Don’t Let Menopause Stall Your Weight Loss Efforts with Dr. Lauren Streicher
Dr. Lauren Streicher
Jonathan: Hey everyone, Jonathan Bailor back with another bonus Smarter Science of Slim podcast. Thrilled about today’s show because we have one of the foremost experts in the world for one of the most commonly asked questions I ever get. We’re just going to dig right in and get some amazing and hopefully helpful answers from someone who, I’ve got to tell you, you’ve seen her all over the place. I don’t know she’s like super woman.
She’s over on the Dr. Oz Show. She’s over here on ABC. She’s doing her thing as an Associate Professor of Obstetrics and Gynecology over at the Feinberg School of Medicine at Northwestern University. She is also acting as a certified menopause practitioner of the North American Menopause Society. She’s an M.D. She’s awesome. Lauren Streicher, welcome to the show.
Dr. Streicher: Well, thank you so much for having me.
Jonathan: Dr. Streicher, I had to have you on because one of, as I mentioned in the intro, the most common questions I get asked is why is it that, so many of the listeners of the show are females who are pre-menopausal, menopausal, or postmenopausal and they’ll start eating a more nutrient dense, hormonally healthy, whole foods and they’ll see benefits.
At the same time their husband who really could care less also starts eating that way as a byproduct of her very intentional efforts. He, accidentally, his pants are falling down, he’s losing weight so fast without even trying whereas she is seeing results but just not as quickly as she would hope. What the heck is going on there?
Dr. Streicher: There’s a lot going on and if you think it’s a question you get a lot, you can only imagine in my office where we really focus on women who are going through the menopause transition, very often this is the very first thing out of their mouth. They’ll say “Okay, yeah. Okay. I can’t sleep. My sex life is over. I’m having hot flashes. What’s with this muffin top? How come I’m suddenly putting on weight?” This really is an enormous issue for these women and it is so distressful.
What I used to say to them, I used to say “It’s not menopause.” Estrogen has nothing to do with gaining weight or losing weights and while that’s true it’s not exactly true because what we know is that if someone’s estrogen level drops and if nothing else were to happen, it’s not as if they would start gaining weight as a result of that but when someone’s estrogen level drops, there’s a whole cascade of events that follow, which in turn can lead to weight gain. The other problem is there’s just a lot of things going on midlife that also make things more challenging in terms of weight so that’s why on average, women will gain two to four pounds per year starting at age 45, even if they feel like they’re doing everything the same and this is what I hear. They say to me “Well, I haven’t change anything. I’m eating the same. My life is the same. Everything is the same. How come I’ve put on 20 pounds in the last five years?”
Jonathan: Dr. Streicher, what are some of those other things? So often the idea of weight regulation is treated with kindergarten like approach of, well you just need to eat less and you just need to exercise more and that’s it, like you’re just not trying hard enough. What are some of the other factors we need to consider here?
Dr. Streicher: Well, I’d like to spend a little time talking about sleep because sleep is so important obviously to think clearly and to be able to function and have energy but I think a lot of people don’t think about what happens when their sleep cycle is disrupted in terms of weight gain and one of the number one disruptors of sleep in midlife women is of course menopause and perimenopause because not only is it the hot flashes that keep women up and running around all night and their mind racing but even if they’re not having hot flashes, we know that fluctuations in estrogen can disrupt the sleep cycle.
There’s a number of things which are going on here. First of all, women who are tired are fatigued throughout the day and without realizing it, they’re decreasing their activity so that’s number one. Number two is, we know that if people can’t sleep, some people get up and answer their email, other people get up and go down to refrigerator and grab a little something and it all adds up if this is happening night after night but the big thing really has to do with the hunger hormones that we all make.
I’m talking about Leptin and Ghrelin of course and we know that these are the two hormones, which really control appetite and those hormones in turn are controlled by sleep. If you have your typical perimenopausal woman who’s just getting maybe five hours of sleep a night, good hours instead of th seven to eight hours she should get, what happens is she’s going to get a lowering of her Leptins, which is going to increase her appetite and she’s going to get an increase in Ghrelin, that hunger hormone, which is going to increase her appetite.
We have the double whammy of the woman who’s not sleeping, gets up, wanders down to the refrigerator, and then in turn she’s going to be hungrier because her hunger hormones are completely off balance and while women don’t associate that with menopause, it absolutely is correlated.
Jonathan: So, sleep is therapeutic, it sounds like?
Dr. Streicher: Sleep is so therapeutic and it has to do with everything aside from the hormones. During the day, if you have a choice between going to the gym or taking a nap, if you hadn’t slept the night before, you’re going to take that nap and again people don’t really associate that necessarily with being a part of what goes on during the perimenopause but it’s a very big part. The other thing we also know is that the food choices that someone makes when they’re tired and feeling lousy are going to be very, very different than if someone is feeling good and feeling energetic.
