The Wisdom of Menopause

by Christiane Northrup

  Thankfully, there are ways to negotiate the metabolic shifts that manifest at midlife and rebalance your hormones without any significant weight or fat gain. I know this path from the inside out, not only professionally but also personally.

  MAKING PEACE (ONCE AGAIN) WITH MY WEIGHT

  My weight has been an issue for me since I was twelve years old, when I went on my first diet. In my teens and early twenties I was always trying to weigh ten to twenty pounds less than I should have, given my rather sturdy frame and large muscles. (No one understood at that time that weight could be a very misleading measure of health.) Throughout my teens, I struggled to weigh 115, a weight I achieved only for a month or so when I starved myself in college. The reason I chose 115 was that according to all the fashion magazines, that was supposedly the “ideal” weight for someone of my height: 5 feet, 4 inches. Back then, no one made any distinction between lean body mass and fat! Now, I clearly see that a goal of 115 pounds for my particular body was not only unrealistic, but also downright unhealthy! In my twenties, I ran regularly and was able to maintain my weight at around 125 with a great deal of effort, which included fighting constant cravings for sweets.

  After my pregnancies I, like so many other women, was never able to get my weight back to 125 no matter what I did. I had run headlong into another aspect of Mother Nature’s wisdom, which has set up postpartum weight gain so that we new mothers will be likely to stay alive during lean times to nurse and care for our children.

  In my thirties, after I had nursed my two daughters for a total of nearly four years, my weight stabilized between 137 and 140. During these years I added weight training to my fitness regimen, and I figured that my weight gain was as much muscle as fat. (Muscle weighs more than fat, but it also burns calories far more efficiently.)

  Finally, in my early forties, I came to a place of peace with my weight and size, even though my skeleton will never be a size 4! Through careful attention to my diet—which had consisted mostly of whole foods, healthy fats, lots of fruits and vegetables, and lean protein—and consistent exercise including weight training, I managed to maintain my body fat percentage at a healthy 22 to 25 percent and my weight at about 140, plus or minus (mostly plus) a few pounds. Yes, I still wanted to lose five to ten pounds, but I wasn’t willing to further change my lifestyle—or give up my regular, though modest, servings of chocolate brownies or pie—to lose them. I was certainly following my own recommendations and keeping my blood sugar stable!

  My Metabolism Takes on a Life of Its Own

  But then a month or so after turning fifty—about the time my periods became irregular—I began, inexplicably, to gain weight. Every day the scale showed another pound, even though I wasn’t eating or exercising any differently. I was horrified. Yes, horrified. Lest you think that this is too strong a word, let me explain. I have the kind of body shape and metabolic rate that could very easily lead to obesity if I were not so disciplined about my diet and exercise routine. There was an upper limit on the scale beyond which I would not allow myself to go, and that number was 144. But now I stood by helplessly and—in the space of a few weeks—watched the scale climb to 149, one pound less than I had weighed at the end of my pregnancy with my first daughter!

  I knew that a new plan of action was called for. But what should it be? I’d been so sure I’d finally won the battle of the bulge and found a comfortable way to eat that would work for me for life. Now what?

  Ketosis and Me

  I decided to try a more extreme form of carbohydrate restriction. Maybe I’d let too many carbs creep into my diet. I went out and bought a copy of Dr. Atkins’ New Diet Revolution. The cover said two million copies had been sold; could that many people be completely wrong?2 In any case, given the connection between carbohydrates, insulin, and weight gain (which I will discuss in more detail below), Atkins’s research and clinical expertise made sense to me.3

  I had also researched ketosis, the metabolic state that results when you cut down carbohydrates enough to begin burning body fat for fuel. Although critics cite ketosis as a danger of high-protein diets, I knew that this metabolic state was safe for people with no kidney problems, at least for the limited amount of time recommended by Atkins and quite probably for much longer periods. More than that, it appeared to be associated with consistent and relatively fast weight loss.

