By Michael Shadowen, intern
Are you in menopause, or a middle-aged woman with the sudden appearance of belly fat, fatigue, hot flashes and sleepless nights? How about a loss of sports performance? Diet can’t make these disappear entirely, but it can ease their effects!
What is Menopause?
Menopause is the point when a woman stops ovulating and has no monthly period for 12 months. As women age into their 40s and 50s, there is a tendency to gain weight. This is where lifestyle interventions such as diet and training interventions are important to maintain strength, to maintain lean mass, and reduce the risk of disease.
Peri-menopause is defined as the five years prior to periods stopping. It is during peri-menopause that women undergo body composition changes due to hormone fluctuation, in particular their sex hormones, estrogen and progesterone levels.
What are Hormones?
Hormones are chemical messengers in your body. They facilitate nearly every bodily process, including metabolism, hunger, and fullness. Because of their association with appetite, some hormones also play a significant role in body weight. Estrogen is a sex hormone responsible for regulating the female reproductive system, as well as the immune, skeletal, and vascular systems.
Levels of estrogen change during life stages such as pregnancy, nursing, and menopause, as well as throughout the menstrual cycle. High levels of estrogen, which are often seen in people with obesity, are associated with an increased risk of certain cancers and other chronic diseases. Conversely, low levels — typically seen with aging, perimenopause, and menopause — may affect body weight and body fat, therefore also increasing your risk of disease. Individuals with low estrogen levels often experience central obesity, which is an accumulation of weight around the trunk of the body. This can lead to other health problems, such as high blood sugar, high blood pressure, and heart disease.
Hormonal Changes during Menopause
During peri-menopause, estradiol – the primary estrogen hormone in the body – starts fluctuating and changes from estradiol (E2) to estrone (E1) upon menopause. Estradiol affects tissue growth, bone health, and blood glucose control.
This change in hormone level may also influence the body fat distribution. In addition, the imbalance of estradiol to progesterone may also cause vasomotor symptoms such as mood swings, brain fog, fatigue, sleepless nights, and hot flashes – making it difficult to adapt to lifestyle interventions and training. Apart from declining estrogen levels, age and other lifestyle factors, may contribute to changes in body composition and increase disease risk.
Hormonal changes alone don’t necessarily cause menopause weight gain. Instead, the weight gain is also related to aging, lifestyle and genetic factors. For example, muscle mass typically diminishes with age, while fat increases. Losing muscle mass slows the rate at which your body uses calories (metabolism). This can make it more challenging to maintain a healthy weight. Genetic factors might also play a role in menopause weight gain. Individuals with parents or close relatives that carry extra weight around the abdomen, are at an increased risk to their body composition to be influenced in the same way. Other factors, such as a lack of exercise, unhealthy eating and not enough sleep, might contribute to hormone fluctuation and menopause weight gain.
Health Promotion and Lifestyle Interventions
Health care of menopausal women emphasizes lifestyle and behavior change to counterbalance the negative effects of estrogen deficiency and minimize the risk of metabolic syndrome, osteoporosis, bone fractures, and vascular events. As part of health promotion and lifestyle adaptation in the postmenopausal period, nutritional habits are essential because they concern all women, can be modified, and impact both longevity and quality of life.
Goal Setting:
Menopausal women should set S.M.A.R.T. (specific, measurable, attainable, realistic, timely) goals for increased physical activity and healthy eating habits as opposed to setting weight loss goals.
- Specific: The goal should be clear and precise while also serving as a personal motivator.
- Measurable: The goal should be something that can be objectively measured so that you can accurately track progress.
- Attainable: The goal should be realistic enough to obtain yet challenging enough to push someone beyond their regular routine.
- Realistic: The goal needs to feel important to a person and align with other fitness-related aspirations.
- Time-bound: This provides a deadline and will help people stay on task and keep the outcome goal a priority.
Physical Activity:
Increasing physical activity is a common goal. Low estrogen levels may leave a woman feeling less capable of working out but training still helps with weight management. Heavier resistance and power level training can aid in improving body composition, bone turnover, and overall strength in menopausal women. The combination of heavy resistance training and high-intensity work increases your post-exercise growth hormone, which is a signal for tissue growth for developing and keeping lean mass. A lot of women worry that lifting heavy will cause them to bulk up, but they don’t have enough circulating testosterone for this to happen.
