Fighting Menopausal Spread
Hormonal fluctuations at midlife cause more than just hot flashes
and night sweats—they can lead to weight gain, too.
By Beverly Burmeier
When Cathy Hofer, 56, of LaPorte, Indiana, entered her menopausal years, she was surprised to find a muffin top peeking out over her waistband. She couldn’t understand why—the high school choir teacher rarely snacked and worked out four or five times a week in her home gym. Wasn’t that enough to stay in shape? “Despite those efforts, I watched myself gain weight,” Hofer says.
What Hofer didn’t know is that menopause itself can actually lead to weight gain. Nutritionist Mickey Harpaz, PhD, says, “Many women don’t realize the importance and consequences of their bodies gradually burning fewer calories as they age, and of the decreasing estrogen levels that cause the body to deposit fat cells at a higher rate than before menopause.”
The North American Menopause Society estimates that 6,000 American women reach menopause every day. Harpaz, who practices in Redding, Connecticut and is the author of Menopause Reset (Rodale Books), says nine out of ten will add pounds, generally around the midsection.
Hormones Out of Kilter
Insulin resistance is a crucial reason women gain weight as they pass through menopause—even if their caloric intake hasn’t changed, says Florida weight management specialist Caroline J. Cederquist, MD.
In this condition, insulin—the body’s chief blood-sugar control hormone—has a difficult time moving glucose into cells to be burned as fuel. “The resulting energy deficiency stresses the body so that further hormones are released, signaling the body to both store more fat and to increase appetite. The result is weight gain,” Cederquist explains.
Hofer believes a hormonal imbalance contributed to her struggle with belly bulge. Here’s why: As estrogen production from ovaries decreases, a woman’s body looks for other estrogen sources.
“Fat cells can produce estrogen, so her body works harder to turn calories into fat to increase estrogen levels. Unfortunately fat cells don’t burn calories the way muscle cells do,” Harpaz says.
The type of estrogen produced also changes; ovaries create estradiol while fat produces estrone.
“Estrone starts to shift fat from the buttocks to the belly, leading to a decrease in curves and an increase in belly fat. This abdominal fat starts to produce more estrone, which just leads to more and more belly fat,” says Michael Aziz, MD, director of Midtown Integrative Medicine in New York City and author of The Perfect 10 Diet (Cumberland House). The change is more than cosmetic; excess abdominal fat has been associated with various disorders including type 2 diabetes, breast cancer and high blood pressure.
While decreases in estrogen (and its partner, progesterone) occur as a normal part of menopause, Aziz believes that today’s processed foods don’t help women cope with these changes easily.
“Excess sugar and elimination of natural fats have led to serious disturbances in these important sex hormones. It is no wonder infertility and early menopause are now on the rise,” he says.
Fight Fat with Your Fork
Harpaz says to forget the traditional notion of diet as a short-term weight-loss program. Instead, think of it as a lifestyle behavior pattern—eating the right foods in the proper amounts and at the correct times to enhance your body’s ability to utilize nutrients without converting them into fat.
The first step is to stabilize your blood sugar levels—and that may mean eating more often, not less.
“Not eating for three or more hours will cause your blood sugar, or glucose, level to drop below normal (less than 65 milligrams per deciliter),” explains Harpaz. “Low blood sugar triggers the menopausal body to greatly increase blood sugar the next time you eat. This triggers increased insulin production which decreases your body’s ability to burn fat.”
Skipping or delaying meals also slows metabolism. Harpaz says, “If you feel hungry and deprived, your body thinks you’re starving and tries to compensate by slowing down how fast you burn whatever calories you give it. This makes weight loss difficult, if not impossible, because your metabolic rate is drastically reduced.”
Eating more often can keep you from eating too much at any one time. When consuming a large quantity of food in a single meal, your body converts excess calories into glucose and triglycerides (blood fats). Harpaz says the resulting spikes in glucose and insulin levels prevent the body from utilizing stored body fat.
Consuming too many carbohydrates at one sitting has the same effect as eating foods in large quantities, Harpaz says. That means two or more servings of cereals, breads, potatoes, legumes or beans, pasta and rice at one meal will raise blood sugar and insulin levels—again preventing weight loss. Excess sugar carbs can be especially damaging. Harpaz warns that eating more than 10 grams of sugar at a time sharply raises blood sugar. And after the spike your glucose levels will crash, leaving you hungry and tired.