  I decided to follow the Atkins “induction” diet to the letter for at least fourteen days. I bought some urine testing strips at the drugstore to test for ketosis. (Ketone bodies, which result from the breakdown of body fat, are excreted in the urine and can be easily tested for at home.) According to Atkins, the presence of ketones in the urine is a virtual guarantee that you’re burning fat for energy. Then I cut my carbohydrate intake to less than 20 g per day, a level of restriction I’d never tried before.

  According to Atkins, the vast majority of people reach a state of ketosis within forty-eight hours. That is how long it takes the liver’s glycogen stores to be depleted so that the body begins to use its fat for energy. So I cut the carbs, waited forty-eight hours, and then began to test my urine two to three times every day. Nothing. The strips didn’t turn purple. Though I actually felt good and had a lot of energy, I didn’t go into ketosis until I began to add relatively high doses of the supplement L-carnitine.

  After a full ten days of carbohydrate restriction, I managed to produce just a little bit of ketosis—the urine strips measured “trace.” But even then I failed to lose weight or inches. In fact, I gained three pounds on the induction part of the Atkins diet. I had now plateaued to a new high. Talk about frustration! Here I was, exercising regularly, eating a very limited amount of carbohydrates, keeping the rest of my food portions normal, and following a diet that has helped millions lose weight. But it didn’t work for me. Like many other perimenopausal women, I had hit a metabolic wall; our midlife bodies seem to hold on to fat for dear life until we learn the secrets of releasing it!

  I finally did. Within four months, I got back down to 140 pounds, and I have maintained it through consistent dietary discipline and regular exercise.

  The following program is based on my own experience, reports from thousands of my newsletter subscribers, and leading-edge research on the effect of food on blood sugar. It is designed to help you tame your midlife fat cells, balance your hormones, and safeguard your health on all levels.

  SIX STEPS TO MIDLIFE WEIGHT CONTROL

  Step One: Maintain Normal Blood Sugar

  and Insulin Levels

  Like many women (and doctors), I used to operate under the delusion that the reason we tend to gain weight at midlife is because our metabolism slows down, our bodies become more efficient at storing energy in the form of fat, and falling estrogen levels result in increases in appetite.4 As it turns out, these metabolic changes, though real enough, are not the result of menopause, per se, but are instead the natural progression of a process that begins much earlier: glycemic stress (from blood sugar that is too high) and resulting insulin abuse. Here’s what happens.

  When you eat too many refined carbohydrates (in the form of french fries, mashed potatoes, cookies, ice cream, soda pop, white bread and rolls, etc.), you get an immediate and substantial increase in blood sugar. This excess sugar in the blood is converted to triglycerides in the liver. At the same time, however, excess blood sugar actually causes inflammation in the lining of blood vessels throughout your body, starting in the skeletal muscles. This is known as “glycemic stress,” a term coined by family physician Ray Strand, M.D., whose research has documented how glycemic stress, if left unchecked, eventually results in syndrome X, which is characterized by central obesity (too much belly fat) and an increased risk for type 2 diabetes, male pattern baldness, and heart disease.

  This has been backed up by the latest research, including the 2010 European Prospective Investigation into Cancer and Nutrition (EPICOR) study from Italy that followed 47,000 participants. The EPICOR researchers reported that women who ate
the most high-glycemic-index carbohydrates had more than twice the risk of getting heart disease as those who ate the least (although the same association wasn’t found in men).5 In addition, another study published the same month and conducted by Emory University School of Medicine was the first to link eating food containing high amounts of added sugar with an increased risk for heart disease. This study, which looked at data from more than 6,000 adults who took part in the National Health and Nutrition Examination Survey (NHANES), showed that those who consume the most added sugar—the kind found in processed foods and drinks, not natural sugars found in fruits and fruit juices—were more likely to have higher levels of triglycerides and a higher ratio of triglycerides to HDL cholesterol (one of the most potent predictors of heart disease).6