We have women who are, throughout the day just so tired and feeling just not themselves but they’re going to grab that fast food. They’re going to grab something that they know they shouldn’t but the other thing that’s happening around midlife, coincidentally the same time that women go through menopause, is they are having a complete change in their lifestyle. Think about it, this is the time when the kids, if you have kids, are off to college and suddenly you’re having adult meals.
Well, an adult meal usually involves a couple of glasses of wine. An adult meal is not dashing off to do the homework and all the other things that busy moms do. It might be sitting and talking and enjoying, going out to restaurants more, eating more and it all adds up. You feel like you might be making healthy choices but even a second helping of something that’s healthy is extra calories and particularly, if you are expending less energy, these are all things that are going to sabotage your weight that are all associated with midlife.
Jonathan: Dr. Streicher, this is such a paradigm shift for many people. If you find someone on the street and you say you are struggling with your weight or if you were struggling with your weight, what do you do and one of the, if not the most common answer is wake up early and go jog on pavement for an hour.
Dr. Streicher: Right, right.
Jonathan: It sounds like that is even counterproductive in some sense.
Dr. Streicher: Absolutely, and the other thing that’s going on I find, when I talk to my patient’s and I certainly always ask them about their exercise pattern, so more often than not, they’ll say “Yeah, I get up early. I hit the gym two or three times a week,” but then what I asked them, always surprises them and in my mind is far more important. I don’t say what is your exercise pattern, I say what is your activity pattern because everybody thinks that as long as they get their two to three hours of exercise in during the week, they’re covered and it doesn’t matter what else they do. When you think of what typically happens with the majority of the population, they get up in the morning, they get in the car, they sit at their desk all day long, they come home exhausted because they didn’t sleep well the night before. They have a long leisurely dinner, and then they sit in front of the TV, so it’s not so much that they’re not getting their exercise in two or three times a week.
They are so sedentary the rest of the time that it doesn’t matter. I think that’s one of the things that is absolutely shocking to my patient’s when they say to me “I work out with a personal trainer. I’m doing this, I’m at my gym three times a week” and I just look at them and say “Yeah, but if you’re sitting on your tush the rest of the time, it’s not going to do it for you.” It’s really a matter of being active and of course I’m a big advocate of walk rather than sit, stand rather than sit, every opportunity you have, wearing a Fit Bit or a Pedometer is so helpful in order to increase awareness and my patient’s tell me when they increase their activity throughout the day.
It really does add up, it really does make a difference. The other thing that’s going on midlife though that I think it bears mentioning is women are so concerned about their hormone levels and a lot of times they’re focusing on the wrong hormone level because thyroid issues very often crop up for the first time in midlife and many women, when they are having issues with feeling fatigued or gaining weight inexplicably, they need to have their thyroid levels checked because one out of ten women who are midlife do have an alteration in their thyroid level that makes everything more sluggish and sometimes it’s subtle.
Sometimes the typical screen that your doctor may do, usually they get a TSH, a thyroid stimulating hormone, which his fine that’s appropriately good screen but sometimes if there are more subtle changes you may need a more extensive thyroid battery. While the screen is fine for someone who is fine and isn’t having issues, if you just cannot find any other explanation for feeling sluggish and weight gain, absolutely talk to your doctor about the possibility that you have a more subtle thyroid issue going on and request a more extensive battery of tests, rather than the typical screen that’s done when you go in for your annual physical.
Jonathan: Dr. Streicher, so we’ve got this baseline of ensuring we are getting adequate rest, that our body is able to repair itself that we’re both in a hormonal and mental state where we can make good healthy life sustaining choices and life optimizing choices. We want to make sure our hormones are in balance as you mentioned and then of course staying active and just being a person. People are designed to move around, so it’s good to move around. There are, are there nuances you’ve seen in terms of nutrition, Dr. Streicher, where say a mother speaks with her daughter about her weight struggles and her daughter’s like, “Well I’ve done this with my eating and that’s really helped me,” and in your practice if the mother then tries to do that, a woman who’s again pre in or post menopause would not see the same results given that different hormonal and just general state.
Dr. Streicher: You’re actually correct that if I ate everything my daughter ate who is very slim, I’m sure I would gain weight. My metabolism is slower than hers and while I’m a very active person I don’t think I’m as active as my daughters are, so that is a piece of it and we all know young people can get away with a lot more. I don’t eat carbs the way I used to when I was younger. I really watch that. I really, really stick to. I eat actually almost everything but I make sure that it’s lean. I make sure that it’s not high in carb. I make sure that is not processed.
