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.