Greetings from Arcadia Women’s Wellness
NEWS YOU CAN USE - July 2024
Metabolism & Menopause
OK, so the biggest question I am hit with from social media and patients regarding weight/body composition changes in perimenopause and beyond, so I will be dedicating this newsletter to this issue to dispel myths and hopefully give some good tips.
Remember though, changes in body weight, shape, composition, and appearance are not all due to hormones alone: they natural side effects of aging and aging is irreversible, full-stop. Any influencer or health care provider who tells you that they have “anti-aging” secret is by definition a shyster. We are all aging and all we can do is try to be our healthiest at our current age.
OUT OF CLINIC notification:
Week of September 9, attending Menopause Society annual conference in Chicago, I will be reporting news you can use on instagram
September 19-October 14 will be on vacation with limited availability
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PLEASE READ…please:
Texts: unless urgent/canceling appt, limit texting to between 9am-5pm, do not expect immediate replies, please sign name.
Appointments: online scheduler; if cannot find time, let me know, currently scheduling ~4 weeks out.
Refills: contact pharmacy & try to plan ahead.
Emails: like you, I am inundated. Limit to quick questions, updates, etc, otherwise, schedule using online scheduler
Lab results: sign up with Sonora Quest/Labcorp; if want to discuss results/follow up after, schedule appointment
Thank you in advance for your understanding & assistance.
Exercise: Helps Weight, but Not As Much As You Think
This might be different from what you have been led to believe. Exercise has been linked with all sorts of health benefits from decreasing risks of mental health symptoms, cardiovascular disease, diabetes, cancer, and dementia to keeping muscles, bones, and balance strong. However most research data indicate that exercise alone plays a very small role in weight loss.
But when we focus on weight loss in menopause it gets a bit more complicated. There are a number of physiological adaptations that interfere with increasing exercise causing increasing weight loss. For example, the first time you run 5m, you burn a lot of calories, but by the 10th time your body burns far fewer calories. Also, increasing exercise has the side effect of increasing appetite and this increase in appetite causes most of us to over-consume calories in relationship to the calories just burned during the exercise.
In addition, weight gain that occurs during the menopause transition isn’t all due to direct hormone effects. The hormonal impact on sleep, body composition, energy, appetite, and motivation likely plays a far greater role in mid-life weight gain despite what some providers of hormone therapy say.
Finally, exercising in excess of calories consumed by diet can lead to metabolic adaptation, where the body holds on to weight when one is depriving it of adequate calories.
The bottom line is consistent, daily physical activity is important for health, but it may not be the quick fix to perimenopausal weight gain. And what you choose is not as important as you think; walking, hiking, jogging, pilates, yoga, dancing, water aerobics, swimming, cycling, barre, weight-lifting…whatever you will do and do consistently. The information your hear that you must “lift heavy” and do HIIT is not necessary for healthy weight, muscles, bones; just like diet, there is not one magic solution.
Alcohol: Non-Nutritive Calorie Source; Ultimate Low-Hanging Fruit
I ask about alcohol use because it has a significant negative impact on health. You likely have heard the news that current research has debunked the theory that alcohol has health benefits. This is a hard fact to accept for those of us who grew up thinking a drink a day was not only OK but conferred health benefits.
As such, we need to consider alcohol a non-nutritive source of calories, much like soda or slurpees (sorry, child of the 80’s!), that contributes to weight gain by increasing calorie consumption in excess of a healthy diet. One night out with several drinks and/or a drink every night can add up to several hundred extra calories.
5 oz glass wine ~130 cal
12 oz bottle beer 220-350 cal
1.5oz vodka/gin/whisky/rum 200 cal
Tequila sunrise. 525 cal
And be honest, measure your wine/spirits pour at home, is it actually 5/1.5oz?
Alcohol contributes to weight gain beyond increased calories. It interferes with sleep, and increases fatigue, depression, irritability, and anxiety which can all interfere with adherence to healthy habits. It also impacts hormones that control appetite, hunger, cravings, stress, and reproductive hormones like testosterone and estrogen.