  Excess blood sugar over long periods of time eventually leads to insulin resistance. Let me explain. Insulin is produced in the pancreas and is responsible for ferrying glucose from the bloodstream into our cells, where it is used for fuel. Good health depends upon our body’s ability to make and utilize just the right amount of insulin to keep our blood sugar at optimal levels and our metabolism working normally. Consumption of refined carbohydrates results in an immediate surge in blood sugar. This triggers the pancreas to secrete large amounts of insulin to process the blood sugar. Every cell in the body has insulin receptors on the surface. These allow insulin to “open the door,” so that glucose can enter the cell.7 But over time, when blood sugar levels continue to be too high, the insulin receptors lose their ability to respond to this abnormal metabolic burden. The excess blood sugar is also stored as fat, which in turn contributes to insulin problems. Over time our cells become insensitive to insulin’s effect and a condition known as insulin resistance develops, in which more and more insulin is poured out, to less and less effect. Eventually neither the body tissues nor the pancreas can keep up with the blood sugar load. Virtually every cell in our bodies is adversely affected by this abnormal metabolic state. In severe cases, an individual with this condition may be diagnosed with type 2 diabetes and require insulin injections to meet the demand.

  About 25 percent of the population appears to be genetically resistant to the adverse effects of overproduction of insulin and insulin resistance. These individuals usually manage to stay very slim no matter what they eat. But 75 percent of the population is not so lucky, especially during perimenopause.

  Most perimenopausal symptoms, such as heavy bleeding, cramps, fibroids, and PMS, will respond to a diet that keeps your blood sugar and insulin levels stable—a diet that will also help prevent cellular inflammation. In general, insulin and blood sugar levels stay normal on a diet of unrefined whole foods that include carbohydrates with a low to moderate glycemic index, such as fruits, vegetables, and whole grains. The glycemic index is simply a measurement of the rate and degree to which a given carbohydrate-containing food raises blood sugar levels. High-glycemic-index carbohydrates—including alcohol, starchy and sugary foods such as cookies, candies, soda pop, alcohol, and white bread, and almost all refined, processed foods—are quickly metabolized into sugar, triggering a rush of insulin into the blood.

  On the other hand, carbohydrates with a low glycemic index break down slowly, raising blood sugar to relatively low levels over a longer period of time. This allows them to be metabolized with only a small amount of insulin.

  Evolutionarily speaking, most of the high-glycemic-index carbohydrates are “new” foods that have been rapidly increasing in our diets only over the last century. Up until then, for millennia, our food supply and metabolism evolved side by side along with the active lifestyles that also keep insulin levels normal.

  INSULIN RESISTANCE (SYNDROME X)

  The medical conditions associated with insulin resistance are collectively known as syndrome X, a term first coined by Gerald Reaven, M.D., a world-renowned endocrinologist at the Stanford University School of Medicine.8 They include:

  ~ Increased risk for type 2 diabetes9

  ~ Abnormal cholesterol levels10

  ~ Hypertension

  ~ Heart disease: coronary artery disease and peripheral vascular disease11

  ~ Obesity

  ~ Anovulation12

  ~ Overstimulation of ovarian testosterone13

  ~ Polycystic ovary syndrome

  ~ Excess hair on the face, hair loss on scalp (male pattern baldness in women)

  ~ Adult acne

  ~ Increased risk for breast cancer and endometrial cancer14

  A diet high in refined carbohydrates makes all perimenopausal problems worse because of its adverse effect on hormone balance. It reinforces the tendency toward excess fat around the waist and belly (central obesity), which in turn favors production of estrogen and androgens. Central obesity and high insulin levels—which can occur even in women of normal weight and BMI—are also associated with higher blood triglyceride levels and low HDL cholesterol. (A low HDL level is one of the first signs of insulin abuse. I had this in my early thirties!) This, of course, has a negative effect on heart health, but it also interferes with the normal mechanism by which the body deactivates free estradiol. A relative increase in the amount of metabolically active estradiol in the bloodstream can target estrogensensitive breast and endometrial tissue, resulting in possible excessive growth of these tissues. This is one of the reasons why hyperinsulinemia (excess insulin in the blood) with insulin resistance is a significant risk factor for breast cancer as well as polycystic ovary syndrome.15 High insulin levels also increase tissue sensitivity to a protein known as insulin-like growth factor (IGF-1), which is known to stimulate the growth of breast and other tissues.16

