We all know that weight can be lost- and many of us have experienced this personally. There is a time period in which our bodies respond eagerly to either an increase in caloric expenditure with vigorous exercise or a decrease in caloric intake. But research shows us that regardless of starting weight, our bodies adapt to our most common weight level and will resist the process of losing weight, particularly as we get older. A review of 16 studies observing weight-loss programs of varying styles all showed significant weight loss, but by five years from the onset of the programs close to 100% of the weight lost was regained. This review included some of the most popular weight-loss programs including the Atkins Diet, South Beach, etc.
The implication of this review is that there is a counter-regulatory process that is triggered by weight loss of more than five to ten pounds. This is why it is difficult for us to maintain weight loss over a long period of time. We experience this as both a desire to eat more than our limited caloric intake (which I think is appropriate, and will discuss later) and an inability to drop inches and pounds despite increased caloric expenditure.
This is an experience shared by many of my menopausal patients, who suddenly find it extremely challenging to maintain the weight that they have been comfortable with for years. Many men and women in their forties and fifties suddenly find themselves gaining weight- particularly abdominal weight- despite no change in exercise or diet. It feels sometimes that no amount of caloric restriction or increased exercise is enough- the weight just keeps coming.
Metabolism and Digestive Health
There are multiple factors that can contribute to this frustrating phenomenon and which often stem from the changing levels of female sex hormones related to menopause. There is new research demonstrating that the human body’s ability to lose weight is tightly correlated with the release of a variety of hormones within the digestive system. This is an area about which I am only beginning to learn, and I will keep you posted as time goes on. What we do know currently is that maintaining a healthy digestive environment is essential for all of these hormonal factors. A healthy probiotic regimen can be the best basic gut support, and it is imperative that we address low enzyme and HCl production (which decrease with age), food allergies, and other possible inflammatory agents in the gut.
It is a mistake in my opinion to simply supplement with Hormone Replacement Therapy (HRT) and expect the metabolism to right itself. There is an incredibly complex cascade of events that can result from hormonal changes that must be addressed in addition to estrogen and progesterone. One of the reasons why I think so many women are placed on HRT immediately by their physicians is that this is the simplest way to address a very complex problem. The downside of this is that of course, most of these women still end up on prescribed thyroid hormones, sleep aids, etc- and STILL GAIN WEIGHT. There are serious negative ramifications to taking extra hormones as well, which most people are now familiar with. I do prescribe these hormones in their bio-identical forms, but I do so only to treat symptoms that I feel cannot be managed with less risky methods, and I try to be as conservative as possible.
Adrenal Gland Function and Stress
One of the often overlooked and very common triggering factors for women going through hormonal changes is adrenal stress and fatigue. The irony of the timing of menopause is that I find a large percentage of my patients happen to have children in their teens and twenties- times when parenting can in fact be the MOST stressful and demanding, though the expectation is that as our children grow older they need us less. In addition to life-stressors, many women experience hot flashes that disrupt sleep and cause additional adrenal fatigue. It is next to impossible to lose weight while you are losing sleep!
The changing levels of female hormones for some women can trigger anxiety and depression, which also demand extra work from our stress hormones. All together, these issues must be addressed and the adrenal glands must be supported through this physiologically stressful time. Signs of Adrenal Fatigue may include:
- difficulty sleeping- delayed sleep onset or frequent waking
- fatigue during the day despite an inability to sleep at night
- abdominal weight gain despite caloric deficit
- low blood pressure
Hormonal changes in any stage of life can also cause the thyroid gland to over or under-produce thyroid hormones. The thyroid is the root of metabolism, and it is very often disturbed by the decrease in estrogen production during menopause (just as many women experience thyroid symptoms during pregnancy). It is also very sensitive to changes in stress hormone production, so while it is often necessary to address these issues with the use of thyroid hormones, most will find that they are prescribed a higher and higher and higher dose of thyroid hormone if the underlying adrenal issues are not addressed.
DHEA and Testosterone
Other hormones are involved in menopausal weight gain in addition to estrogen and progesterone. DHEA and Testosterone can be major players in the metabolism changes that occur during these years, and it is essential that they are both assessed and addressed if necessary. DHEA is also intimately involved in healthy adrenal function and can be depleted when we demand more work from those glands.
Other tricks? If a weight-loss regimen or supplement sounds to good to be true, chances are it is too good to be true. There are very few researched materials that actually help the body lose weight and maintain weight loss without causing permanent damage to a healthy metabolism (as daily caloric restriction will). Some promising substances that show very moderate improvement FOR WOMEN WHO ARE ALREADY EXERCISING REGULARLY AND MAINTAINING A HEALTHY DIET (I hope you noticed my capitals!!!) are Resveratrol, Green Tea extract and a variety of other nutrients that improve insulin sensitivity.
The bottom line is that we do not understand the majority of WHY women tend to gain weight during menopause, and I still do not feel that we have a healthy perspective in American society on menopause in general. Why do we struggle so with this transition while women in other countries seem to sail easily through it? The biggest concern that I have in general with my menopausal patients is that I see a vicious cycle of continuing to reduce caloric intake as low as 1200 calories per day while still exercising 3-5 times per week, which can cause permanent and irreversible damage to a woman’s healthy metabolism. Be sure to address all of the above factors with your physician and allow yourself to look forward to the possibility that you might enjoy this next stage of your hormonal life more than any other before it!