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Archive for July, 2017

During menopause, weight is easy to gain (in fact, some weight gain is almost inevitable) and hard to lose, for all the reasons we mentioned in the last post: metabolic change, loss of muscle mass, hormonal change, sleep deprivation, and stress.

So, ladies, if you’re just entering menopause—heads up! Game-changer ahead! Women who enter menopause close to their ideal weight have a better chance of maintaining it; however, women who tend to yo-yo or who have a hard time maintaining a healthy weight will tend to end up at the high end of their weight range.

Don't eat anything your great-great grandmother would not recognize as food.Whatever you did in your 30s to keep your weight in check isn’t going to work anymore. You’ve lost about 20 percent of your muscle mass and you need about 200 fewer calories per day you enter your 50s and 60s. Forewarned is forearmed, as they say. Simply recognizing this fact may help you step away from the hamster wheel of yore and toward a regimen that actually works.

The good news is that the best weight management strategy—the one that will work for the long haul—will also keep you stronger, more flexible, healthier, and capable of maintaining an active lifestyle for far longer. You’ll be able to travel, garden, play with the grandkids, get up off the floor, carry heavier loads, and remain generally pain-free.

The bad news is that it’s hard. A realistic and effective strategy to maintain a healthy weight requires self-discipline and lifestyle change. For the rest of your life. As you’ve probably guessed, you have to get serious about exercise and your diet—how much and what kind of food you put in your mouth.

Sure, you can go on a killer diet; you can take medications that will help you lose weight. But you probably already know the drill here—without lifestyle change, you’ll put it right back on and then some. Only now, you’re much more vulnerable to a host of serious, life-altering ailments, such as joint problems, diabetes, and cardiovascular trouble.

So let’s talk about ways of eating that work for older women. We’re not talking about draconian measures that you’ll have a hard time maintaining. In fact, overly rigorous dieting can actually cause you to lose muscle mass and slow your metabolism even more, which is the last thing you need right now.

  • Focus on fresh, real, homemade food. You need to consume fewer calories, but they need to be high-quality, nutritious calories. Think whole grains, fresh fruit and vegetables, nuts, and legumes. Don’t go crazy on low- and non-fat foods, which are unhealthy in hidden ways. Instead, go for the unsaturated fats in olive or sesame oils, avocados, nuts, and salmon or tuna. “…[nutrient-rich, unsaturated fat] keeps your skin supple and your body from drying out. Basically, it’s like putting lotion on your body but from the inside out,” says Dr. Christine Gerbstadt in this article.
  • Speaking of calories: A sedentary older woman in her 50s and 60s should consume about 1600 calories per day. If you’re more active, bump that up to 1800 calories. To lose one pound per week, you need a daily 500-calorie deficit, either through diet or exercise. I’m thinking it’s better not to gain that weight in the first place.
  • Protein is important to replace muscle and protect bones—5 to 6 ounces of lean protein per day, such as that in dairy products, poultry, and fish.
  • The best diets for older women are the Mediterranean diet and the low-carb diet. Vegan and vegetarian diets are also good for weight loss and have been linked to greater longevity.
  • In the beginning, a structured meal plan is helpful. Write down what you’ll eat in the morning, so you don’t find yourself peckish in the mid-afternoon and absentmindedly reaching for the cookies. Later, you can mentally plan your daily menus. Try to establish a regular pattern, so you get used to eating at about the same time each day.
  • Avoid sugar, but don’t be obsessive about it. If you’re too rigorous, you may just be setting yourself up for a binge. An occasional treat is a nod to mental health.
  • Alcohol (even in red wine) is not your friend. Alcoholic drinks are full of sugar and high in calories. One 4-oz. (half-cup) wine or beer per day is the limit. 1.5 oz. for spirits.
  • If you slip up, it’s not the end of the world. Start fresh the next day. Just don’t give up.
  • Bariatric surgery is a highly risky last-resort. But it does work, and may be less risky than years of obesity,
  • Oh, and drink plenty of water.

“My body has changed, so I’ve got to change with it. I can’t do what I did 20 years ago and expect to stay slim,” says nutritionist and co-author of The Full Plate Diet Dr. Diana Fleming in this article.

