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Menopause: weight gain, hot flashes, insulin resistance, diabetes

healthy women in menopause or perimenopause

While the average age of menopause is 51, many of the changes women experience start 6-10 years earlier during those peri-menopausal years. In episode #50 of the Energize Your Life Podcast, Dr. Jo interviews Hillary Wright, a registered dietitian nutritionist and one of the co-authors of the book, Menopause Diet Plan. Hillary discusses how to deal with weight gain, belly fat, insulin resistance, brain fog, and hot flashes during menopause - and perimenopause. 

Below is just some of the topics of discussion in the podcast. To learn more, play the podcast recording above. 

Read Dr. Jo's Blog on 3 Strategies for Dealing with Belly Fat

The Menopause Diet Plan

Dr. Jo: Hillary, tell me why you and Liz Ward chose to write about Menopause. Hillary: Well, it's interesting because Liz Ward and I have been friends, since college. We met as lab partners in organic chemistry. We have very similar senses of humor, complimentary personalities, and we've been friends, for 30 something years.

Hillary: So we're both registered dietitians. We both have three children, I have three boys, she has three girls. And, they have known each other their whole life. We always said we should do something together. Originally, years ago, we thought we'd have a radio show.

Dr. Jo: So why a book about menopause?

Hillary: Well, we both actually didn't hit menopause until around 55. But, it's the run up to menopause (perimenopause) where everything starts to change. And, that can be 6-10 years before menopause.

Hillary: I actually found that phase to be more disruptive than menopause. Because you're trying to you know deal with all of these changes that are making you start to wonder what's normal. Liz and I had these conversations about, "Is this happening to you, too?"
Hillary: And, we realized that just wasn't enough discussion about this, because I have a number of friends who are eight or 10 years older than me. One of the most useful things I heard ever was from my friend Donna, who was about 10 years older than me.

Hillary: I telling me her that my memory was going down the tubes and she said, "Oh don't worry, it gets better. And she was right. But during that like super turbulent time when your hormones are up and then they're down, it was worse. And, it's also a time of life, where women's lives are often tremendously in flux.

It's Not Just About the Hormones

Hillary: You know, there is a tendency to blame everything that happens in midlife on menopause and certainly deserves a lot of attention. But there's usually a lot of other things going on - and it's different for everyone.
Hillary: Some women still have young kids while some some women have older kids at home. Some women have older parents that they're really involved with.

Dr. Jo: Or going through a divorce, like I was.

Hillary: Yes, and some women are now in a more interesting job and traveling more and eating out. And, all these things take a toll on your time, your stress levels, and in your ability to sleep - at a time when your estrogen is starting to fall and your body is changing metabolically.
Hillary: Women need to realize that these changes that occur with menopause can not be micro-managed. We need to accept that no matter what you do, you're likely not to look the same as you did when you were 25.

Weight Gain During Peri-Menopause

Dr. Jo: You mentioned weight gain during menopause. What's average and where does it come from? 

Hillary: We looked at a lot of data from the large study called the SWAN study. The researchers found that the average woman starts to gain weight in their early to mid 40s and gains on average about a pound and a half of weight per year.

Hillary: And, that weight gain starts to level off about three years after menopause which technically is 12 months without a period actually.

Belly Fat

Hillary: With declining estrogen levels, there is a natural shift of body fat to the abdomen. 

Dr. Jo: True. My weight is the same, but my waist size is not.

Hillary: Right. You're like a good example of someone who to me looks the same as they've always looked. And, it makes others think, "I must not be trying hard enough."

Hillary: But we all come into this world with our genetics. I just did my 23 and me and not surprisingly, I'm 88.9% Irish, British Isles - and I have what we call the chicken body. I'll never gain weight on my legs - just get bigger on the middle, which we know is not good for diabetes risk.

Insulin Resistance and Diabetes

Hillary: Type two diabetes runs in my family. This is a largely reversible condition if you address it early enough.

Dr. Jo: What is insulin resistance and how can we treat it?

Hillary: We know a lot about insulin resistance, because in its most advanced stage it causes type two diabetes.

