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Special Topics:  Weight Gain

[adapted from The Premature Menopause Book, by Kathryn Petras]

It’s summer -- and you’re going to the beach in your bathing suit...or wearing shorts and tank tops...or at least thinking about it. At this time of year more than any other, you’re more aware of your body.  Or it's the holidays -- and you want to look fabulous for those parties you're invited to.   Or it's just any day, and you want to look and feel wonderful.

But you step on the scale, and the little arrow is higher. Or you look in the mirror and don’t think you look as good as you used to. You feel heavier. You feel like you look different.

It’s a common problem for women like us going through early menopause.

You’ve gained a few pounds.. Your body looks different. You’re noticing a new, very annoying, roundness to your tummy. Your waistline seems to have disappeared. The scale is becoming your enemy...yet you’re not doing anything differently than you used to. What is going on?!?!

Let’s start with something that drives me -- and many other women in early or premature menopause -- crazy: Many books and articles insist that women put on weight during menopause because they’re older. It’s not a function of menopause, they argue. It’s a function of aging. Your metabolic rate drops as you age, which accounts for the weight gain. In addition, older women are often more inactive.

Well, maybe this applies to the average woman in menopause who is in her 50s . But what if you’re in your 20s or 30s -- and you start noticing the creeping weight gain and new thicker body contours? I know I did....and dozens of prematurely menopausal women I’ve spoken with have seen it happen to them as well. We’re not middle-aged. We’re still young. So, regardless of what the books say, it can’t be age that causes these changes. And it isn’t. It’s your hormones, plain and simple.

So there’s a good chance you’ll notice your weight going up -- even though there’s been no change in your diet or exercise habits. You might notice your body shape changing as well -- shifting from a "pear" shape to an "apple" -- as weight starts to accumulate more around your waist and abdomen instead of your hips, thighs and buttocks. You might notice your waistline disappearing, as your body becomes thicker through the middle. And, finally, you might notice that dreaded "buddha belly" -- a new rounder tummy, especially below your belly button, that just doesn’t want to go away.

Okay, so these changes aren’t life-threatening. . . but they do affect your ego at a time when you least need it. They also affect older women in menopause, of course. But, in truth, it’s often worse for women in premature menopause. The biggest difference? When you’re going through this in your 20s or 30s, the changes in your appearance are often more apparent than the changes an older woman in menopause goes through. (especially to you), simply because most other women your age aren’t experiencing the same thing. Other women in their 20s and 30s aren’t getting the so-called "middle-aged spread" that women in their 50s experience, but you are.

Why is this happening? As I said before, most of this is due to your hormone levels. Lower levels of estrogen may cause a variety of physical side effects. First, because estrogen is stored in fat, many researchers believe that, when you enter menopause -- whether naturally or through surgery, your body responds by holding on to fat cells in an effort to boost the lagging estrogen levels. The result? It’s tougher to lose fat and much easier to keep the pounds on.

Second, as estrogen levels drop, your level of androgens -- the so-called "male" hormones -- increases in relation to the estrogen. Unopposed by the higher levels of estrogen your body used to have, the androgens produce male characteristics -- in this case, the shift in body fat from your hips, thighs and buttocks to your midsection, resulting in the "apple" shape that is more common in men and in postmenopausal women (which, incidently, also increases your risk of heart disease.)

Third, low estrogen levels affect the production of collagen -- which results in drier. thinner skin, sagginess of tissue, and lack of muscle tone -- all of which contributes to a change in your body shape.

Low progesterone levels (in relation to estrogen -- which is popularly called "estrogen dominance") also cause a number of side effects. Among the more common ones: increased bloating and water retention -- which may not be actual fat, but makes you look heavier, and blood sugar fluctuations -- which can increase your appetite and slow your metabolism.

Finally, there’s the mood connection. As you know, declining hormone levels can cause mood swings, depression, anxiety. This is because the levels of serotonins and endorphins in your brain apparently drop in the face of fluctuating hormones. What raises serotonin levels in your brain? Certain foods, like chocolates. Often, when you go through premature menopause, you notice you have food cravings -- much like you did when you had PMS. But unlike PMS, your hormones don’t bounce back to regular levels, so you may have food cravings longer than in the past. . . and, unfortunately, cave in and eat more of the foods you shouldn’t, like fats, salty snacks and sweets.

Regardless of what some people have claimed, then, there does appear to be a biological basis for the changes in your body. It’s not in your mind. It’s in your hormones.

So that’s the bad news. But all is most definitely not lost! There are three very basic things you can do to help fight the changes in your body brought on by changing hormone levels:

1)  Boost your hormone levels through HRT or natural supplements.

2)  Eat correctly.

3)  Exercise regularly.

It’s a simple prescription to be sure -- but it’s one that can make a big difference!

This month, we’ll take a quick look at how replacing hormones can help (and when it doesn’t....), as well as some tips on how to eat right to help you lose the weight you might have gained....and keep it off!  Next month, we'll focus on exercise.

Hormone Replacement Therapy: Will it Make Me Fatter....Or Fitter?

