The Wisdom of Menopause
Page 29
Your waist/hip ratio is a quick way to gauge your risk. Measure around the fullest part of your buttocks. Then measure your waist at the narrowest part of your torso. Divide your waist measurement by your hip measurement. A healthy ratio is less than 0.8. The ideal is 0.74. A ratio greater than 0.85 is associated with all the health risks listed above.19 Ray Strand, M.D., an expert on diagnosing and reversing the effects of insulin resistance, prefers using your waist measurement in inches because it directly measures belly fat. If your waist measurement is more than 34.5 inches, there’s a strong likelihood that you already have insulin resistance and metabolic syndrome.
Body mass index (BMI) is another way to measure your health risk. To determine your BMI, simply find your weight and your height on the table on the following page. A BMI of 24 or below is ideal. For people who don’t smoke and aren’t chronically ill, a BMI of 30 or higher (considered obese) is associated with a two to three times greater risk of dying prematurely compared to a person with a BMI of 24 or less. For those with a BMI between 25 and 29 (considered overweight, but not obese), the risk of premature death is still 20 to 40 percent higher than for those at normal weight.20
Percentage of body fat is the final number you’ll need. This can be measured by your doctor, at a health club, or at your YMCA. Though it’s possible to purchase over-the-counter devices that measure body fat, I have not found them to be very accurate. It is possible to have a healthy body fat percentage (between 20 and 28 percent for women) and have a BMI that is higher than 24. This is especially true in athletes who have a great deal of muscle mass.
If your waist/hip ratio, BMI, and body fat percentage are all in the healthy range, then you simply have to fine-tune what you are already doing to maintain your weight and balance your hormones. If not, then do whatever you can to lower your risk. A 1999 study from Harvard Medical School found that women who gain approximately twenty pounds in adulthood experience a decline in physical function and vitality even greater than that associated with smoking. (And speaking of smoking, a 2010 study shows that obesity has now become a greater health threat than smoking. The prevalence of smoking over the last fifteen years has declined by 18.5 percent, while the proportion of obese people has risen 85 percent.21 And according to new statistics from the Centers for Disease Control and Prevention, an unheard-of 28 percent of Americans over the age of twenty are now obese, with the percentage increasing steadily since 1997.) Weight gain in the Harvard study was also associated with an increase in bodily pain, regardless of a woman’s baseline weight. The reason for this is that excess fat produces inflammatory compounds, such as cytokines and interleukin 6, that cause tissue damage and pain. Happily, this is all reversible. Once the overweight women lost weight, all characteristics of health and vitality improved.22 This is very good news. You don’t have to reach your ideal weight; even a modest five-or ten-pound fat loss—or achieving a BMI that is one number lower than your current number—can dramatically improve your health, lower your blood pressure, and balance your hormone levels.
FIGURE 11: BODY MASS INDEX CHART
Step Three: Check Out Your Metabolic Stressors
In her book Fight Fat After Forty (Viking, 2000), Pamela Peeke, M.D., a researcher with the National Institutes of Health, documents the connection between toxic stress and toxic weight gain—the kind of weight that accumulates in the abdomen and puts women at risk for premature death. Toxic stress can come from any daily challenge, but a number of circumstances make it especially common in women over forty: the resurfacing of childhood trauma, perfectionism, relationship changes such as divorce and caregiving, job stress, acute or chronic illness, dieting, and the effects of menopause.
This explanation clicked with me because my initial perimenopausal weight gain coincided with new stresses in my life. The scale started to climb just before Thanksgiving, when my older daughter arrived home for her first vacation from college and we officially launched our first holiday season as a “broken” family. My daughters were scheduled to split their holiday time between my house and their father’s, a situation I had always been sure would never happen to us.
I was also caring full-time for a friend who was recovering from major spine surgery. I was preparing her meals, trying to anticipate her needs, watching her go through excruciating pain unrelieved by narcotics, and generally trying to provide a safe place where she could heal. For well over a month I was basically on call twenty-four hours per day, with only an occasional break. In retrospect, no wonder the pounds piled on.
Get out your calendar, do some detective work, and see if you, too, have a stress pattern that could be leading to weight gain. Be particularly aware of the danger of the late-afternoon hours when the main hormones that allow us to mount a response against stress—serotonin and cortisol—tend to fall, leaving us feeling more vulnerable to our underlying emotions. In particular, when serotonin, the “feel-good” neurotransmitter, is depleted, we are apt to eat anything in sight—particularly refined carbohydrates—to bring it back to normal.
The effect of stress on weight also works in the opposite direction. One of my perimenopausal physician colleagues recently went on a trip with one of her grown children, who is in medical school. They went to a stimulating medical meeting and then explored the Grand Canyon together. Though she paid no attention to her diet and ate whatever she wanted, she arrived home six pounds lighter! She told me, “I think that my cortisol levels returned to normal because for ten days I got to sleep through the night and not worry about being called in for an emergency. And besides that, my serotonin was up from all the exciting conversation and healthy sunshine I was getting!”