Staying fit and trim after menopause is no picnic, but feeling healthy, capable, and in control of your life is worth every uneaten ounce of chocolate.

 

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As if the hot flashes, mood swings, night sweats, and sexual challenges weren’t enough, now you can add weight gain to the menopausal whammy.

That’s right. In case you hadn’t noticed (fat chance!), women tend to gain about 10-15 pounds on average—from 3 to 30 pounds is the typical range—during and after menopause. And because our entire metabolic mechanism is different now, that weight is blessedly hard to take off.

“I feel like my body has betrayed me,” said one of my patients.

“Prior to menopause I was able to maintain a weight loss of 70 pounds. I see that 25 pounds have come back and nothing I seem to do is helping,” said another woman.

Weight gain during menopause isn’t totally related to “the change.” Lifestyle, genetics, and, yes, hormonal fluctuation all play their respective roles, for better or for worse. But the weight goes on, and the way that happens is different from weight gain in previous years.

So, if you’re accustomed to losing weight easily—or not gaining it in the first place—this development may come as a puzzling and unpleasant surprise. And if you struggle with your weight, be forewarned: The deck is about to be reshuffled, and that struggle may become harder yet. The single bright spot is that you’re in a very big boat with a lot of other menopausal gals—up to 90 percent of us gain weight during this transition, according to this article.

Menopausal weight gain is different because:

  • It’s slow and steady—one or two pounds per year. Not enough to really notice, but the cumulative effect sneaks up on you.
  • It accumulates attractively around the abdomen. Belly fat. The kind that’s linked to heart disease and diabetes.
  • Breasts are bigger and the back is fattier. This might be nice for those of us who’ve always been lacking in that department, except that now, accompanied by a slowly enlarging belly, not to mention the back fat, the overall effect is less than flattering to our contemporary visions. And for those who were always well-endowed, well, a little (or a lot) more may simply be overkill.
  • It’s hard to lose. While “hard to lose” is a functional definition of weight gain, this is different because it’s part and parcel of a more profound change in how your body processes energy.
  • Body shape changes. Previously, you may have been a string bean or a curvaceous plum. Now you’re a round apple.

In order to effectively tackle this unsettling turn of events and to grasp why the things you did before aren’t working now, it helps to understand the underlying mechanism.

For one thing, muscle mass, which is an efficient burner of calories, slowly decreases with age. Now, even your resting metabolism (when you aren’t active) is lower. Adding insult to injury, loss of estrogen compounds this effect. Studies of lab animals suggest that estrogen has a regulating effect on appetite and weight gain. Animals with lower estrogen levels ate more and moved less.

When the ovaries stop producing estrogen, fat cells tend to take over. Ovaries produce estradiol, a “premium” estrogen; fat cells produce estrone, which is a weak, inefficient estrogen. This hormonal change increases the body’s efficiency at depositing fat, especially, we find, around the abdomen.

What used to work in the past may not now.A recent study confirmed that certain proteins and enzymes that enable cells to store more fat and to burn it less become more active in post-menopausal women. “Taken together, these changes in bodily processes may be more than a little surprising—and upsetting—for women who previously had little trouble managing their weight,” comments Sylvia Santosa, assistant professor in Concordia University’s Department of Exercise Science in this article.

You got that right, sister.

Menopause packs a couple more weight-inducing changes: insomnia and stress. When you don’t sleep well (and who does, what with night sweats and cratering mood swings?), levels of ghrelin, known as the “hunger hormone,” rise and levels of the “fullness hormone” leptin drop. That’s why you get the nighttime munchies. A study of over 1,000 volunteers (The Wisconsin Sleep Cohort Study) found that those who slept less had higher ghrelin levels and lower leptin levels—and also had a higher body mass index (BMI), i.e. they weighed more.

And we all know what stress eating does to our waistline.

So, what’s a stressed-out, sleep-deprived, menopausal woman to do? It’s a challenge, without doubt. However, when we understand the mechanism—what’s happening to our bodies on a biological level—then we realize that doing what we did before isn’t going to work. We need to change up the paradigm if we want to control our weight and maintain a healthy, active post-menopausal lifestyle.