Since we often put weight on because our estrogen levels are low, usually we can keep that weight off -- or, at least, gain less -- by replacing estrogen. It makes sense, right? But then why do so many women say that they gain weight on HRT?

That’s the million dollar question -- but there’s actually a simple and logical answer.

First, let’s look at the facts about HRT and weight: A widespread look at HRT, the PEPI trial -- as well as other smaller studies -- found that while women on HRT did often put on a few pounds, those women who weren’t on HRT gained more weight. In fact, some studies have shown that many women actually lose weight on HRT

One possible reason: When you’re in premature menopause, your estrogen levels drop -- so your body may try to up its fat content to store and produce as much estrogen as possible. When you go on HRT, you’re getting the estrogen your body expected to have, so it doesn’t need that extra fat any more. In addition, when your estrogen levels are low, you tend to put on weight in your middle -- more like a man. This accounts for the "disappearing waistline" that so many women in premature menopause experience. When you replace estrogen, your body reverts to its normal weight-distribution, which for most women means putting weight on in their hips, thighs and lower abdomen instead of the middle.

So why do some women say they think they’ve gained weight on HRT? To some degree, this might depend on the type you’re taking. Progestins tend to make you retain water and bloat more. Even if you haven’t actually gained fat, you may feel (and look) as though you have -- especially if you’re on cyclical progesterone, that is, taking it for only part of the month. Natural progesterone doesn’t seem to have this side effect as much; and often works as a diuretic instead, helping you lose water weight. Other women have found that lowering their dosage of estrogen or progesterone helps keep bloating down. Finally, others report good luck with patches instead of pills. You can read more about this in the discussion about the different forms of HRT.

But, all in all, weight gain isn’t something you should worry about when you consider going on HRT.

One side note, though (and I hate to say this....but I’ve noticed it in myself!): There is one area in which women on HRT do seem to gain inches: Compared to menopausal women who aren’t on HRT, women on HRT have shown in a number of studies to gain less weight in their arms and their middle...but there does appear a tendency towards adding inches in the hips and thighs. And, in truth, this is something I’ve noticed in myself...unfortunately! So, while my waistline is back and my midsection trimmer, there is a little added weight below my waist.

But, that said, all in all, overall HRT will help you keep your weight in line -- and reverse many of the changes you may have noticed in your body.

What if you can't -- or won't -- take hormones?  Well, there are still ways to boost your estrogen levels and help reverse that weight gain.  Phytoestrogens -- which are high in foods and supplements like soy and flaxseed -- can  help you raise your estrogen levels the natural way.  No, they're not as potent as replacing hormones.  But they still can make a difference.   Think about adding soy foods to your diet, putting ground flaxseed in salsad -- or taking the early route and getting supplements like flaxseed or red clover capsules from your health food store.


Eating Right for Early Menopause

Now on to something that’s easy for any of us to control: How we eat. Since weight gain is so prevalent when you go through early menopause, it’s vital to be sure you’re eating the best foods given this change in your body. And, happily, it’s really not that difficult.

Here are a few very simple tips that can help -- many of which are really obvious, but they definitely bear repeating!

  • Think low fat -- to keep your weight down and to cut down on the risk of disease.

This is one of the best things you can do for the overall health of your body. First, as you know, premature menopause increases your risk of heart disease. By cutting down on fat, you can help shift the odds in your favor and help prevent heart disease. Saturated fats raise your blood cholesterol level -- so a low fat diet will help you keep your cholesterol levels down. A low fat diet also appears to help prevent cancer. If you’re on HRT and concerned about breast cancer, this is particularly important, as studies have indicated that both breast and ovarian cancers are linked with a high-fat diet, particularly one high in fats from dairy foods, such as butter and whole milk products.

As for weight control, cutting down on fat is a definite help. More often than not, high fat foods are also high calorie foods -- which certainly doesn’t help you keep your weight down. Typically one gram of fat has over twice the calories as a gram of protein. And not only is fat usually more caloric, it also coverts quickly and easily to body fat.

But don’t think that you have to go crazy and cut all fats from your diet. Recent studies have indicated that an extremely low fat diet may actually be harmful to your health. Your best course of action? Be aware of fats; opt for lower fat foods; and cut saturated fat from your diet.

  • Keep your fiber intake up.

Fiber is your friend when it comes to healthy eating. It fills you up, keeps your digestive tract healthy, and helps you eliminate some of the fats you eat. In addition, it can help prevent certain types of cancer and lower your cholesterol. You need both insoluble and soluble fiber. Insoluble fiber helps keep your elimination regular and helps protect against cancers of your intestinal tract. Foods high in this include: whole grains; fruits and vegetables Whole grains are the "good" carbohydrate to eat. They combine slow metabolization, high fiber, and the good "mouth" feel of carbohydrates makes whole grains a wonderful choice when you’re in premature menopause. The fiber in whole grains can help you keep your weight down. It fills you up quickly and keeps you feeling satisfied for a longer amount of time than other foods -- which is a definite plus when you’re trying to avoid overeating. As for fruits and vegetables, they too can fill you up -- plus many of them are high in antioxidants -- which can help your heart and help fight cancer risks.

