Weight Gain, Muscle Loss & Mortality in Midlife
Let’s talk about the mid-life weight gain associated with peri-menopause, and I’m going to come right out and say it.
I do believe that there has been a cultural gaslighting of women’s complaints, especially the weight gain, characterizing the complaint as not-important or strictly a vanity issue. And the fatigue ….psychosomatic!
Let’s face it, medicine is still largely predominant male-centric. That, combined with the lack of research geared towards women’s health (especially minority women), has created a system in which women’s complaints are under-appreciated and misunderstood.
The research that does happen in Women’s Health goes into the hot flashes, vaginal atrophy, and osteoporosis. That’s not enough. It’s the metabolic diseases and changes that occur with menopause that are not researched enough, and unfortunately, this is where the mortality risk is highest.
Menopausal changes are not just quality-of-life annoyances (hot flashes, sleep disturbances, painful sex), they are cardio-metabolic disease amplifiers, accelerating biological aging and increasing the risk for osteoporosis, insulin resistance, and heart disease.
Plain fact: it’s the hormone decline that fuels these changes and symptoms, and so many physicians overlook this.
NIH and the pharma industry alike tend to prioritize drug classes[1] with high return on investment: GLP-1 agonists, anti-depressants, sleep drugs or statins for example,—Not the cheap, natural, off-patent hormones. And without massive RCT data specific to Bio-identical Hormone Replacement Therapy (BHRT) and metabolic endpoints, the FDA simply won’t issue recognition or approvals.
Our hormones protect us, they protect our organs and our inner workings. When we don’t have enough estradiol, we tend to get more fat around the belly (surrounding and engulfing our organs), and muscle protein synthesis and mitochondrial function declines.
Why is weight gain bad?
My expectation for post-menopausal women is not a Barbie doll-model-movie star body. That body type is typically not achievable, or desired by many, and not necessarily healthy. But with the alarming 2023 statistic, over 70% of women are overweight or obese, I feel we need to talk about body fat and weight distribution because it relates to metabolic health and longevity.
Weight gain is not always a product of overeating. Oftentimes, when a woman transitions into menopause, there is actually a chronic undernourished state (which further depletes your thyroid, adrenal and ovarian reserves), as women often start cutting calories and “carbs become the enemy.”
A woman will gain an average of 1 lb per year during the menopausal transition, with central fat accumulation as a hallmark. There is a 4–14% increase in fat mass over 1–4 years, despite a woman’s commitment to a healthy diet and exercise routines. Seems not fair, right?
Weight matters because it drives insulin resistance, adult onset diabetes, non-alcoholic fatty liver disease and cardiovascular disease. For each year after menopause, a woman’s odds of developing metabolic syndrome increases by about 24%.
Regardless of your weight (because insulin resistance also happens in “skinny” women too), have your cardiometabolic markers checked, including an advanced lipid profile, thyroid, A1C, fasting insulin, and consider a calcium artery calcium score, and remember that heart disease looks and feels very different in a women’s body, compared to our male counterparts. You may have had PERFECT lipids pre-menopause, but be prepared for some mighty shocking changes in what used to be perfect on your blood work.
In postmenopausal women, the higher the insulin resistance, the more strongly it correlates with greater risks of both all-cause mortality and cardiovascular mortality.
A study of over 22,800 Women’s Health Initiative participants tracked for nearly 19 years found that women in the highest insulin-resistance quartile (via HOMA-IR) had a 63% higher risk of all-cause mortality (HR = 1.63) and a 26% higher risk of cancer-specific mortality (HR = 1.26) compared to the lowest quartile.
Is HRT a tool to mitigate metabolic syndrome?
The journal, Cancer J. 2022 ; 28(3): 208–223 says
“Prevention of new onset diabetes mellitus with menopausal HRT is a particularly important primary CVD preventive strategy since metabolic syndrome and insulin and glucose dyscrasias, as well as new onset diabetes mellitus are common manifestations following menopause and represent major causes of CVD and morbidity in women.”
Thankfully, more physicians are being re-educated and working with the constantly evolving research on HRT and are finally offering women options that are not just the big Pharma metformin, sleep drugs, GLP-1 agonists and statins and antidepressants.
So, let’s get your hormones into balance and into ranges that support metabolic health.
All that said, hormone supplementation is not for everyone, and even women who receive them, it’s not a cure-all-holy grail.
Here are some relatively attainable suggestions for mitigating the metabolic changes!
Time your carbohydrates with your workouts, 30 grams of carbs will replace your stored glycogen and make your workout more meaningful.
And if you really want to know your carbohydrate tolerance, get a continuous glucose monitor to see how your blood sugar changes with your food intake. DEXACOM is a good non-prescription device.
To support health span and life span, emphasis needs to be placed on sustaining muscle mass, by way of strength training and eating nutritious, real food. Target your muscle mass, instead of just using weight as your “barometer” of healthy aging, especially because sustaining muscles helps regulate glucose and insulin sensitivity. Click here [2] some general guidelines for exercise for per-post menopausal bodies.
If you are interested in learning more about your body’s fat/muscle/bone composition, check out a DEXAfit [3] site near you. Testing is about 130 dollars, and is a great way to gather starting point data before embarking on a strength training regiment. Routine/annual screens help to track your progress!
And for my recommendations on protein intake and strength training to combat sarcopenia and muscle anabolic resistance, click here![4]
One last cool bit of new research I’d like to share.
(You know me, always talking about gut health. )
But get this, your microbiome actually helps to build muscle. The more diverse your intestinal gut population is, the higher your butyrate levels will be (it’s a short chain fatty acid) and the higher your butyrate levels are, the higher skeletal muscle index in the postmenopausal women.
Take home: This underscores the potential for microbiome-targeted interventions (dietary fiber, probiotics) aimed at increasing butyrate production to support musculoskeletal health during menopause.
link to “menopausal, there’s a drug for that!
link to my blog, the peri-menopausal exercise prescription
link the the anabolic resistance blog
