The Wisdom of Menopause

by Christiane Northrup

  For more information, visit the HCG and Obesity website (www.hcgobesity.org) or its sister site, the Oral HCG Research Center (http://oralhcg.com/English). To order HCG drops, see www.hcgdietdirect.com or www.hcgdrop.com. A helpful Internet video about preparing sublingual HCG is available at www.youtube.com/watch?v=C7sTnSUT6RQ&feature=relat ed. I also recommend the following two books: Harmony Clearwater Grace’s HCG Diet Made Simple: Your Step-by-Step Guide Beyond Pounds and Inches (Harmonious Clarity Group, 2009) and Linda Prinster’s HCG Weight Loss Cure Guide (CreateSpace, 2008).

  THE HORMONE-BALANCING FOOD PLAN

  Given the average lifestyle of today’s perimenopausal women, it’s not difficult to see why insulin and estrogen become unbalanced, putting us at increased risk for everything from heart disease and high blood pressure to arthritis and breast cancer. Fortunately, when you follow the food plan I suggest here, you won’t have to wait long to feel better. In a matter of days, you’ll probably notice that your sleep improves, you begin to lose excess fat, various troublesome symptoms begin to disappear, and your skin takes on a healthy glow. At the same time you’ll be reducing your risk for the diseases of aging.

  Eat at Least Three Meals a Day

  Many women skip both breakfast and lunch, saving up their calories until dinner. The problem with this approach is that the metabolic rate naturally peaks at noon and decreases after that. So the food you eat at night is far more likely to be stored as excess fat compared to the food eaten earlier in the day. Here’s another reason why you can’t afford to skip meals for weight control: it is well known that yo-yo dieting and periodic starvation lower your overall metabolic rate over time, resulting in a body that is so metabolically efficient that it is possible to remain at the same weight despite a very low-calorie diet. That’s why, when I faced my own midlife weight gain, severe calorie restriction was not an option. I had starved myself too many times in my teens and twenties, including fasting. I’ve always had a relatively slow metabolic rate, and now midlife was lowering it further. I couldn’t risk another slowdown. It is also clear that severe food restriction often results in a decrease in beneficial lean body mass but not necessarily a decrease in body fat. That means that after severe food restriction, you might end up with a higher percentage of body fat than when you started.

  Most perimenopausal women do best when they keep their blood sugar stable throughout the day by eating frequent, smaller meals. I highly recommend a snack at around four in the afternoon, right during the time when blood sugar, mood, and serotonin tend to plummet. This snack can keep you from overeating at night when you get home. (If you don’t, you’re apt to begin your evening meal the minute you get home and then end it when you go to bed, in a desperate attempt to make up for a full day’s worth of deprivation.)

  To successfully negotiate the metabolic challenges of midlife, you need to be patient. And you also need to rethink your “diet” mentality. In other words, you need to think of your new metabolism as something that will require a new way of living and eating, not another quick-fix diet. (I certainly learned that when I tried the Atkins induction program.)

  Focus on Portion Size, Not Calories

  Instead of calorie counting, concentrate on eating the highest-quality food available, in smaller portions. Cup your two hands in front of you. That’s how big your stomach capacity is. Limit your intake to no more than that at each meal or snack. Overeating in general—regardless of the food—is associated with overproduction of insulin. In general, the food portions in U.S. restaurants are much bigger than in Europe, which is one of the reasons Americans are so overweight compared to Europeans. (That is changing, however, and obesity has become a global problem.) At one local restaurant, for example, the chicken dish I usually order comes with two halves of a chicken breast. I always eat just one and take the other home with me for another meal.

  In order to keep my weight stable, I’ve had to cut down on my total food intake, eliminate grain products most of the time (see below), virtually eliminate desserts and decrease all sugars (see box on sugar on page 248), make lunch the biggest meal of my day, eat very lightly at dinner, and increase my exercise time.

