence the bloating and quick weight gain. In addition, an insulin resistant state drives the body to preferentially store energy as fat instead of burning it as fuel–an incredibly efficient metabolism. Lovely. So, my diet reflected more protein and produce. I stayed away from more processed plants foods and embraced beans and legumes–the kinds of carbs that allow for a nice slow rise in blood glucose over time and a far more muted insulin response. I felt satisfied without struggling with rebound cravings that make all things white, savory, and sweet utterly irresistible.
WHY MANAGE STRESS
By far the most difficult factor to manage included all sources of stress. Any potentially challenging situation met with beads of perspiration. Not cool. Too little sleep and poor quality of sleep made everything worse. I started practicing extreme self care, making sure my activity was joyful, not just what I should do. I indulged in manicures, pedicures, buying myself flowers, listening to music, and playing scrabble with friends. I scheduled massages and put even more effort into cooking. Each meal reminded me that enjoying just enough delicious food satisfies in a way that overeating never will.
Still, the symptoms didn’t totally subside and I continued to gain belly fat. After four years, I sought help outside of the conventional medical system. I appreciated the opportunity to receive bio-identical hormones from a more progressive gynecologist, and met regularly with her to adjust dosing while working with a compounding pharmacy. The sweating stopped and my sleeping improved. My mood lifted and I felt more resilient.
So, try diet and exercise, but not just any diet and any exercise. The insulin resistant nature of menopause typically means you may benefit from more protein and adequate fat with carbohydrates primarily coming from the produce section as well as beans and legumes. You may need to experiment to find what works for you.
Strive to enjoy tasty, balanced and satisfying meals so that you will not be inordinately seduced by the constant parade of starchy and sugary treats that pass before our eyes. Seek opportunities to move with joy. It is time to abandon the archaic notion of going for the burn. You need to go for burning the fat– and burning fat for fuel requires working with your body, not beating yourself up. Ironically working out too hard can actually make insulin resistance worse.
Lastly, if you do consider hormone replacement therapy, consider bio-identical hormones delivered directly to your skin. Your body will soak up the most biologically active form of estrogen, feeding your brain, your metabolism, and your libido. Bonus.
If you come across something that works for you, consider letting me know in the comments section below or via email: firstname.lastname@example.org. I’m waiting to hear.