Alcohol slows the metabolic rate, reducing the amount of fat burned for energy. It is used as a primary energy source before glucose and lipids, which are then stored as fat.
In short, avoiding alcohol may be the one thing you can do to achieve weight loss and health goals… a two-fer! If looking for pounds to drop after dedreasing alcohol, do not expect it overnight…since alcohol’s impact is more than simply increased calories it may take months to see the full metabolic benefits so hang in there!
If you need more motivation, read the 2023 Canadian Recs on Alcohol & Health and if you need help decreasing alcohol consumption contact me for an RX for naltrexone (also increases weight loss) and therapy referral, both of which can help you be successful.
Supplements: Improve Weight Loss/Body Composition…Nope!
Long story short, no. This is just not true, there is no such thing as speeding up metabolism, “natural” Ozempic, burning belly fat, shredding, or any other the other things you might be tempted to buy from Tic Tok or IG influencers, even the ones who are doctors. Save you money!
What CAN help you in your efforts:
Correcting nutrient deficiency if detected: B12, iron, vitamin D needed for energy & metabolism; calcium intake through dairy products & supplementation has been shown enhance weight loss especially in mid-section in addition to preventing bone loss, fiber supplements for those who struggle to get recommended 25g in diet… that’s it
Estradiol has been shown to decrease appetite, and have a favorable impact on on body fat distribution, especially central adiposity, that occurs with decreasing estradiol levels
Testosterone, if deficient may contribute to decrease in muscle mass, and therefore, reduced energy expenditure & weight gain, as does supraphysiologic levels found in pellet/injection use
Contrary to oft heard fear, menopausal hormone therapy has not been shown to increase weight/body fat, but may help guard against it. In fact, a recent study showed the contrary: estradiol increases resting energy expenditure by up to +222 cal/d in context of HRT, suggesting a preventive effect of on weight gain. It should be kept in mind that weight loss alone is not an accepted use of MHT, but can be a positive side effect when used for other symptoms.
For those who still struggle and are overweight, medications like metformin, Contrave (buproprione/naltrexone) and Qsymia (phentermine/topiramate), and either ingredient alone with or without oral semaglutide may be helpful.
For those with obesity & diabetes, meds like semaglutide & tirzeptide are available if above meds/lifestyle hasn’t helped, studies have demonstrated that the use of MHT with these meds improve weight loss than either alone.
The main point here is that many are looking for a “natural” solutions for all sorts of things, but like hair loss, wrinkles, and hot flashes, some menopausal symptoms are improved with medications and money spent on supplements is just wasted.
AND LASTLY, A RECIPE
And Lastly, Not One, But TWO Recipes
Last, but not least diet is of course a piece of the puzzle, even though we know weight at any age is more than “calories in, calories out”. Science tells us that there is no need to go all in on vegan, keto, paleo, low/no carb, gluten-free or, one I just heard on IG yesterday, “plant free”. (insert face palm/eye roll emoji). And as for fasting, the research supports the common sense not eating/drinking after dinner and eating when hungry in the am, for example, kitchen closes at 6pm and reopens at 9am…a 15h “fast” if you will. And, as above, keep non-nutritive drinks to a minimum.
What the research does tell us is that a Mediterranean-style eating plan (minimally processed whole grains/legumes, fresh vegetables/fruits, EVOO, nuts/seeds, moderate consumption of fish, low amounts of dairy products, very low intake of red/processed meat, and wine) not only reduces the risk of all chronic diseases, but is the one most associated with weight loss/maintenance.
This week I made an amazing Coconut Fish Bake from NYT cooking using frozen halibut & barramundi from Sprouts that fits the bill & had leftovers for a couple days…win/win!
If you just can’t fathom turning on the oven, I hear you! You might also try the ultimate savory smoothie, this refreshing NYT cooking Gazpacho with a side of crusty sourdough for a quick meal…I went veg-rogue and added some bell peppers, carrots from the garden…yum
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