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1:35 Cassie: Let’s start with an understanding of fat gain in the postmenopausal body and muscle loss. I’d love to hear your take on that. Wendy, why does it happen? How can we prevent it?
Wendy: As women, our bodies start changing hormonally in our 30s. And then they seem to accelerate after that once you hit menopause. And of course, all of that is going to change according to sort of what you’re eating and what medications you’re on. Men are different, men have testosterone levels that sort of slowly decline over time. And so men don’t experience this rapid body change like women do.
Before we hit menopause, our hormones are stable. And then as we hit menopause, hormones diminish quickly and significantly. Estrogen is the hormone that tends to give us lean muscle mass, and as it declines, the fluctuation in estrogen can create hot flashes.
But as our body has this protective mechanism of when estrogen declines, it wants to store fat around the middle, because it’s protecting our bones against osteoporosis. And so it’s almost like putting more weight in the core. And so even though this is great for our bones, to some degree, it’s not great for cardiovascular disease, it’s not good for our emotional health, it’s not good for our physical health. And so how to combat that, you know, has many different ways.
3:28 Hormone replacement is one of the best things you can do to slow the negative symptoms of menopause.
And obviously, it’s a very convoluted topic. And some people are like, I’ll never take hormone replacement. Some people are like, I’m open to it, but I’m afraid of it. And so I encourage you to, you know, reach out to me, because I feel like, you’re going to take hormone replacement to help, you know, to help your body feel young and feel lean and not have joint pain. It’s something that you can do safely and effectively.
In 2002, the Women’s Health Initiative study made everyone afraid of hormones because of fear of increased risk of strokes and breast cancer. And really the meta-analysis that looked at the same data 10 years later was like, oops, we kind of did some things wrong in that study. So that fear may be misplaced.
Cassie: Yeah, I think that’s a really helpful understanding of the biology and recognizing that these changes are happening for a reason. And yeah, like it may it may not be pleasant and yet, you know, having some empathy and self compassion for ourselves, which is something I talk about a lot, and also knowing things you can do. And just to clarify, as a Registered Dietician, hormone replacement is not within my scope of practice, so I would refer them right back. Yes, that understanding that, that, you know, you might have heard bad things about it in the past and that is more of an outdated understanding is important to know.
Wendy: Yeah. And I think an important addition to that is there are some women, you know, even just this morning, I had a patient that said, Is this going to make me gain weight by getting on hormone replacement therapy, because they equate it to sort of going on the birth control pill and their youth and then gaining weight, which is pretty common. And I would say that no, it’s dose dependent. And if you take way too much of a hormone, it can make you bloated and puffy. But you know, obviously, I’m, I’m aiming for just enough to improve bone density and heart health and cognitive function. And not you know, overdosing that which I think a lot of people are like, let’s get hormones to the age of when we were 30. And it’s like our bodies, even if you, you know, people say, what’s the proper estrogen progesterone ratio, or estrogen testosterone ratio? And, you know, I always have to laugh about that question. Because it’s like, well, it depends on the person.
Cassie: And this might be a question people are wondering, I know, I am at this moment, can someone who’s been postmenopausal for a number of years, you know, 5-10 years start hormone replacement therapy and get some help?
Wendy: So there’s something called the timing hypothesis. And what that states is, basically, the longer you’re away from that last menstrual cycle, the greater the risks associated with using hormone replacement.
Cassie: So it may not be a good option?
Wendy: No, it doesn’t rule it out. So if someone had been on hormones, you know, for many years, and then discontinued for a year or two, and then wanted to get back on, you know, with every case, and every patient, it’s a, you know, you look at all the benefits, and you look at all the risks, and you look at the bloodwork and you look at you know, are they sleeping, you know, are they getting hot flashes, if someone comes in and they’re like, I feel amazing, but I have too much weight, hormone replacement may not be appropriate.