- Heavy resistance training – 6-8 rep range rather than in the 12-15 rep range
- High Intensity Interval Training (HIIT) – repeated, extremely hard bouts of work interspersed with periods of recovery
- Plyometric training (jumping) – this actually cause a change in gene transcription that improve metabolic function (muscles become more efficient at usage/storage of sugar in the body), and also improves bone strength
Women who are peri and postmenopausal are primed to burn fat but lose their strength and power. Introducing more HIIT and resistance training will help build power and strength. Make sure appropriate rest and periodization is built into the training plan.
Nevertheless, training is only part of the solution.
Nutrition and Diet:
Nutritional changes help counter hormone fluctuations, so they make good goals. Diets high in red meat, processed foods, sweets, and refined grains increase variability in estrogen levels, which may raise the risk of chronic disease. Thus, for menopausal women, dietary interventions should focus on decreasing risk for chronic disease through weight loss, better body composition and metabolic parameters.
The Mediterranean Diet
The Mediterranean diet pattern, along with other healthy habits, may help the primary prevention of bone, metabolic, and cardiovascular diseases in the postmenopausal period. It consists of the use of healthy foods that have anti-inflammatory and antioxidant properties. The Mediterranean diet leads to a small but significant decrease in blood pressure, reduction of fat mass, and improvement in cholesterol levels.
This diet reduces the consumption of saturated animal fats in favor of unsaturated vegetable fats and a high intake of polyphenols and n-3 fatty acids with anti-inflammatory and antioxidant properties. The phenolic compounds (polyphenols) come from extra virgin olive oil, whole grain cereals, nuts, legumes, vegetables, red wine, and fruits. Due to their antioxidant and anti-inflammatory properties, the synergistic consumption of these Mediterranean foods could represent an ideal nutritional pattern in menopause.
Getting Enough Protein
Additionally, higher protein intake over the current RDA of 0.8 g/kg/day may be advisable for older adults. Optimal protein intake may be ranged from 1.2 to 1.6 g/kg/day with peak timing (boluses of 20-40 grams spread throughout the day, centered around training) is necessary to not only maintain lean body mass, but maximize gains. Recent observational studies show that this higher protein intake is associated with higher lean body mass and lowers risk of frailty and better physical function.
Conclusions
Although several forms of dietary interventions exist in the literature, the most thoroughly-researched and most clinically effective option is the Mediterranean diet. On top of that, peri- and post-menopausal women tend to follow the Mediterranean diet well, which improves results. Furthermore, increased intake of quality protein at optimal times throughout the day is not only an effective dietary intervention for menopause, but the aging process as well. A greater adherence to these dietary interventions for menopausal women could then reduce the risk for becoming overweight/obese, improve body composition and metabolic parameters.
Contact Dr. Schubert here, especially if you are interested in her services related to Medical Concerns! Learn more about the Mediterranean Diet for athletes. If you’re not in the menopause/perimenopause phase of life, check out this article on the effects of the menstrual cycle on sports performance.
References
- Barrea L, Pugliese G, Laudisio D, Colao A, Savastano S, Muscogiuri G. Mediterranean diet as medical prescription in menopausal women with obesity: a practical guide for nutritionists. Crit Rev Food Sci Nutr. 2021;61
- Cleveland Clinic. Estrogen: Hormone, function, Levels & Imbalances. Published February 2022.
- Golden N. Dietary Protein & Post menopausal women (60-90 years) . NASM. Published September 6, 2022.
- Lombardo M, Perrone MA, Guseva E, et al. Losing Weight after Menopause with Minimal Aerobic Training and Mediterranean Diet. Nutrients. 2020;12
- Pugliese G Dr, Barrea L Dr, Laudisio D Dr, et al. Mediterranean diet as tool to manage obesity in menopause: A narrative review. Nutrition. 2020;79-80
- Silva TR, Oppermann K, Reis FM, Spritzer PM. Nutrition in Menopausal Women: A Narrative Review. Nutrients. 2021;13