  Skeletal muscles are designed to burn blood sugar effectively, which is why maintaining adequate muscle mass and exercising regularly are important keys to maintaining stable blood sugar. But as women age, they often stop exercising as much as they did in their teens and twenties. Lifestyles become increasingly sedentary, so by the time they hit perimenopause, many women have replaced their muscle mass with fat and years of insulin abuse have stored excess energy as fat—particularly abdominal fat. (Fat weighs less than muscle but takes up more space. This is the reason why so many midlife women notice that their clothes don’t fit well anymore even though they haven’t gained any weight!) One of the earliest signs of insulin resistance is increased belly fat—that spare tire around the middle. Body fat is loaded with insulin receptors, and the fatter you get, the more insulin it takes to get blood sugar into the cells. Type 2 diabetes will often disappear simply with weight loss alone.

  Glycemic stress and insulin resistance are also associated with heartburn, insomnia, swelling, sugar cravings, fatigue, and excess daytime sleepiness—all of which are associated with tissue inflammation that is the result of the complex interaction between insulin, blood sugar, stress hormones, and essential fatty acids. People with excess body fat, from years of eating high-glycemic-index meals, actually produce high levels of inflammatory chemicals such as IL-6 (interleukin 6) from their body fat. They are prone to aches and pains, estrogen dominance, and PMS as a result. Ultimately, glycemic stress leads to insulin resistance and, later, diabetes and/or heart disease, if left unchecked.

  MORE REASON TO AVOID PROCESSED FOODS

  The added sugars in processed foods aren’t the only reason they’re unhealthy for you. The sodium and preservatives these foods often contain are also far from harmless. Recent research from the Harvard School of Public Health shows for the first time that processed meats contribute to higher levels of both diabetes and heart disease.17 According to a 2010 meta-analysis that examined data from twenty different studies looking at one million adults from ten countries around the world, daily consumption of 50 grams of processed meat (the equivalent of either one typical U.S. hot dog or two slices of deli meat) was associated with a 42 percent higher risk of coronary heart disease and a 19 percent increased risk of diabetes. Processed meats were defined as those that had been preserved by smoking, curing, or salting (which also
includes sausage and bacon).

  However, eating twice as much unprocessed red meat a day didn’t raise risk of either heart disease or diabetes. This certainly shouldn’t be seen as a license to bring on the double cheeseburgers with impunity, but it is a caution about the dangerous effects of the added ingredients in processed foods. The researchers found that while the red meats and processed meats had similar amounts of saturated fat and cholesterol, the processed meats had four times the amount of sodium as unprocessed meat—and they also contain nitrate preservatives.

  Step Two: Measure for Health—Waist/Hip Ratio, Body

  Mass Index, and Body Fat Percentage

  Years of eating too many refined carbohydrates and exercising too little finally catch up with us at midlife. Slowly but surely, our lifestyles predispose us to central obesity (excess belly fat), which is a problem. Abdominal fat cells are more metabolically active—and potentially more dangerous—than the fat cells on your hips and thighs. Abdominal fat increases blood triglyceride levels and is a sign of insulin resistance.

  And belly fat cells also pump out too much androgens and estrogen. The classic apple-shaped figure is associated with an increased risk for heart disease, breast cancer, uterine cancer, diabetes, kidney stones, hypertension, arthritis, incontinence, polycystic ovary syndrome, urinary stress incontinence, gallstones, stroke, and sleep apnea.18