I bet you thought there would be a pill for this. 

A natural product, perhaps? Just take one per day and you will look ripped and have an automatic spray tan? I think you know by now that I am not the person who is going  to sell you that. Anyone who tries to sell you a healthy metabolism in a pill is lying to you. Side note: CHECK THE LABEL FOR CAFFEINE AND LAXATIVE HERBS. No one person has all the answers for you, including myself. But being middle-aged physician who is interested in fitness, I am learning a thing or two that I would like to share.

Here’s the good news and the bad: the steps required for a healthy metabolism and optimal weight are the same steps that will keep us healthier long-term. I work with so many women between the ages of 45 and 60, so I am constantly troubleshooting this with my patients. Particularly in the years after menopause, the metabolism requires some serious attention. There are only three golden rules that apply to every patient:

1) Every person’s metabolism is unique. This means there is no one approach that everyone can use to reach your ideal weight. You will have to use trial and error to see which approach is the best fit..

2) The faster you lose weight, the more likely you are to gain it all back.

3) The more years you spend at a particular weight or size, the harder it will be to change your body from that state. The upside of this is that we each have a unique and wonderful body, and embracing that will help you find the right path for you.

4) Our bodies were designed to move and to do hard work, and if you aren’t willing to do some hard work with your body you likely will not achieve the results that you want. Exercise in some form is mandatory if you want a healthy metabolism. Don’t be scared, because this looks different for everyone. And using relaxation can actually help you improve your metabolism!

Rate of Weight Loss

Most pounds lost are gained back. We see this time and time again, in study after study. This is partly because our bodies are excellent at maintaining body mass for the purpose of preserving our survival (more calories stored is more chance at survival, historically speaking). This is also partly because extreme measures to lose weight loss often slow down our metabolism, which means that the inevitable return to unrestricted eating (or even long term caloric restriction for most people) will lead to even more weight gain. (Read more about this HERE)

Aging and Stress

These facts above are even more true as we age, because our reproductive and stress hormones really begin to show themselves. They affect our metabolism in many ways. It is very common for me to see a woman entering menopause with the magical triad of stress: loss of estrogen, teenagers in the home trying to navigate the path to adulthood, and aging parents requiring care. If a woman is dealing with these or other stressors AND trying to have a successful career, the stress hormone production is even higher. Most women need to really start to focus on cultivating relaxation to counterbalance those stress hormones as we get further into and past our forties. If stress isn’t addressed, the metabolism can’t function in our favor.

When we are in our 20s and 30s we can often get away with crushing it at work, running on minimal sleep, working out long and hard, and still pretty much reaching our goal weight. Our metabolisms are much more forgiving, and our bodies are much more able to meet the demands of a stressful life. Our stress hormone production is up to the task. All of our systems function more optimally earlier in life, so we have the advantage of a healthy thyroid, mitochondrial function and better iron stores to help us produce lots of energy.

But because these hormones are designed to help us store calories in preparation for winter or generate energy to hunt for our next meal, relying on them more with age becomes counterproductive. We are still designed to live in caves and hunt for our food. Our stress hormones don’t care about your spin class or your refrigerator contents. They just want you to survive long enough to reproduce. What this means is that when we are more tired, and using more stress hormones, we can experience this as weight gain, fatigue during the day, and disrupted sleep at night. Sound familiar?

This is one of the reasons why I jokingly say that I understand why women can get pregnant at 13 or 14. I was an idiot at that age but I will tell you right now that I stayed up all night for fun, which is something that makes me want to absolutely throw up now as a middle-aged woman. Part of the definition of aging is a deterioration of the systems in our bodies: hormone production, detoxification, cell turnover, etc. We feel this as more fatigue, lower muscle mass, bigger hangovers, more sleep disruption, irregular periods. Our systems become less efficient as we age on almost every level.

So what this means for us is that we need to pivot, sometimes 180 degrees, and honor the aging metabolism. Given that there were years of my young life when I ate at Jack in the Box three times daily (shout out to the spicy crispy chicken sandwich!), I am pretty sure that as I get older and better educated the potential exists to feel better and better. We just need to work out smarter, not necessarily harder. And we need to be honest about our stressors and our lifestyle, in order to forge a path that works for our bodies.

So What Can I Do and To Whom Should I Listen?