  Eat Protein at Each Meal

  That means eggs, fish, lean meat, dairy food, or a vegetarian alternative to animal protein, such as soy protein powder, whey protein powder, whole soybeans, tofu, or tempeh. Beans contain protein, but they also contain a considerable amount of carbohydrate. Though the carbohydrate in beans tends to be on the low end of the glycemic index, beans can be too high in carbohydrate for some perimenopausal women. They work very well for others. You have to judge this for yourself.

  Protein needs vary depending upon your size and physical activity. The bigger and the more active you are, the more you need. In general, if you have any tendency toward weight gain at midlife, your diet should be about 40 percent protein, 35 percent low-glycemic-index carbs, and 25 percent fat. You don’t have to adhere to this rigidly at every meal and snack, but it’s an average to shoot for over about a week’s time.30

  If you are at risk for any condition, including cancer, stimulated by excess estrogen, you might want to increase your protein even more. Protein can actually decrease your risk. Here’s how it works: When the liver, body fat, and ovaries metabolize estrogen, they use an enzyme system known as cytochrome P450. A diet rich in protein increases the activity of the entire P450 system, thus helping to protect your body from overstimulation by estrogen. In one study, for example, individuals who were fed a diet that contained 44 percent protein, 35 percent carbohydrates, and 21 percent fat experienced a profound shift in their body’s ability to deactivate excess estrogen.31

  Cut Down on Refined and High-Glycemic-Index

  Carbohydrates and Sugar, Including Alcohol

  Remember, not all carbohydrates are created equal. One gram of carbohydrate from table sugar has a different metabolic effect than the same amount of carbohydrate from blueberries.

  Keep your blood sugar stable and you’ll experience:

  ~ More energy

  ~ Ability to sustain exercise

  ~ Clearing of brain fog

  ~ Ability to build muscle

  ~ Less hunger—ability to control portion sizes and cravings

  ~ Fewer PMS symptoms

  ~ Fewer hot flashes

  ~ Better-looking skin

  ~ Clear eyes without puffiness or dark circles

  ~ Deeper, more restful sleep

  ~ Stable moods and more optimism

  Your success will be contingent on eating foods with a low glycemic index (GI). The glycemic index was created to measure how much the blood sugar rises after you eat a carbohydrate meal, using white bread as the benchmark. White bread has a glycemic index of 100, whereas the glycemic index of corn is 54, an apple is 38, and an avocado is 0. The rule of thumb is white and processed foods have a very high glycemic index, whereas whole foods and those high in protein typically have a low glycemic index. Research supports this way of eating. A 2010 study from the University of Denmark reported in the New England Journal of Medicine found that people who’d lost weight on a restricted-calorie diet were more successful keeping the weight off if they followed a higher-protein, lower-glycemic-index diet than they were following diets that were either lower in protein or diets allowing higher-glycemic-index foods, or both.32

  Eliminate as many refined carbohydrates from your diet as possible. That means cutting out foods made with refined white flour, such as muffins, rolls, bagels, biscuits, French bread, breadsticks, crackers, snack foods, and pretzels. A few exceptions do exist, however. Jennie Brand-Miller, Ph.D., of the University of Sydney, one of the world’s leading authorities on the glycemic index, notes that pasta has a relatively low glycemic index because it is harder to digest than most other flour products. Al dente pasta has a lower glycemic index than overcooked pasta. Also, sourdough and pumpernickel breads are low-glycemic-index foods because of the acidity of the dough. (Similarly, if you add lemon jui
ce, lime juice, or vinegar to a dish, you will lower its glycemic index.) You also need to eliminate soda pop, which is nothing but sugar water. Soda sweetened with Truvia, made from the stevia plant, is now available. It’s known as Zevia and it’s a healthy alternative to other diet sodas. The aspartame sweetener in conventional diet sodas is dangerous. (See chapter 10.)

