The Menopause Metabolism

kayakgirl

Hi all:

I was trying to figure out how much protein I need and came across this website which seems to have some interesting information. I am not buying their diet plan I just thought the information about menopause metabolism made sense. Agnes

from  http://www.bistromd.com/The-Menopause-Metabolism.aspx

The Menopause Metabolism

As a female physician who specializes in weight management, weight gain during menopause and peri-menopause are the most common condition I deal with.

So many women share the history of never having had to worry about weight until all of a sudden with perimenopause or menopause it is like a switch has turned off, and somehow their metabolism has changed. The history a typical patient will give to me sounds something like, "I have always needed to work on my weight- eat the right things and exercise - and I still do. But now everything I used to do to control my weight no longer works. Instead, I am gaining weight despite being more careful, exercising more and eating less. Help! I am so frustrated."

Where am I in this "Change of Life"

First, let's define what menopause actually involves. Menopause is officially designated when a women has stopped having menstrual periods for one year or when blood tests show that there are very high levels of pituitary hormones called gonodatropins. Gonoadotropins are hormones that are released by the pituitary gland in the brain to signal the ovary to mature and release an egg each month. The hormone levels have a patterned rise and fall each month during a woman's reproductive years. Levels become very high once the ovary is no longer able to respond to these hormones and ovulation no longer occurs.

Perimenopause is the term given to the years that lead up to menopause. In these years, the ovary is starting to decline in function and an egg is no longer released consistently each month. Sometimes months go by without a normal ovulation. If hormone levels are checked in these years, the gonadotropins can be normal to mildly elevated. The associated symptoms can be hot flashes, night sweats, fatigue, mood changes and weight gain. Perimenopause may last for years.

The symptoms of hot flashes and night sweats can be explained by the erratic fluctuations in hormones that occur in these years. Physicians have been able to treat women who seek relief from these symptoms with hormone replacement therapy.

But It's Not Just A Hormonal Change

Many women will do whatever it takes to try to correct hormonal issues to lose weight. It is typically not an issue of taking HRT (hormone replacement therapy) or not. I let women know that there is no evidence that taking hormones or not taking hormones affects a woman's ability to control her weight with perimenopause or menopause. The studies show that during the years after menopause, the average woman will gain thirty pounds. Women who take hormones may experience less initial weight gain, but several years later; women on hormones have gained a similar amount of weight compared to women who have never used hormones. Obviously it is not just a hormonal issue.

Hormone replacement therapy has long been controversial and has been more so since the Women's Health Initiative trial published in 2002 showed that women who took the synthetic hormone Prempro were more likely to experience heart attacks or strokes. Prior to this study, the prevailing thought was that hormones protected a woman's heart because women experience more heart attacks and strokes after menopause compared to men. Since this study, hormone replacement therapy is still prescribed, if needed, during peri-menopause if the physical symptoms are unbearable. Typically physicians try to use hormones for as short a time frame as possible. And it is no longer recommended that women take hormone replacement therapy to prevent heart disease, which was what many physicians had recommended prior to the WHI study trial.

Most women today plan to ride out menopause without HRT, using only supplements like black cohosh to ease symptoms. The interesting thing is that no matter whether or not women are on HRT, the average weight gain in the years after menopause is still thirty pounds. Obviously, the problem is not solved by adding reproductive hormones.

Research Sheds Some Light

New research on the effects of the female sex hormone estrogen in the brain lend credence to what many women have suspected about the hormonal changes that accompany aging-namely that menopause causes weight gain in most women. Scientists have long sought to understand how changes in hormones during menopause could account for the increase in appetite and accompanying weight gain that often occurs among aging women.

Researchers used a series of animal experiments to show how estrogen receptors located in the hypothalamus serve as a master switch to control food intake, energy expenditure, and body fat distribution. The research showed that when these receptors are disabled, the animals immediately begin to eat more food, burn less energy, and pack on pounds.

Using gene-silencing RNA interference, the researchers deactivated the ER-alpha receptors in the VMN, while the estrogen receptors in other regions of the brain maintained their normal capacity. They found that when estrogen levels in the VMN dipped, the animals' metabolic rate and energy levels also plummeted. The findings show the animals quickly developed an impaired tolerance to glucose and a sizable weight gain, even when their calorie intake remained the same. Additionally, the excess weight went straight to the abdomen, creating an increase in visceral fat.

The accumulation of abdominal fat puts both men and women at a heightened risk of cardiovascular disease, diabetes, and insulin resistance. When menopause occurs and body fat shifts to the abdomen, women find themselves no longer protected from these negative consequences as they were in younger years when body fat was primarily carried in the hips and thighs.

Is weight gain with Menopause inevitable?

When trying to come up with a solution to the challenge of avoiding the seemingly inevitable weight gain, I thought, "Will I, like most of my patients, be bewildered and gaining weight in several years despite doing all that I can to prevent it?" This was the question I often asked myself during the day-to-day clinical practice of medicine in weight management. It has been one of the driving questions that I seek answers for when I go to conferences or read the scientific literature. I have found some very encouraging answers to the dilemma and my patients are very grateful.