The young adults and kids eat, as far as I am concerned, way too much process foods. They don’t even know what they’re eating and it’s so important to really be aware as you talk about of course, of knowing what you’re putting in your mouth but the other thing that I actually want to come back to because I feel like I didn’t address it when we talked about menopause and perimenopause. I kind of slid over the, it’s not your estrogen but in all fairness there is something that does happen when estrogen levels go down that is absolutely directly related to the loss of that hormone and that’s the redistribution of weight.
I will have women who are really on top of it. They are fit, they are active. They are terrific and they haven’t gained any weight at all that they come in and say “You know, my clothes don’t fit the same. I’ve got this little muffin top. What’s going on here?” and what’s going on is that there’s a redistribution of weight and so women need to know that’s not their fault. It’s not that they’re doing something wrong. This is a direct consequence of lower estrogen levels is that you will get a redistribution of the weight that you have.
Now, interestingly, women who are taking hormone therapy, estrogen therapy, or estrogen and progesterone therapy do not have as much of that redistribution of weight because of course they are replacing some of the estrogen which they’re no longer making and while that’s not a reason to go on hormone therapy, it is certainly one of the nice side benefits that a woman gets who does choose to take estrogen but there is definitely something going on there that is directly from the lack of estrogen.
Jonathan: Hormone therapy is an incredibly popular topic in this community and in this life stage. One thing that might not get talked about as much and maybe should be, is how certain types of foods and certain types of exercise and certain types of sexual activities and certain forms of sleep can also be hormone therapy in a sense because they very much impact your hormones. Is that on the right track?
Dr. Streicher: Yes and no. When we are talking about estrogen specifically, we know that women who are postmenopause, whether they exercise, don’t exercise, whether they’re eating certain foods or not eating certain foods, that’s not going to budge their estrogen levels at all. I wish it did. I wish that there was more of an impact but the reality is, if you measure estrogen levels in women who do everything right nutritionally and who exercise, it’s not going to be any different than women who don’t.
What you are going to see of course are the benefits of eating right and being appropriate weight and exercising in terms of the symptoms of menopause. We certainly know that women who are of normal body weight tend to have for example less hot flashes than women who are overweight and it’s not so much tied up in the specific foods that people eat as to specifically how overweight they are. We know that exercise goes a long way in terms of minimizing hot flashes and making people sleep better and feel better. While it doesn’t budge the estrogen level per say, it can go a long way to help with the symptoms that are a result of low estrogen.
Jonathan: Love it. There is a key distinction here between when the body stops or down regulates the production of estrogen, it’s done, so unless you put some more in exogenously, you’re not just going to reboot that but we mentioned some other hormones like Leptin and ghrelin and insulin and it seems like, correct me if I’m wrong, those are more manipulable.
Dr. Streicher: Well absolutely, because estrogen as you correctly said is produced by the ovaries and once the ovaries are out of business nothing’s going to get them any action again but of course the hunger hormones, the leptin’s and the ghrelin’s are not produced by the ovaries and those continue throughout life to be altered by the things that you do, sleeping one of the big ones that we’ve already covered but ghrelin specifically is produced in the stomach and the pancreas and that’s not going to change throughout your hormonal life when it comes to menopause.
The other place of course that woman makes estrogen that they may not be aware of, is in their fat cells and that this isn’t a good production of estrogen. This is estrogen that hangs out and actually can increase to risk of certain cancers, specifically breast cancer and uterine cancer which is why overweight woman are at risk but having estrogen produced in fat cells is not going to help with menopause symptoms. It does actually help bone health which is not a reason to be overweight. We know that women who are very, very thin, is one of the risk factors for osteoporosis because not only are they not making estrogen from their ovaries anymore but there’s not estrogen from their fat cells.
Overweight women are far less likely to have osteoporosis than very thin women but again the overall health benefits of being lean are so much greater than that not to mention women who are thin and who exercise are going to dramatically decrease their risk of osteoporosis.
Jonathan: Dr. Streicher, you have a deep medical history, I don’t mean like your personal medical history but maybe that was not the right phrase. You have a deep experience in medicine.
Dr. Streicher: We know what you meant.
Jonathan: You are obviously burst in the science and you are a truth teller. You’re interested in the truth. As of mine, sometimes we know that the truth is not as magical as infomercials might be and one interpretation of what we’re talking about here and just what I’ve seen in the research is there is no magic menopause weight gain cure. There is no magic anything anywhere and anyone who says there is, you might want to look someplace else but people hear this and they say okay so are you just saying like we know we need to eat smarter.
You know we need to exercise smarter. We know we need to sleep smarter. Are you saying that as I become pre, during, and post menopausal that I just need to dial it up in those areas and I tend to say yes but the good news is, you’re more capable now and you’re smarter now and you’re wiser now than you’ve ever been. While you may need to put a little bit effort in, you’re also way more capable than you’ve ever been, so it’s a good place. What do you say?