  Cutting down on sugar also means eliminating or cutting way back on alcohol in every and any form, including wine coolers, wine, beer, and hard liquor. Alcohol is nothing but sugar in a form that is so absorbable that its effects are felt within minutes in the brain. One of the first things women notice when they eliminate the empty calories found in alcohol is that they lose weight very quickly. Many also notice that their hot flashes go away as well. That’s because alcohol significantly interferes with estrogen metabolism and causes an almost immediate hormonal imbalance, with too much estrogen in the blood relative to progesterone.

  You also need to eliminate or cut way back on sweets: candy, cookies, cakes, and pastries. You may still want to have them on special occasions, but as your blood sugar stabilizes, you’ll find that your craving for these foods will decrease dramatically and you won’t like the way you feel after eating them. (Dark chocolate and full-fat ice cream, by the way, are low-glycemic-index foods—just don’t gorge on them!)

  According to Dr. Brand-Miller, you don’t have to avoid all high-glycemic-index foods—just plan around them. For example, you could have a meal with a high-glycemic-index food as long as the other foods on your menu are low-glycemic-index. The net effect will be a low-glycemic-index meal. (For more information on the glycemic index, including a database of foods and their GI values, visit www.glycemicindex.com, a website maintained by the GI Group of the University of Sydney in Australia.)

  Remember, your body will be able to burn stored fat and keep your insulin and blood sugar levels normal only when you don’t eat or drink excessive amounts of the wrong kinds of carbohydrates. Otherwise excess blood sugar will be stored as fat, which will accumulate not just on your belly and hips but also in other places, including your arteries, heart, and brain.

  THE SKINNY ON SUGAR

  Fitness trainer and author Jorge Cruise has made a major contribution to our understanding of the effects of sugar on the body, the subject of his bestselling book, The Belly Fat Cure (Hay House, 2009). Cruise points out that sugars of all types (lactose, sucrose, fructose, glucose, etc.) are added to and hidden in all kinds of foods, even those that are moderate-or low-glycemic-index. Cruise’s research and that of many others suggests that for most of human history, the average daily intake of sugar was no more 15 grams per day. Today, the average sugar intake is 47 teaspoons per day, which is about 200 grams!

  Cruise’s dietary approach for health and fat loss involves his carb swap system, in which you limit your total intake of sugar to 15 grams per day along with six daily servings of carbohydrates. One serving is 5–20 grams of carbs. A slice of bread or ½ cup rice is considered to be one serving. Anything under 5 grams isn’t counted. When you follow Cruise’s approach, which involves reading food labels, you quickly realize that foods that you thought were fine are in fact often filled with sugar. For example, I was shocked to find that ½ cup spaghetti sauce often contains as much as 13 grams of sugar! But a slice of sprouted wheat bread (Ezekiel brand) contains no sugar at all (and would be considered one serving of carbohydrate).

  Once I started to read labels to determine sugar content, I was stunned. I found that foods such as yogurt, which we have been conditioned to think of as healthy, are actually loaded with sugar. But a handful of nuts or a hard-boiled egg is not. Once you begin to limit the total amount of sugar in your diet and focus on other healthy foods, you’ll find that you sleep better and feel better. And heartburn will be a thing of the past for most. (That’s because sugar raises insulin levels, which change the chemistry of gastric mucus, leading to heartburn.)

  As you decrease sugar in your diet, you’ll also notice that you can add back healthy fats without any adverse consequences. Cheese omelets, avocados, nut butters, and coconut oil have now become a regular part of my diet. And I’ve come to see that for the vast majority of people, low-fat diets are part of the problem. They don’t work. Over the past thirty years or so, as we have replaced fat in the diet with hidden sugars, people have become fatter and fatter. (See the discussion on healthy fats on page 254.) So do yourself a favor: start decreasing sugars of all kinds—and go ahead and enjoy some healthy fat.

  Even the government’s dietary guidelines are getting on board with this idea. When the guidelines were updated in 2010, they emphasized for the first time ever the need to cut down on added sugars and solid fats (those that remain solid at room temperature, such as hydrogenated fats and saturated fats), which together make up 35 percent of the average American diet without contributing any nutrients. The guidelines also suggested that Americans avoid—not just limit or moderate—sugar-sweetened beverages. It’s about time!