The Role of Carbohydrates

The answer I have found and implemented successfully in treating my patients for weight gain comes down to carbohydrate tolerance. Carbohydrate tolerance refers to the ability of the body to metabolize and use nutrients. This is determined by hepatic (which means liver) regulation and peripheral usage, which means how the other cells of your body use energy. The factors which affect carbohydrate tolerance are diet, muscle mass, physical activity, age and gender.

A young male athlete has a high tolerance to carbohydrate. He has a larger muscle mass due to his young age, his male gender and his high level of physical activity. The young male athlete is able to utilize his carbohydrates or glucose right at the level of his muscles. The young male athlete would be able to run and perform well with a diet high in carbohydrate so much so that athletes have practiced carbohydrate loading before events of peak performance. This gives cells the fuel needed to supply the large demand for energy.

This high carbohydrate, low protein diet, which is also the backbone of the food guide pyramid, provides optimal nutrition for the athletic male. In fact, the food guide pyramid was developed from information gathered from active men in the military. But what about the postmenopausal woman who is obviously more sedentary, what does she need?

Most women become less active with age and experience a decline in muscle mass. Even women who still continue to exercise experience a decline in muscle mass due to age, but the decline is much less than that seen with sedentary women. A high carbohydrate diet requires one of two things:

1) utilization of energy by the skeletal muscle

-Or-

2)storage of excess calories into body fat.

As a woman's muscle tissue declines, fat tissue is becomes the site where her extra dietary carbohydrates will be delivered and stored. More is going into storage than is being utilized by muscle tissue. She gains body fat, usually in the central or abdominal area of her body. The rise in abdominal fat is what triggers the cascade of an important metabolic hormonal imbalance called insulin resistance, which directly affects the risks for heart disease. Insulin resistance makes it very, very difficult for lots of carbohydrates to be used by skeletal muscle tissue. In my practice, I find a high correlation with menopause and the onset of insulin resistance in women who have been previously insulin sensitive.

Women who carry weight in their abdomen will usually have higher insulin levels and eventually higher blood glucose levels consistent with pre-diabetes. The abdominal weight causes her bad cholesterol to increase while lowering her good cholesterol, which is the pattern that contributes to heart disease. Abdominal fat also increases the level of inflammatory hormones, which also contribute to heart disease. In my opinion, it is the deposition of abdominal fat and not lack of estrogen that is the main reason women experience more heart disease after menopause.

Another low-carb diet?

Since women in the perimenopause or menopause years have a difficult time tolerating a high carbohydrate diet, what is the best diet for them? Post menopausal women do better with a controlled carbohydrate diet which contains adequate lean protein. Controlled carbohydrate does not mean the no carb or even low carb diet that many women think of with regards to the Atkins diet or other similar low carb diets. ‘Controlled carbohydrate' means that the total amount and timing of the carbohydrates needs to be controlled.

A great example from my practice is a 56-year-old woman who comes to see me. She is eating a ‘healthy diet' of cereal and fruit every morning or the breakfast meal of fruit alone. This woman is only having carbohydrates aside from a small amount of protein in milk. She will not be getting enough protein at this meal and will be having too much carbohydrate loaded at one meal. A better breakfast for her might be cottage cheese and fruit or another variation could be eggs (or eggbeaters) with whole-wheat toast. Both of these breakfasts contain both carbohydrates and protein but a lesser amount of carbohydrate and more protein.

Do I just eat lots of meat?

I find most women don't enjoy eating large amounts of meat. Many women who have tried low carb diets don't like them due to the amount of protein that is recommended to be eaten and the strict limitation on carbohydrate foods they enjoy. Women who work with me learn that adequate protein is not excessive protein and all protein does not have to be sourced from meat. In fact, one of the best protein sources for postmenopausal women is not meat at all. I recommend whey protein, which is derived from dairy products. Whey protein contains a high concentration of branched chain amino acids, which are the building blocks of all protein and hence muscle tissue. Whey protein encourages and allows maintenance of muscle mass as a woman loses body fat.

Weight gain during menopause is the norm in the United States but it doesn't have to be. Thousands of women who have worked with me over the years have been able to adjust their diet to meet the nutritional needs that are unique to this stage of their lives. Often women report being unable to lose any weight at all, despite starving themselves or exercising more than they ever used to. Significant calorie restriction without ensuring the proper intake of nutrients for this stage of life does not produce a loss of body fat. Rather a woman who eats like this will lose lean muscle tissue and her metabolism will drop to deter starvation. As she breaks her rigid dieting, she rapidly gains body fat due to her decreased metabolic rate.

Will I feel hungry all the time?

Women are able to eat more and lose weight once they understand how their body is metabolizing nutrients. Their cells no longer feel ‘starved' and are getting adequate lean protein to satisfy their energy requirements. Those cells are no longer sending ‘hungry' signals to body tissues, and their body will begin to ‘let go' of fat mass. Hunger and carbohydrate cravings lessen--as protein is much more slowly digested and provides greater satiety. We also avoid the ‘sugar crash' that happens after a high carbohydrate meal, in which case a person may feel even more hungry than before they ate!

The metabolism that arises with the onset of menopause can be very frustrating, but is very treatable. I have had success helping so many patients lose weight despite the changes their body has undergone. My goal is to correct body chemistry so that the body relearns how to lose weight and create a stable metabolism long-term.