Title: Can a Plant Based Diet help with Menopause and Weight Gain?
A common misconception is that we experience a slowing of metabolism around the age of menopause. Despite how common weight gain around menopause is, we don't actually see a change in metabolic rate around that time. What is going on and what can we do about it?
The most common question that I get is, does our metabolism slow as we age? And while the answer to that question is, yes, this slowing occurs after most of us experience weight gain and it only accounts for less than a 1% change from year to year.
According to Herman Pontzer and his team the amount of calories that our bodies burn each day, termed "total energy expenditure", is relatively stable through out adult lifetime (1). And there is no difference between men and women if we account for muscle mass and body composition (1). It comes with no surprise that men tend to burn more calories each day because they tend to have larger bodies and more muscle mass than women. What is surprising, is that women with equal body compositions burn the same average amount of calories. That is why it is so important that we engage in a regular strength training routine throughout our lifetime, to gain and maintain our muscle mass.
While the average age of menopause in the USA is around 51-52 years of age, we don't begin to see a drop in total daily calories burned each day until about age 60 (1). After age 60 our total daily energy expenditure declines by an estimated 0.7% (+/- 0.1) each year, with translates to a 26% slowing by age 90 (1).
So what is actually going on? Why is weight gain so common around menopause? While there are theories about why this phenomenon occurs, I want to be clear that the research on this topic is grey at best. While there are documented examples of women who gain weight when menopause occurs, not everyone agrees on the cause.
Studies that follow cohorts of women suggest that we gain on average 1 lb per year (3). That said, our weight gain appears to be more closely linked to our age, rather than directly related to menopause (3). But there are scenarios where we see that women who enter menopause earlier in life, have experienced more weight gain around that time (2). Reasons that someone might enter menopause early include having our ovaries removed, taking certain chemotherapy agents, or in the case of a genetically inherited premature ovarian insufficiency, to name a few (2). When women enter menopause earlier than expected, there does appear to be a trend towards weight gain (2).
At menopause, our bodies experience hormonal changes. Follicle Stimulating Hormone (FSH) rises and Estradiol (commonly referred to as Estrogen) goes down. Menopause is not a diagnosis that is made by blood tests, instead it is defined as 12 months without any menstrual bleeding (4). This decrease in Estradiol has been associated with less non-exercise activity thermogenesis (NEAT)(5)(6).
Okay, but does that mean that we should all be taking hormone therapy to avoid weight gain? Not so fast. Hormone therapy with prescription Estrogen +/- progesterone comes with serious side effects. With most of us at the highest risk for heart attack and stroke as we age, there is a concern that Hormone therapy can significantly raise CRP levels in the blood (7). CRP is a marker of systemic inflammation and it significantly raises our risk for heart attack and stroke. Read all about CRP and what you can do about it here. Hormone therapy is estimated to double our risk of heart attack and stroke (7).
Other contributing factors that account for added weight gain at menopause include poor sleep due to hot flashes and sweating. This lack of sleep and fatigue can increase our cravings for higher calorie dense foods. Our brains actually crave more calorically dense foods then we sleep poorly (8). Researchers studying sleep deprivation found that how we feel about our lack of sleep (for example, if we perceive our lack of sleep to be severe) effects the foods that we crave (8). Participants who reported feeling significant sleep deprived craved an average of 600 (+/- 289) kcal per day (8). If you're familiar with Kevin Hall's work, then you'd notice that an extra 600 kcal is around the amount consumed to feel full on an ad-lib diet of high-fat or processed food compared to a low-fat and unprocessed food diet, respectively.
For every 10 kcal change in overall intake that we make over time, it is estimated that our weight will fluctuate by about 1 lb. A 600 kcal increase in average daily calories would lead to an estimated 60 lbs of weight gain over time.
So what can we do about it? What do I think? It is clear that we are gaining weight as we age, and for some, menopause appears to accelerate this change. In the words of Dr. Michael Greger, "when we think about weight loss, our goal should not be to fit in a skinnier casket". We should approach weight loss with the lens of sustainability and wellness. The optimal diet for this wouldn't be a diet at all. It would be a different eating pattern that we could sustain in the long-run so that we can maintain our weight and health. Here at Lifestyle Medicine Maine, that's precisely what we do. We help people learn how to transition towards a plant based diet, but without the dogma of needing to forever give up meat or dairy. You choose what is best for you.
Our Weight Loss and Wellness Program is designed to give you the tools and the evidence to make true and lasting changes. This isn't a diet, it is a community of people who are looking to optimize their health and weight loss. It is a program designed to help us take action towards our goals. With so many of us knowing "what we should be doing", the difference between those of us who continue to weight gain weight and those of us who achieve optimal health lies in taking different actions. That's why we engage in different challenges each week that help us to explore the foods that we choose to put on our plates. If you're interested in joining a welcoming community of people who are on the same journey, then join us for session 02 of the we week program. Learn more about it here and feel free to schedule a free consultation with our clinician, Jessica Krol, FNP, DipACLM so that she can answer your questions here. Session 02 begins Sunday, April 7th at 10am EST. See you soon!
References
Daily Energy Expenditure through the Human Life Course. Pontzer, et al. Journal Science. (2021) https://doi.org/10.1126%2Fscience.abe5017 (free full-text link: https://www.science.org/doi/epdf/10.1126/science.abe5017 )
Weight, Shape, and Body Composition Changes at Menopause. Fenton. Journal of Lid-life Health. (2021) https://journals.lww.com/jomh/_layouts/15/oaks.journals/downloadpdf.aspx?an=01525309-202112030-00002
Weight gain and the menopause: a 5-year prospective study. Guthrie, et al. Climacteric. (1999) https://doi.org/10.3109/13697139909038063
Hormone changes associated with the menopausal transition. Su & Freeman. Minerva Gynecology. (2009) https://pubmed.ncbi.nlm.nih.gov/19942836
Obesity and weight management at menopause. Proietto. Australian Family Physician. (2017) https://pubmed.ncbi.nlm.nih.gov/28609591/
Modulation of Energy Expenditure by Estrogens and Exercise in Women. Exercise and Sports Science Reviews. (2018) https://doi.org/10.1249/jes.0000000000000160
Inflammatory Biomarkers, Hormone Replacement Therapy, and Incident Coronary Heart Disease: Prospective Analysis From the Women's Health Initiative Observational Study. Padhan et al. JAMA. (2002) https://jamanetwork.com/journals/jama/fullarticle/195231#:~:text=Several%20studies%20indicate%20that%20oral,among%20women%20taking%20these%20agents.
The impact of sleep deprivation on food desire in the human brain. Greer, et al. Nature. (2013) https://www.nature.com/articles/ncomms3259
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