by Catherine W. Britell, M.D.
I remember when our sons were little, they’d occasionally come in with a sad face and a story about a teacher punishing them for something they didn’t do or having been repeatedly fouled in a basketball game and the referee never calling it. I’d always tell them something like the following:
“You know, sweetie – life is never fair; but YOU are absolutely AMAZING! You are so smart and so talented and so good that you will do wonderful things!”
In many ways, it’s wonderful to be a “mature woman”. As much as I miss my children, it’s great to be able to pursue my own interests now that they’re on their own. I love that my job has evolved to doing that which most inspires and delights me. And who misses those monthly cycles? Not me for sure! It’s great being the same person every day! Yet, there are some things about growing older and losing your hormones that, frankly, seem a bit unfair.
If you are getting into the SANE program after menopause you may face some unique challenges. You may find that you are not achieving the results that others seem to be realizing, despite “doing all the right things”. You may hop on the scale each morning to the same old number; going up or down a couple of pounds depending on how much salt you ate the previous day or two; but not budging overall. Your clothes fit about the same as they did last month. Your husband loves what you’re cooking for supper, and may be losing pounds and inches despite his eating granola and fruit for breakfast and a sandwich and dessert for lunch. “Collateral weight loss” on the part of husbands is very common. It’s UNFAIR, and often adds to your feelings of helplessness and defeat.
I’m here to tell you this: Life is unfair; but you’re smart and amazing and wonderful and you will make this work. But it will take longer and you will have to work harder than your younger or male counterpart.
First, it’s good to understand the “how” and “why” of your “mature woman” uniqueness when it comes to building muscle and burning fat. When sex hormones decline, there is a change in important fat-regulating hormones including ghrelin, leptin, insulin, and adiponectin . Ghrelin controls hunger/satiety signals and food intake. Adiponectin is involved in lipid and lipoprotein metabolism . Leptin is implicated in satiety and also in the generation of oxidative stress in blood vessels. Both leptin and adiponectin are involved in insulin sensitivity and pathways related with the occurrence of metabolic syndrome in postmenopausal women and the development of coronary artery disease. All this often translates to abdominal fat gain, a tendency toward metabolic syndrome or diabetes and an increase in cardiovascular disease.
Furthermore, aging and hormonal change make it more difficult to build muscle. After menopause, it has been shown that there is denervation and dropout of Type II muscle fibers, and muscle composition tends to change to predominantly Type I fibers. So, for older women, the metabolic changes that we would like to induce by strengthening Type II muscle fibers are more difficult to achieve. This seems to be made worse when there is lower intake of protein and Vitamin D; but generally does not seem to be made better by adding hormone replacement therapy.
So, what IS the strategy for losing fat and gaining muscle, increasing metabolism, energy level, and feelings of well-being for the post-menopausal woman?
Eating SANEly is the first and most important step. A SANE diet will reverse many of the fat-controlling hormone changes described above. But we probably can’t afford as many “cheats” as our younger or male counterparts. For example, that glass of wine with supper perhaps ought to be saved for a special dinner out once a month or so. And beer…not worth it. And fruit, as much as we love its beauty and natural health benefits, probably needs to be relegated to a berry or orange-slice garnish once in awhile instead of a serving or more per day. Even low-sugar fruit often has enough fructose to get in the way of our losing fat. The other thing that’s useful is taking a look at our actual fat intake. Although many delicious fats are somewhat SANE, we need to remember to keep those in balance with lean protein and non-starchy vegetables. Our tendency, when we grab a handful of nuts now and then, put a pat of butter on the veggies, or include egg yolks and cheese with our fritatta, is to overbalance our diet in favor of delicious fat, when we add that to the naturally-occuring fat included in the meat and fish in our meals. As good (and indeed, necessary) for us as fat is, it’s also easy to overdo with this tasty food, and find that too many of our calories are fat-based.
Also, we need to do everything we can to help our fat metabolism along. Don’t forget the fat-burning properties of green tea!
As far as exercise goes, we know that we can minimize Type II muscle fiber loss by USING them! So, we need to follow through with our eccentric exercise program. Even then, we need to keep as generally active as we can all day long in order to keep our metabolic level as high as possible.
How about hormone replacement therapy (HRT)? Well, there are conflicting reports on whether HRT will have much if any beneficial effect on the fat-regulating hormones or building muscle. The status of other information on the health effects of HRT is still somewhat murky; with the exception of perhaps increased incidence of stroke with HRT. If you’re considering HRT, you need to carefully discuss the pros and cons with your personal physician. Overall, at this point, it doesn’t look as though HRT will have a significant effect on weight loss and body composition.
How about plant-based hormones? Reports on the efficacy of black cohosh preparations (i.e.,Remifemin) and soy isoflavones with or without black cohosh (i.e.,Estroven) on relieving menopausal symptoms vary. With soy there are some significant adverse effects. Additionally, hypothyroidism has been reported with high soy intake when iodine intake is low. So far, there is no consistent data on whether supplementation with phytoestrogens has any effect on post-menopausal body composition or fat or glucose metabolism. Again, consult with your personal physician about the advisability of taking phytoestrogens supplements.
The lignans in flaxseed have been touted to improve menopausal symptoms; but they probably don’t. However, flaxseed has other health benefits that shouldn’t be ignored, including decrease in inflammation, improved lipids, and improved blood sugar….all of those significant menopausal changes described above. We should probably eat as much milled flaxseed as we can without getting uncomfortable gas or diarrhea.
Those who have experienced menopause know that sleeplessness can be a problem. We know that lack of sleep raises serum cortisol, which will make fat loss extremely difficult under the best of circumstances. So, it’s really important to pay attention to this issue; perhaps limit caffeine intake, and develop a regular “settling down” routine before bedtime. Sometimes yoga or meditation can help with control of that “racing mind” that doesn’t seem to let us settle down at night.
So, a few concrete suggestions:
- Be compulsive about eating enough protein (1 gram/lb up to 200 gm/day) and non-starchy vegetables (10 servings). Even if you’re not very hungry, your body will go into “shut-down” if you stop eating. Don’t forget mid-morning and afternoon snacks.
- Use fruit as a garnish only.
- Go VERY easy on the nuts, and monitor added fat carefully.
- Minimize alcohol intake; and avoid beer or sweet liquors
- Consider a vitamin D supplement of 2000 iU/day if you’re not out in the sun every day.
- Maximize milled flaxseed intake. ¼ cup per day is good if tolerated.
- Faithfully do the eccentric exercises and cycle-based HIIT as suggested in SANE.
- Pay attention to “sleep hygeine” techniques to minimize hormone-induced sleep problems.
- Try to be active each and every day. Get out in the fresh air when possible, move around, try to get a little sun every day, keep yourself socially engaged and intellectually stimulated.
So, it’s going to be a bit more of a challenge for those of us who are post-menopause to lose fat and gain muscle; but it is certainly possible, and the reward is well worth it: Adding YEARS to our LIVES, and more importantly, adding LIFE to our YEARS.
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