Hillary: Type two diabetes is taking off because of excess weight gain.

Dr. Jo: And, inactivity.

Hillary: Insulin resistance is a really complex thing, but basically when we eat carbohydrates, of any type, within about 60 to 90 minutes it's our blood as glucose or  blood sugar. This has to happen - we need it beause all the cells of our body use glucose.

Hillary: The amount of glucose that shows up in your blood after eating/drinking is directly proportional to how much you ate or drank. And, this quantity is going to dictate how much insulin your pancreas thinks it needs to secrete to sweep that glucose out of the blood and into the the cells can be energized and fueled.

Hillary: Insulin is like a key. It runs around and unlocks all our cells. It's what we call an anabolic hormone because it's designed to make cells grow. So when insulin is unlocking cells (to let blood sugar into the cells), the cells are growing.

Hillary: But insulin is an empty starvation hormone. It doesn't like to waste fuel.

Hillary: When all the essential cells are full, they're going to shut the door. The excess glucose has to go somewhere. It can't stay in the bloodstream because it's toxic. So the extra glucose gets turned into triglycerides and is stored in our fat, especially in our abdomen.

Hillary: The ironic thing is that insulin will then literally stand outside your belly fat like a guard and say I'm keeping it. And, it doesn't even want to give it up unless you're at risk of starving.

Hillary: Carrying around excess weight can aggravate the gene for insulin resistance. Being sedentary really aggravates the gene for insulin resistance. In fact, we know that people with pre diabetes if they start exercising, even if they don't lose any weight they're less likely to go on to develop diabetes.

Drinking Calories

Hillary: Because your body composition is shifting, most people cannot get away with eating like they used to. If women continue to eat and drink their calories through their 40s into their 50s as they did in their 30s, the majority of them are going to gain weight.

Hillary: The sugary drinks are associated with increased risk of diabetes, but studies tell us that women at middle aged and older are drinking more alcohol than they used to, too.

Dr. Jo: I hear from a lot of women in this timeframe, who are drinking alcohol, because it helps them to relax. And, they think that alcohol helps them to sleep better. But, it doesn't, does it?

Alcohol and Sleep

Hillary: Right. You may fall asleep easier, but the alcohol is more likely to wake you up in the middle of the night.

Dr. Jo: And prevent you from getting that deep restorative sleep that's important for managing your blood glucose and weight.

Hot Flashes

Dr. Jo: Sometimes it's hard to get a good, solid night's sleep and as we get older but let's talk about hot flashes because that can disrupt sleep, too.

Dr. Jo: My night sweats, during menopause were so bad that I would be soaked from head to toe and even after changing my clothes, the bed was too wet to get back in it. And, you mentioned that you've never had a hot flash.

Hillary: Clearly, people have different sensitivities to all the hormonal changes. Liz and I, when writing the book, looked for diet or lifestyle changes that can fix hot flashes and we found nothing that's consistent.

Hillary: Some things can aggravate hot flashes - like smoking and excess body fat. But there was nothing like a clear diet and lifestyle solution. We looked at herbs and again, nothing consistent helped. 

Hillary: Some women report improvements in hot flashes when they eat soy foods. But those phytoestrogens (in soy) are like 100 to 1000 times weaker than estradiol, which is what we produce.

Dr. Jo: I tried soy, too. But I got to the point where I just was getting good sleep and was so sleep-deprived that I worried that I was going to run the car off the road. So, the doctor started me on hormone replacement therapy.

Hormone Replacement Therapy

Dr. Jo: I went through menopause early and was off them before the age of when most women start menopause. But, it turned out it was to my advantage since I found out, at age 50, that I have osteopenia - weak bones, but not yet osteoporosis. And, hormone replacement therapy tends to strengthen bones. So, they may have been weaker if I hadn't been on the hormones.

Hillary: It is very important for people to consider all the pros and cons of hormone replacement therapy. Decades ago, doctors put all women on it and kept them them on it for ages and ages. And, then, research lead doctors to advise most women to avoid the hormones completely. Now the trend is more in the middle where medical professionals consider the individual person's clinical picture.

To listen to the entire interview, click below.

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