Step Four: Exercise
If you don’t already exercise, there is no time like the present to start. Your muscles are loaded with insulin receptors. The more muscle mass you have and the more heat you generate from your muscles on a regular basis, the more efficiently you’ll burn carbohydrates and body fat. You’ll also be protecting your bones and your heart and boosting your health-related quality of life in a number of ways. (One 2008 study even showed that moderate physical activity improved these health-related quality-of-life factors in midlife women significantly more than hormone therapy did.)23
The government’s new Physical Activity Guidelines for Americans recommend two and a half hours a week of moderate exercise (such as brisk walking, water aerobics, ballroom dancing, or gardening) or one and a quarter hours a week of vigorous exercise (such as racewalking, jogging, swimming laps, jumping rope, or hiking uphill with a heavy backpack). The recommendations further suggest an additional two days a week of muscle-strengthening activities, such as weight training, push-ups, sit-ups, or heavy gardening.24
If you already exercise, change your routine. Perhaps you’ve found yourself, like me, stuck at a metabolic roadblock, even though you’ve already changed your diet and are exercising regularly. When this happens, it is usually because your body has adjusted to your current level of activity—just as it’s possible to maintain your weight on as little as 1,000 calories per day, because the body’s metabolic rate simply decreases to accommodate its perception of starvation.
In order to get your stubborn fat cells to release their load, you have to confuse them a little. Try a different exercise routine that recruits other muscles. If you’ve been walking, try a stair-stepper, an elliptical trainer, weight training, or a cross-country ski machine. The idea is to get your body out of its metabolic rut.
I personally had to increase the intensity and length of my weight-training sessions while cutting back on my walking—something that had become so easy I barely even broke a sweat. The weight workouts were much harder. Over time this switch worked. Currently, my workouts involve regular Pilates, walking, and an elliptical trainer. I rarely use weights anymore because the Pilates takes care of maintaining good muscle tone. (This is a highly individual decision. I build and maintain muscle very easily without weights. But this is not true for many women.)
SHALL WE DANCE? THE TRIUMPH OF TANGO
It should come as no surprise that dance is wonderful exercise, and certainly more fun than doing crunches or jogging on a treadmill. But recent research indicates that the Argentine tango may be the dancing queen, trumping other forms of exercise and even other types of dance, for improving health.
Two recent studies done by researchers at Washington University School of Medicine in St. Louis looked at teaching people with Parkinson’s disease how to tango. The first study divided patients into two groups—one taking Argentine tango lessons, and the other taking more conventional strength and exercise classes. Both groups attended one-hour sessions twice per week for a total of twenty sessions. The tango group focused on stretching, balance, footwork, and timing—and, of course, dancing the tango (both with and without a partner). The exercise classes focused on core strengthening and stretching in both seated and standing positions.
While both groups benefited, only the tango group showed improvement in all measures of balance, fall prevention, and gait.27 They were also more confident about balance by the end of the study than was the other group. Even more telling, almost half the people in the tango group attended extra sessions after the study concluded, and demand was so great that free weekly tango classes for Parkinson’s patients and their partners started up as a result. (Even some patients who had been in the conventional exercise group joined!)
The researchers have completed a second study comparing the effects of tango, waltz/fox-trot, and tai chi on health-related quality of life for Parkinson’s patients. Each group got twenty lessons over a thirteen-week period. The results: those in the tango group significantly improved mobility and social support, while those in the other dance groups (plus a control group) reported no such gains.28
Many factors were credited for the tango group’s success, including the dynamic balance, turning, moving backward, and initiation of movement at a variety of speeds that are required in tango. In addition, because tango is danced with a partner, researchers believe it can help people learn to work together to overcome problems. Social support certainly contributes in a major way to emotional well-being.
Thanks to the promise of these studies, the same researchers are now following tango-dancing Parkinson’s patients for a year, holding the dance classes in a community center rather than in the hospital so that participants feel more like dancers than study subjects.
Parkinson’s patients are particularly interesting because they lose functional mobility faster than healthy people. So if the tango can help this group make significant gains in mobility, just think how it can help the rest of us improve ours!
Step Five: Get Your Thyroid Checked
About 25 percent of women develop or have preexisting thyroid problems by the time they reach perimenopause. Excess levels of estrogen relative to progesterone can lower thyroid function, and so can excess stress-hormone levels. These conditions are very common during perimenopause. Low thyroid function is associated with a decreased metabolic rate. If you have any symptoms of thyroid problems (fatigue, weight gain, cold hands and feet, thinning hair, or constipation), get your thyroid checked. I finally did this during my own metabolic slowdown and found out that my thyroid hormone levels were consistent with what is known as subclinical hypothyroidism, which is characterized by normal thyroid hormone levels in the blood but a slightly elevated level of TSH (thyroid-stimulating hormone). I had no symptoms other than the weight gain. I started on a very low dose of thyroid hormones—levothyroxine (T4) and triiodothyronine (T3)—which I used for about two years, after which things returned to normal. (Though most doctors prescribe only levothyroxine, many women do better on a combination of T3and T4, such as Armour or Nature-throid, which is available through formulary pharmacies.) It’s difficult to say whether the thyroid or hormone replacement is what finally turned my weight gain around, because I also changed my exercise routine and cut down on all refined carbohydrates. In addition, the stress I was under decreased dramatically when the holidays ended and my friend recovered fully. I was eventually able to get off the thyroid replacement altogether. Many women need only increase their intake of iodine and their thyroid function will return to normal. (See chapter 4 for a full discussion of recommended TSH levels as well as a discussion of how iodine affects the thyroid.)