Soluble fiber keeps your blood sugar levels stable, and is metabolized slowly -- a real help in keeping from overeating. Foods high in soluble fiber include: apples, barley; beans; flaxseed; prunes; rolled oats, oat bran.

  • Be sure to get as much (low fat) calcium as possible.

You already know that you’re at a great risk for osteoporosis -- so clearly calcium is a must in a good premature menopause diet. Low fat dairy products supply you with needed protein and keep your bones strong without adding too much fat. And calcium-rich vegetables, like broccoli, are another good source. .

  • Don’t forget protein -- for overall health and (a nice plus) weight loss.

Protein can help you build your body and burn calories -- quite an effective one-two punch! But all too often, especially recently, people tend to overlook the benefits of protein, especially as a way of keeping weight in check.

In recent years, the emphasis has been on high-carbohydrate eating. Books and doctors extolled the virtues of carbs and claimed that a high carbo diet was the best thing for you. But the pendulum is shifting back, and more books have been coming out asserting that high protein/low carb is the way to go.

Regardless of whom you believe, there is no question that protein is a necessity in your diet. It is made from amino acids, some of which your body makes -- and others of which you can only get by eating protein. It is, in one form or another, present in every cell of your body. It makes, maintains and repairs cells -- from muscle to other tissues. It is a crucial ingredient in everything from your bones to your hair; and makes up such vital substances as hormones (such as insulin) and disease-fighting antibodies.

It’s clear, then, that protein is a must in anyone’s diet. But it’s especially important if you’re going through premature menopause -- and here’s the big reason why:

You can actually jump-start your metabolism with protein. Protein’s thermic effect is higher than that of carbohydrates or fats. In other words, you burn more calories when you digest a high protein meal than one high in fats or carbs. So you’re getting more bang for your buck when you eat protein. One other big plus: because it is used in the manufacture of insulin, protein helps keep blood sugar levels stable -- a big plus when it comes to preventing both mood swings and food cravings.

  • Because it may be easier to add or keep weight on due to premature menopause, remember to keep an eye on calories.

For a while there, it seems as though everyone forgot about calories. Articles, books, and nutrition experts were focusing on low-fat eating as a way of keeping your weight down. Well, that is true to a large degree -- higher fat foods do usually help you pack on the pounds. . . especially because they’re usually higher in calories!

It’s a simple scenario: Calories are , in effect, energy units. They’re what your body burns as fuel. But if you take in more calories than you burn, you gain weight. It’s that simple. On the whole, it doesn’t matter if they’re "good" calories or "bad" (although some nutritionists believe it’s easier to pack on pounds if you eat too many carbohydrates -- because it affects your insulin levels.). But, on the simplest level, if you’re trying not to gain weight, you have to burn the calories you eat -- and, of course, be sure you don’t wind up with too many calories in the course of a day’s eating.

How much is too much? It really depends on the individual -- your height and weight, your body build, your fitness level, and how active you are. But it’s good to keep in mind that only 3,500 calories add up to one pound of added weight -- and those 3,500 calories can add up over time, especially if you’re not exercising.

So calories count. . . but (here’s the good news!) you don’t have to -- and frankly, shouldn’t -- count calories. If you follow the good eating guidelines included in this section, you’re well on your way to keeping your calorie intake in check painlessly.

  • Try to eat more before 5:00 PM -- and try not to eat anything after 8:00 PM.

Some studies have said it makes no difference -- that calories are calories, no matter when you eat. But other studies have shown you’re best off eating large meals earlier in the day. You’re more active, so you can burn off some of the calories you’ve taken in. In fact, to put it more scientifically, many studies have shown that it takes about four hours after eating for your blood-triglyceride levels to rise. So, if you have a large dinner at 7:00 or so, your triglycerides will hit their height at 11:00 -- right when you’re going to bed or lying on the couch watching television. . . which means you’ll probably wind up storing them as fat. In general, try to follow that old saying: "Breakfast like a king, lunch like a prince, dinner like a peasant."

  • Drink water whenever you can remember to -- and definitely before meals.

Water not only is good for your system, it also fills you up, so you’ll eat a little less.

  • Eat more soup!

It sounds like a no-brainer, but recent studies have found that people who eat soup before a meal eat less. It’s even better than water, since you’re getting nutrients.

  • Finally, give in to your cravings . . . . a little.

Eating well and healthily doesn’t have to mean depriving yourself. You are going through premature menopause; you have a lot going on already; there’s no need to punish yourself. Often allowing yourself a little something you crave can help you keep eating properly.

For example, according to several surveys, chocolate is the number one food craved by women with PMS and women in menopause. A key reason? It increases the levels of serotonin and endorphins in your brain, making you feel better. So having a little chocolate may help you stabilize your moods and chase away the blues. . . which is well worth the small amount of fat and sugar you’re eating. Of course, you can’t overdo it, though!