Everything I am learning about the middle-aged metabolism I am learning through continuing education, by talking with my cherished friends of all ages, by adapting treatment plans constantly with patients to according to their metabolisms and needs, and by learning from colleagues who I consider pioneers in this department. There are very few trainers out there, in my opinion, who speak to how changeable and individual metabolic function is over age 45. For example, even though the Ketogenic diet has been popular for more than a few years, there are almost no studies that look at this diet in women. One of the reasons I see it fail for women is because I think stress hormones can really get in the way of ketogenic success. I learned this through trial and error in both myself and my patients. (Not against this style of eating, just being clear that it does not work for everyone in every stage of life!) I have listened to so many podcasts on keto diets and most of them feature men talking about men doing this diet. This is changing slowly, but I still don’t feel there are a lot of good resources out there.

I am always experimenting with different types of exercise, nutrition, and stress management. I am a huge Dr. Jade Teta fan, because he is one of the first people to address this special interaction between hormones, stress and metabolism. Ironically, even though he is a man, he really understands the unique challenges mentioned here. I HIGHLY RECOMMEND you follow him on instagram, listen to his podcasts, buy his book, or consult with him. I really cherish his words and his approach.

I also love trainers who are not obsessed with extremes. There is a local trainer named Mindy Garrett with Mind and Body Elite who has an EXCELLENT Instagram feed with quick and easy tips for supporting, not stressing, your metabolism. She is an excellent resource and helps folks of all ages and sizes. Extremes in exercise can be exhilerating and adventurous, but long-term they can be really damaging. For long-term health more moderation in exercise tends to be successful.

My Bottom Line

So here are some ideas for you to try on:

1) If you are exhausted, don’t push yourself through hard or long workouts. As we age our workouts need to be hard but not necessarily long. Shorter HIIT workouts can go a long way. Remember that long workouts, especially if you are tired, will cause you to run on more cortisol, which in turn will cause you to hang onto and store more calories. I could go on and on about this because for those of us who grew up with aerobics it’s all about longer and burning more calories. But would you believe that some of my female patients do better, and lose more weight, when they work out LESS? Honor your energy, and work with a trainer to design a workout ideal for you. I would rather my patients do 20 minute weight workouts (they should be HARD) twice weekly than hour long boot camp sessions four times per week, if they are exhausted.

2) Cardio is great for your cardiovascular system, and great for burning calories, but if you are stressed and tired a walk might be better exercise for you. You have to burn calories (Dr. Teta reminds me of this fact, and it holds true across the board). But if you are exhausted, longer cardio again will cause you to gain weight or hold on to weight, and to also be more tired! Use walking to move your body, cultivate relaxation, and burn a few calories. Walk with a friend, a pet or a good podcast.  I am not telling you not to do cardio! I love long hikes and walks and bike rides. I am just reminding you to listen to your body. If you are a runner, you might need an additional rest day per week. Try it for a few weeks and see how you feel.

3) If you are too tired to work out any the time, please for the love of all things holy schedule an appointment with your doctor!!! You need to be worked up! Try taking your hour of scheduled workout time to take a nap, have sex, or watch a movie. Let yourself not push it all the time- and be patient while you figure out the cause of your fatigue. It is so frustrating sometimes but not every stage of life is the time for you to work out.

4) Good sleep is imperative for a good metabolism. If you aren’t sleeping or if you are sleep-deprived, you will be reaching for more calories and more carbs. It makes it much, much more difficult to lose weight or improve your metabolism. We do so much repair work during deep sleep, so especially if you are trying to improve your athletic performance you want to make sure this is dialed in. I am a terrible sleeper and I love to exercise, so this has been a hard one for me to really practice. But it will be a game-changer if you invest in your sleep first.

5) Don’t starve yourself. Please consider working with a nutritionist or physician if you are hungry all the time. If you are fighting hunger, you are cranking stress hormones. See above- very counterproductive long term for metabolism. The one exception might be a short period of time in a ketogenic diet. General recommendations to lose pounds (if this is your goal) is a 200 calorie-per-day deficit to lose a half-pound per week. I rarely recommend losing faster than this. You are so much more likely to gain it back. I always tell my patients that I would rather they spend six months getting them to their ideal weight by creating a lifestyle they enjoy, find satisfying and sustainable, than lose five pounds per week just to gain it back. It’s not worth it.

I hope some of this is helpful. It takes at least a few visits with a patient to troubleshoot these ideas and determine the best approach. The underlying contributors to fatigue and metabolic function must be addressed for long-term success. And I often refer out to colleagues for additional support in nutrition and training. For most people there is a middle ground that is more work to achieve, but that helps to create a flexible metabolism with a lifestyle that feels good and is good for you. It takes time to understand your unique physiology, particularly during these years when your body is going through major changes. Be patient with yourself. Be willing to troubleshoot and experiment. Be thrilled that aging is going to bring you much more satisfaction and stability. Be nourished every week by what you eat and do with your body. And most importantly….. LIVE LIKE YOU GIVE A DAMN!!