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

So many women will share the history of never having to worry about weight until all of a sudden with perimenopause or menopause it is as if a switch has turned off and metabolism has changed. Or the history is that "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."

To read about the definition and symptoms of menopause and perimenopause click here.)

But what about the weight gain during menopause? Many women would take hormones or not take them if they knew that their use or avoidance would prevent menopausal weight gain. 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. What the studies show is that in 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.

Can weight gain during menopause be avoided? Or will I, like most of my patients, be bewildered and gaining in twenty 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 answer comes down to carbohydrate tolerance. What this is referring to is how the body metabolizes and uses nutrients. Carbohydrate tolerance is determined by hepatic (which means liver) regulation and peripheral usage, which means how the 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 great 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 and his muscle mass is large. 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.

The high carbohydrate, low protein diet, which is the backbone of the food guide pyramid, is providing optimal nutrition for the athletic male. But what about the postmenopausal woman who is 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 it is much less of a decline than that seen with sedentary women. The high carbohydrate diet requires utilization of energy by the skeletal muscle or storage of excess calories into body fat. As a woman's muscle tissue declines, the fat tissue is where her extra dietary carbohydrates will be stored. She gains body fat, and usually more fat in the central or abdominal areas of her body. The rise in abdominal fat is what triggers the cascade of an important hormonal imbalance called insulin resistance, which directly affects heart disease risk.

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 increases her bad cholesterol and lowers her good cholesterol, which is the pattern, which 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.

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 carb 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 in eating a "healthy diet" of cereal and fruit every morning or the breakfast meal of fruit alone. This woman will not be getting enough protein at this meal and will be having too great of a carbohydrate load at one meal. A better breakfast for her might be cottage cheese and fruit or eggs or eggbeaters with whole-wheat toast. Both of these breakfasts contain both carbohydrates and protein but lower amount of carbohydrate and more protein.

And what about protein? I find most women don't enjoy eating large amounts or 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 come from meat. In fact, one of the best protein sources for postmenopausal women is not meat but rather 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 allows for 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 herself 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 weight loss. Women are able to eat more and lose weight once they understand how their body is metabolizing nutrients.

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Caroline J. Cederquist, M.D. is a board certified Family Physician and a board certified Bariatric Physicians (the medical specialty of weight management). Dr. Cederquist is the founder of Bistro M.D., a home diet delivery program that specializes in low calorie gourmet food that is delivered to your home or office. Bistro M.D. serves as culmination of Dr. Cederquist's expertise and experience in the world of medical weight loss.