Eating often also gives your body more work to do. Consuming, digesting and assimilating food five or six times a day burns calories. In addition to three square meals, small snacks such as fresh fruit or vegetables, nuts, yogurt or rice cakes approximately two to two and a half hours after a meal help control glucose levels and keep you in the fat-burning zone.
What you eat can affect your metabolism. “It takes more calories to break down and digest carbs and protein than fat; therefore, a diet based on a higher intake of carbs and protein than of fat results in a higher metabolic rate,” says Harpaz. What’s more, eating more fiber—40 to 50 grams a day—can help suppress appetite by slowing the absorption of nutrients into the bloodstream, which helps you feel full longer.
A healthy diet is based on whole foods. “Real food doesn’t have labels. If there’s a label, don’t eat it,” says NAMS-certified menopause practitioner David Miller, MD, who with his wife, Lovera Miller, MD, wrote Womenopause (O Books).
If that sounds a bit extreme, at least learn to decipher the nutrition facts information required on all packaged foods. Check serving size, since many packages contain multiple servings—substantially raising the calorie count if you eat it all. Avoid any product with more than 650 milligrams of sodium per serving; too much sodium causes water retention and makes weight loss more difficult. Try to stay below 30 grams of fat and 10 grams of sugar (any ingredient ending in ose) per day. Beware of “fat-free” foods, as these often contain excessive sugar or potentially harmful artificial sweeteners.
Miller recommends whole foods that contain vitamins C, E and D, as well as calcium and fish oils. This puts fish (especially cold-water species such as salmon), organic dairy, whole grains, vegetable oils, nuts, vegetables and fruits on the menu. Produce also supplies phytonutrients, natural substances that boost health. (One example is resveratrol, which according to a study in the Journal of Biological Chemistry, appears to help activate a fat-controlling hormone called adiponectin; for more natural weight control aids see the box on page 40.) Even natural foods require portion control, however, so limit servings of each food on your plate to an amount the size of your fist.
Willette Sonshine, 63, of Redding, Connecticut, a client of Harpaz’s, has lost 52 pounds in the last year. She eats every two hours and writes down everything she consumes. “It keeps me accountable,” she says. “I don’t count calories or worry about food exchanges, and it’s okay if I occasionally splurge on a bowl of ice cream.”
Physical activity complements a healthy diet. “When you exercise, you lower insulin level and increase glucagon, the fat-burning hormone that opposes insulin action,” “When these two hormones are in balance, you shed pounds,” says Aziz.
The first way to maximize exercise’s effects is to aim for 30 minutes every day; walking is a good, low-impact start. Harpaz says exercising in the morning allows you to reap benefits all day because the increase in metabolism rate lasts up to 12 hours post-workout. Doing aerobics also keeps blood sugar stable and builds stamina for activities outside the gym.
While any exercise is better than none at all, cardio sessions should last for at least 30 to 45 minutes because it takes 15 to 20 minutes before the body starts to utilize its fat stores. A moderate level of exercise—so that you’re sweating slightly and breathing is mildly labored—uses 50% to 70% of your maximum capacity and burns more of the fat you want to lose.
Exercise not only redistributes weight away from the abdomen, it helps build muscle and increase the ratio of lean body mass to fat. This is especially important after menopause because women have a higher percentage of body fat than men, but muscle accounts for about 90% of the body’s metabolic rate.
Resistance training helps build extra muscle. Doing pushups (from your knees, to start) and using resistance bands—basically oversized rubber bands—can help you achieve a firmer, more toned look. (Check with your healthcare practitioner if you’re just starting out, especially if you have a pre-existing condition.)
Stress, whether emotional or physical, can be a big factor in menopausal weight gain. Harpaz says prolonged stress can lead to adrenal fatigue resulting in body aches, tiredness, poor sleep and changes in the way the body metabolizes foods. “Don’t take the remedial effects of sleep for granted, but try to get seven to eight hours of uninterrupted snooze time a night,” suggests Miller.
Identify common triggers that sabotage weight loss success—boredom, low self-esteem, unrealistic expectations or feelings of deprivation—and work at eliminating them. Modify stressors for those things in life that are changeable, and don’t fret about those you have no control over.
Harpaz suggests remembering times and events that made you happy and using them to set goals for the future. Establish a time line for what you realistically hope to accomplish, but don’t get bummed by inevitable slumps; focus on where you’re going rather than where you’ve been. Be kind to yourself, affirm your goals and trust yourself to stay motivated.
Imagine yourself already achieving your dreams—including dreams of a thinner, happier you. Sonshine says, “There’s no magic; it’s just common sense. Losing weight has helped with every aspect of my life and health.”