This paradigm shift involves a different approach to both diet (Note: I did not say dieting!) and exercise. No magic pharma pill or painless regimen. Still, we can regain control of the bathroom scales despite the slings and arrows of our slowing metabolism and estrogen-storing fat cells. And honestly, we might end up with better health habits than we ever had before.

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Your Brain on Estrogen

Estrogen, as you know all too well these days, does a lot of good things for your body and your mood. Maybe you didn’t know that it also does a lot of good things for your brain.

“In preclinical studies, estrogen was shown to improve energy production, reduce oxidative stress, increase brain cell survival during damage, enhance the release of protective chemicals, and improve memory,” according to this recent article.

So, you may ask, what the heck happens in the brain when estrogen disappears after menopause? Researchers are also asking if estrogen, or the lack thereof, plays a role in Alzheimer’s disease, the most common form of dementia, which disproportionately affects women.

Neither menopause nor lack of estrogen is directly linked to dementia, or specifically, to Alzheimer’s disease. No smoking gun or causal connection has been found despite numerous studies comparing women who have taken estrogen with those who haven’t.

“…Evidence from cohorts in Melbourne, the United Kingdom, and rural Taiwan suggests that the natural menopausal transition probably does not have important effects on episodic memory or most other cognitive skills,” states this National Institutes of Health (NIH) article.

So, what does happen in the brain when estrogen production declines after menopause? Are all those “senior moments” really the result of our estrogen-starved gray matter? Does estrogen replacement therapy (ERT), have any effect on brain health? Finally, although no treatment exists for Alzheimer’s disease, could estrogen play a role in preventing or delaying its onset?

While these are all tantalizing questions that researchers are beginning to tease apart, no actionable answers are forthcoming, yet. Frankly, research results are all over the map. You may remember the groundbreaking 2002 Women’s Health Initiative that was responsible for a seismic shift in the routine use of estrogen therapy after concerns about risk of breast cancer and heart disease–some of which were misunderstood or at least miscommunicated.

Less well-known was that a cognitive component to that study (the Women’s Health Initiative Memory Study) found that the risk of dementia increased, sometimes dramatically, for women over 65 who were on hormone therapy.

However, several recent studies suggest that beginning hormone therapy at a younger age may have a protective effect on the brain. A recent study in Norway and another in Finland determined that taking estrogen before and during menopause, resulted in increased brain volume, especially in the hippocampus, which is the area associated with memory and sense of place and which is most disrupted by Alzheimer’s disease.

These conflicting results have led to the “critical window” hypothesis: that at some points in the menopausal transition, estrogen may help preserve brain function while at others, not so much.

“Most researchers seem to accept the idea that a critical window exists during which estrogen treatment is most likely to be beneficial. ‘The question is, when is that window open, and when is it closed?’ ” said Roberta Diaz-Brinton in this article.

Diaz-Brinton suggested that healthy cells may be more likely to respond positively to estrogen but older or “sickly” cells may not. This is the “healthy cell bias of estrogen.”

Frustratingly, for those of us approaching menopause, the data continues to roll in and not much is consistent enough to define a course of action. Obviously, a bunch of variables confound the picture: how the estrogen is administered (whether by pill or patch); what kind of estrogen is administered (bioidentical, equine, or some other formula); certain genetic factors; the combined effect of estrogen plus progestogen (for women who still have a uterus); plus all the other variables of country, culture, health, and lifestyle.

The current position of the NIH, which can be expected to take a conservative position, is that “it is unknown whether estrogen effects on Alzheimer risk are modified by age of use or by use during a critical window close to the time of menopause.”

Probably the most reasonable course of action is to continue to follow general medical guidelines to take the smallest dosage of estrogen for the shortest period of time to relieve menopausal symptoms. According to the most recent studies, that’s when it might do your brain the most good. Beyond the menopausal years, evidence suggests that it either has no effect or it has a negative one.

And, for our daughters’ sake if not our own, let’s continue to speak out about the importance of research in women’s as well as men’s health. We are not the same.

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