  Once you understand where the sugar in your diet is coming from, you can experiment with eating more than the recommended 15 grams of sugar per day. Some people find that the sugar in fruits and vegetables doesn’t cause any weight gain at all because those foods usually have a relatively low glycemic index. Others have to be very careful, even with fruits. This is largely an individual issue.

  Here’s the bottom line: sugar is highly addictive. Though I had been following a low-glycemic-index diet for years, I found Cruise’s work to be a wake-up call about the amount of sugar that I was actually consuming. To keep the pounds from creeping back, I had to decrease even what I’d previously thought of as “healthy” sugars. This has made a world of difference for me, and for many others as well.

  IF YOU ARE A TRUE CARBOHYDRATE ADDICT

  Women who grew up in alcoholic or chaotic family systems may have brain and body chemistry that is overly sensitive to the effects of food, and particularly to the neurochemical known as serotonin. Serotonin is released in the brain quite rapidly when you eat certain carbohydrate-rich foods, such as most breakfast cereals or cookies. True carbohydrate addicts cannot stop after eating a few cookies or potato chips. They don’t seem to have a normal satiety mechanism in place, most likely because food is being used as a drug to soothe emotional pain. If this describes you, I recommend consulting one of the following books:

  Potatoes, Not Prozac (Simon & Schuster, 1999), by Kathleen DesMaisons

  The Sugar Addict’s Total Recovery Program (Ballantine, 2000), by Kathleen DesMaisons

  Holy Hunger: A Memoir of Desire (Knopf, 1999), by Margaret Bullitt-Jonas

  Consume Grain Products with Caution

  Even if you have eliminated refined grains in all forms, you can still get into trouble with whole wheat, whole rye, whole oat, or millet flour. A fascinating line of research now suggests that the degenerative diseases that currently plague the human race didn’t arrive on the scene until agriculture became widespread. Paleoarcheological studies show that many of the ancient Egyptians were fat and had dental caries—diseases associated with a grain-based diet and virtually absent in hunter-gatherers.

  Many carbohydrate-sensitive individuals find that eating grain products triggers binge eating. I’ve certainly seen this happen with brown rice—a “health food” that I used to consume regularly but have had to virtually eliminate. I’ve also had to eliminate nearly all whole-grain bread products, even the unleavened ones. (One line of thinking suggests that yeast bread is difficult to digest because of the potential for yeast overgrowth in the intestines. Unleavened bread is better tolerated by many, but not everyone. Even a whole-wheat tortilla wrap sandwich at lunch tends to make me feel groggy and bloated.) Looking back, I can see that eating too much bread has been a problem with me for years. But at perimenopause, my body finally said, “Enough!”

  In addition, about one in three people is intolerant of gluten, a protein found in grains (including oats, wheat, kamut, rye, and barley) used in man
y foods, such as wraps, breads, pasta, pizza, and rolls. About 1 percent of Americans have full-blown celiac disease, an autoimmune disorder of the small intestine characterized by an inability to digest gluten. But this isn’t just a digestion problem. People with celiac disease or gluten sensitivity have a higher risk of death, mostly from heart disease and cancer. A study published in 2009 that followed 30,000 patients for about fifty years found a 39 percent increased risk of death in those with celiac disease, a 72 percent increased risk of death in those with gut inflammation related to gluten, and a 35 percent increased risk of death even in those who were sensitive to gluten but did not have a positive intestinal biopsy indicating celiac disease.33

  Most people with gluten intolerance don’t know they have it. You can find out if you have gluten sensitivity with a blood test that looks for specific anti-gluten antibodies, but an easier way is to eliminate all gluten from your diet for two to four weeks and then reintroduce it. Be aware, however, that gluten hides in soups, salad dressings, sauces, and a host of other foods. For a complete list of gluten-containing foods, visit www.celiac.com. I also recommend the book The No-Grain Diet (Dutton, 2003) by Joseph Mercola, D.O.