Step Six: Quell Cellular Inflammation
The number-one reason for cellular inflammation—and all the diseases and symptoms associated with it—is a refined-food, high-glycemic-index diet, which has the following characteristics.
~ Too many refined carbohydrates, resulting in the overproduction of insulin. Too much insulin favors the production of proinflammatory substances such as prostaglandin F2-alpha and the cytokines.
~ Deficiencies in the polyunsaturated fats known as omega-3 fats. Omega-3 fats are necessary for the function of nearly every cell in the body, particularly those of the nervous system, brain, eyes, and immune system. Omega-3 fats also decrease cellular inflammation. Currently, levels of the especially important omega-3 fat DHA (docosahexaenoic acid) are 40 percent lower, on average, in American women than in European women.
~ Too many trans fats, usually from margarine and shortening, which increase cellular inflammation. (See Trans Fats: The Bad Actors of the Fat World.)
~ Deficiencies in the micronutrients that are necessary for combating cellular inflammation. Too little vitamin C, vitamin B6, and magnesium, for example, favor the overproduction of pro-inflammatory substances.
Unremitting stress is also a factor in cellular inflammation. It results in the overproduction of epinephrine and cortisol, stress hormones that promote cellular inflammation. Caffeine, which is often used to alleviate the effects of stress and fatigue, has the same effect. When you follow the hormone-balancing food plan below, supplement your diet with additional antioxidant nutrients (see Protect Yourself with Antioxidants), and consciously decrease stress through meditation, relaxation, and regular exercise, you will be well on your way to quelling cellular inflammation.
HCG MAY BE THE ANSWER TO STUBBORN WEIGHT
PROBLEMS
Some midlife women simply cannot lose weight no matter what they do because of abnormalities in the hypothalamus and pituitary. But the good news is that these women can in fact lose excess fat using a dietary approach developed in the 1950s by A. T. W. Simeons, M.D. He discovered that small injections of a hormone known as HCG (human chorionic gonadotropin) along with a very specific 500-calorie-per-day diet led to safe and rapid weight loss in his patients with stubborn weight problems. Despite the severe caloric restrictions, his patients reported normal energy levels because as the HCG releases fat stores from the body, it also allows the body to use those calories for energy.
Dr. Simeons’s original protocol, Pounds and Inches, is available online (see http://hcgweightlosshelp.com/pounds_and_inches.pdf). Author Kevin Trudeau wrote a book about Dr. Simeons’s protocol entitled The Weight Loss Cure “They” Don’t Want You to Know About (Alliance Publishing, 2007), which, while a bit paranoid, is largely accurate.
The plan requires patients to have injections of extremely small
amounts of HCG into their subcutaneous fat each day for at least twenty-six (and up to forty) days, thereby resetting the hypothalamus. For those who haven’t achieved all the weight loss they desire at that time, they can begin a second cycle of the protocol. After the injection phase is over, you then follow a diet free of grains and refined foods for an additional three weeks. When that period is over, you will actually be able to eat a dessert now and then without a weight gain—but you must follow a healthful low-glycemic-index, additive-free diet.
For those women who don’t want to go through daily injections, HCG is also now available in drops you put under your tongue, and they are just as effective.29 The HCG diet is not FDA-approved, but many qualified naturopaths and physicians prescribe it, and I recommend that you work with one of them rather than attempt to follow this regimen on your own.
On an energetic level, I believe that these minute amounts of HCG hormone act as a sort of “rebirth” for the body and the metabolism. After all, the body hasn’t “seen” this hormone since pregnancy or—if you’ve never been pregnant—since your own body was being formed in utero. I have followed the progress of a number of individuals on this diet plan and I can attest to the beneficial effect it has had in changing their relationship to food. Most find themselves eating far less after they’re finished with their HCG protocol. It also appears to act as a sort of detox program. Many report better joint mobility and flexibility. Though it’s not FDA-approved, the HCG protocol is far safer than bypass surgery and yo-yo dieting. But it’s also not for the faint of heart. It requires discipline. If you decide to embark on this diet, I recommend that you extend phase 2—the part of the plan with no grains or starches—to three weeks instead of two and continue daily weighing from then on. The minute you gain two or more pounds, go back to the very low-calorie diet for one day. In this way, you will be able to maintain your weight loss successfully over time.