Dr. Streicher: Absolutely, women are living longer than they ever had before and there are actually more women alive right now who are post menopause than in the entire history of civilization. Think about it, 100 years ago, life expectancy was 40 maybe 50 and now women who are healthy and doing all the right things can expect to live well into their 80s and that’s why it’s so important to address these things.
When we talk about midlife it used to be 50s, that was not midlife, that was end of life and now it truly is midlife and there are so many things that a woman can do to increase her ability to not only live long but to live well. There’s actually one last little thing we didn’t talk about that I do want to add into this whole soup of what someone can do to improve the chances that they’re not going to gain weight. The whole issue of incontinence which is a big topic in itself but just one point I want to make is that almost 30% of women who are midlife and older have issues with involuntary loss of urine, with leaky bladders and 50 percent of those women avoid exercise because they know that they’re going to lose urine if they exercise, which then translates to gaining more weight.
While people don’t often associate incontinence and weight gain, there is a very strong scientific literature coming out showing that there is an association. It’s important for your listeners to know that if they are leaking urine, that this is treatable. It is not just because something is common doesn’t mean it’s normal, it is not normal and if they can fix the leaky bladder, there is a much greater chance that not only will they be more active but more active in a meaningful way. You’re more likely to jump. You’re more likely to even walk briskly. We have women who are wearing a diaper just when they go through a brisk walk, so it’s a little off topic but it’s actually very much on topic.
Jonathan: I love, love the distinction between common and normal because something is common even more generally, overweight and obesity does not mean it’s normal.
Dr. Streicher: Yeah, and there’s something I think you and I both talk about a lot is the normalization of obesity. I would say to a woman when I see her in the office, “You know you’re really about 30 pounds overweight” and she looks at me absolutely shocked and says “All my friends are the same weight” and just because everyone is overweight doesn’t mean that that’s normal or that’s a good place to be.
Jonathan: Dr. Streicher, as we progress in our time on this planet, it sounds like we need to be more intentional about how we eat, more intentional about how we sleep, and more intentional about how we move. The good news seems, well that’s not bad news, but the better news is that, as we progress we also have more time to do that. You mentioned it’s not, maybe we don’t need to rush to get the kids on soccer and to do this and that. This is the time in our lives when maybe we do need to spend more time on ourselves and the good news is you can, so it works out quite well.
Dr. Streicher: I think it’s terrific. I will say to women, for the first time in your life, it’s not about kids, it’s not about this one, it’s not about that one. It can be all about you and don’t be ashamed of that. That’s an okay thing to make it all about you.
Jonathan: Speaking about all about you, let’s talk a little all about you here Dr. Streicher because I know you’ve got a delightful upcoming book coming out called Love Sex Again, got to hear about that just in general Dr. Streicher, what’s next for you?
Dr. Streicher: Well the main thing right now of course is the book. I’m very excited about this book, which really talks about the medical conditions that can sabotage someone’s sex life because if you look at the books out there right now about sex, it’s all about relationship and there’s a lot of different books that will help you fix your relationship but that doesn’t matter if you’re having painful sex, loss of libido, loss of desire, and this is the case for over 50% of midlife women.
When I started taking a really good look at things like the impact of diabetes, heart disease, menopause, cancer, antidepressants, on someone’s sexual health. I’m just blown away at how much of an impact it has and realize that there was really nothing out there that women could turn to, to get the information because you can have the best OB/GYN in the world but most gynecologists have not had a whole lot of training and sexual health. I’m very excited about my book, about getting the message out there.
We talked about women are living longer and the kids are out of the house and now is the time when you should be able to finally have great sex. You should be able to have pleasure, whether it’s with yourself or a partner and it’s really time to bring that taboo topic out into the open. I’m very excited about the book and that’s what I’ll be working on for the next few months. In addition, I’m continuing to blog. I write for the Dr. Oz website. I write for Everyday Health and then of course I still love seeing patients. I’m still seeing my patient’s and doing surgery and that’s what I’m going to be doing for the next few months.
Jonathan: Well, you are certainly a living, breathing, practicing example of what we’re talking about here in terms of dedicating your time and energy to not only helping yourself live as well as possible but to helping others live as well as possible and I salute you for that, so thank you so much for joining us and for being the change we want to see in the world Dr. Streicher.
Dr. Streicher: Well, thank you so much for having me. It’s been a pleasure.
Jonathan: Listeners, I hope you’ve enjoyed this conversation as much as I have. Again, our guest today is Dr. Lauren Streicher. You can learn more about her at her website drstreicher.com, her last name is spelt S-T-R-E-I-C-H-E-R.com and that upcoming book, very exciting is Love Sex Again, a gynecologist who fixes the medical problems that are sabotaging your sex life. Remember this week and every week after, eat smarter, exercise smarter, and live better. Chat with you soon.