Weight Management in Menopause

by Jade Teta ND, CSCS, and Keoni Teta, ND, LAc, CSCS

Keoni and I typically write more scientifically referenced articles for the Townsend Letter, but in this article we are going to keep it clinical.
We have a very good track record in dealing with weight gain around the time of menopause. So much so that we developed an online program that has literally helped thousands of menopausal women figure this thing out.

This article gives a overview of our approach to practitioners who have been struggling with this issue in their practice.

Background and Protocol Rationale

Estrogen and progesterone, while lower in the fat-burning hierarchy compared with insulin and cortisol or thyroid and adrenaline, nevertheless do impact a woman’s fat-burning metabolism.

Estrogen is an insulin sensitizing hormone and a hormone that controls the negative impact of cortisol. Progesterone opposes the action of estrogen on insulin, but works together with estrogen in controlling the negative impact of cortisol.

Why is this important? Because insulin and cortisol are a bad hormonal combination for fat loss. These two hormones, when combined in high amounts over long periods, push the female physiology toward storing fat when calories are high (as opposed to building muscle) and reducing the amount of fat burned when calories are low (burning muscle instead). This is a bad combination for any woman, but a menopausal woman is affected to a much greater extent.

Since insulin and cortisol may be the primary culprits in female belly-fat storage, the transition into menopause often results in fat gain, especially around the middle.

An Approach to Fixing the Issue

Patients are far more carbohydrate reactive and stress sensitive after menopause. Which means that the carbohydrates they once ate without affecting their waistlines may now be too much and do just that.
Likewise, the stressful exercise and lack of sleep that they could tolerate in their younger years, while still remaining lean, will now start to show on their waists.

To deal with these hormonal impacts, requires a far more insulin-centered approach than a caloric one. In other words, whereas a lower-calorie diet may have been enough in their younger days, they may now need to watch their starch and sugar intake as well.

Food Prescription?

At menopause, it may no longer be just refined sugars that are the issue. You may want to counsel regulation of all foods that have potential insulin-promoting action. This includes many foods that are regarded as “healthful.”
Whole-grain breads, sweet fruits, dairy foods, and starchy vegetables, which may have once been a central part of their lean diet, may now be working against them. Reducing these foods while simultaneously increasing low-starch vegetables, low-sugar fruits (berries, apples, and pears), and protein foods has been a very simple approach for us in dealing with menopausal weight gain and belly fat. It also reduces many of the associated risk factors (i.e., BP, HgA1C, triglycerides, etc.).

How to Exercise?

Exercise too must be approached differently. Cortisol is produced during intense exercise and long-duration exercise. This includes long-duration jogging or running and high-intensity interval training (HIIT), metabolic conditioning, or weight training.

However, intense exercise that is short also raises growth-promoting hormones such as HGH and testosterone, and these hormones work with cortisol to burn fat and build, or at least maintain, muscle.

Long-duration exercise works differently. It has a different hormonal impact, and it may exacerbate the negative effects of cortisol because it raises cortisol without the balancing action of the growth hormones. And raising cortisol this way during menopause, a time when the female physiology is far more susceptible to the negative impact of cortisol, can frequently cause more issues than it solves for weight gain.

For this reason, we prescribe shorter intense exercise. We have seen it be more beneficial and tolerable compared with long-duration moderate-intensity exercise.

Cortisol can also be controlled and lowered nicely by relaxing activities. These include leisure walking (to be distinguished from power walking), restorative yoga (to be distinguished from intense yoga), and tai chi, as well as massage, sauna, and other restorative nonexercise practices.

All of this is important because the dominant message sent to menopausal women, from the typical nutritionists and doctors, as well as the mainstream press, runs completely counter to all we just covered. The message is to do more jogging and power walking, not less. They are instructed to eat more grains and dairy and less protein. And they are rarely told to lift weights or educated on the benefits of rest and recovery-centered activities

Together, a lower insulin-promoting diet and a smarter stress-inducing exercising regime can make a huge difference. Remember, the menopausal physiology is more carbohydrate reactive (estrogen is no longer there to help offset insulin) and more stress sensitive (estrogen and progesterone are not there to dampen cortisol’s negative effect).

The changes to diet, exercise, and lifestyle can help combat menopause weight gain. Here are the changes that we recommend:

1. Leisure walk daily 1 hour per day (it lowers cortisol). Preferably do it in a nature setting (it lowers cortisol even more). A study out of Japan published in the Journal of Physiological Anthropology in March 2007 showed some very interesting metabolic effects of walking, especially when done in a natural environment.

2. Weight-train intensely at least 1 time per week, preferably 3. These sessions should be short. Shoot for less than 60 minutes or even better, less than 30. They work great along with walking too. Studies demonstrating this were published in 2000 out of the Journal of Clinical Endocrinology and Metabolism (85[2]) and in the March 2004 issue of the American Journal of Physiology, Endocrinology and Metabolism (286).

3. Drastically increase nonstarchy vegetable intake while cutting back on starchy foods, grains, and dairy (this does not mean not to eat these foods, just eat less).

4. Raise protein intake with foods that are mostly protein (fish, chicken, etc.) versus mostly starch or fat (beans and nuts have some protein but far more starch and fat). To help, consider a protein powder replacement shake 1 or 2 times per day.

5. Build in restorative and relaxing activity. A concept we call “rest-based living.” Sleep, nap, physical affection, laughter, massage (even self-massage such as foam rolling), sauna, restorative yoga, and tai chi are all great.

I know that many practitioners will want to know, what about supplements and HRT? Sure, they can work, but not like the above recommendations. We have found that prescribing supplements or hormones without getting the lifestyle stuff above is a lot like trying to clean up a spill on your kitchen floor with a Dixie cup instead of a mop. It won’t do nearly the job you want it to.