7:02 Other factors influencing postmenopausal weight gain
Wendy: And, you know, I would say that, it’s not the first thing I mean, we kind of jumped into that, because that’s sort of the biggest trigger for that middle of the weight, or middle of the body weight gain and sort of the immediate help, but also metabolically, our bodies are changing. So as our ovaries reduce, you know, production of hormones, our thyroid may become affected. And it’s amazing to me how many people go into their doctor, and they say, I’m having weight gain, I’m not sleeping, you know, and they’re sort of given some options, they’re usually given a birth control pill prescription, or they’re given like an antidepressant of some sorts.
And obviously, there’s so much more to caring for our bodies at this age that, you know, it’s really important that you consider all the factors and Cassie and I had the benefit of working together at a company that we collected so much data on patients, and we collected Fitbit data, so how much they were sleeping, how much they were exercising, we collected my fitness pal data, what they were eating, they would send pictures of food, we would look at 180 analytes in the blood, we would look at their genetics.
8:14 The role of genetics in postmenopausal weight gain
Wendy: It’s important to ask yourself, am I predisposed towards weight gain around the middle, because we can’t forget genetics, right? Because if you have a mother and a grandmother and sisters and they’re all sort of like Rubenesque, so to speak, they’re no bigger breasts, bigger hips. No matter how you eat, you’re never going to have you know, sort of the you know, female athlete skinny, you know, body that’s just not the body type. And so I think there needs to be some realistic expectation about the genetics that we carry. And also the habits that we form day to day.
8:47 Postmenopausal belly fat
Cassie: Yeah, yeah. You know, one of the questions that someone asked is what’s with this refrigerator shape, I now have 20 years after menopause. She says she’s more of a box shape than she’s ever been, even though she’s doing strength training. And she says, I’m pro aging, but this is a real drag any suggestions?
Cassie: And I think this goes along with several questions I got coming back to this idea of fat gain and muscle loss and understanding that with less estrogen estrogen tends to be the the fat gain in the butt, the hips, the thighs that like curvy, you know, Lady shape. And when estrogen lowers, then your fat, your fat distribution changes. The other thing that can happen that many people forget about in this time of life is cortisol. And if anyone knows me knows that I’m talking about our stress hormones all the time, especially in this time of, you know, during or post pandemic or who knows where there’s just a lot of uncertainty and more stress triggers. And the reason that comes into this conversation is because during the menopausal and postmenopausal years research shows that those can be some of the most stressful in a woman’s life, and on top of it, you know, lowered estrogen can raise cortisol as well. And so we’re looking at increased belly fat, that visceral fat around organs that can lead to change, you know, increased risk of chronic disease. So that’s why some of the belly fat may occur.
Topics that follow:
10:29 How to lower cortisol
14:01 How strength training benefits postmenopausal women
16:07 Whether DHEA supplementation is appropriate for postmenopausal women
17:51 Intermittent fasting and belly fat
24:12 What is sarcopenia and how to avoid it, plus how much protein do postmenopausal women need?
29:58 Are soy foods OK for postmenopausal women?
32:51 Are nuts too high in calories?
35:20 Bone health for postmenopausal women including nutrients and exercise
44:03 Dealing with postmenopausal metabolism slowing and self-acceptance
50:44 Best calcium supplementation for postmenopausal women
51:43 Reduced sex drive in postmenopausal women (and what to do about it)
56:01 Postmenopausal brain fog
57:34 Over-the-counter medication (like Benedryl) and risk of dementia
58:34 What tests to get in annual bloodwork to check postmenopausal health
Essentrics – a live attendee recommended workout
Cassie Christopher is a Registered Dietitian, Emotional Eating Expert and owner of Cassie Christopher Health Coaching. She has a Master’s degree in Nutrition and specializes in helping women in midlife and beyond find the Courage to Trust themselves around food. She helps women stop the cycle of all-or-nothing dieting that leads to numbing emotions with food so they can develop a supportive relationship with food, their body and their health, so they can eat with joy instead of eating to seek joy.
Wendy Ellis is a seasoned naturopathic physician with 20 years of experience in the treatment of menopause.
She has lectured extensively around the US for clinicians wanting to become more proficient in treatment of endocrine dysfunction / hormone replacement. Educating patients about their health is an important part of her clinical practice. When she’s not in the office, Dr Ellis can be found hiking in the woods with her dog, boating with her family on Puget Sound, gardening or spending time in the kitchen.