Read an Excerpt

The Ultimate Nutrition Guide for Menopause

John Wiley & Sons

Chapter One

"Losing weight is only half the battle. The real work is keeping it off. When I finally told myself that everything I did to lose those 10 pounds is everything I have to do to keep them off, I was finally successful. I said goodbye

preventing weight gain

"I used to be able to just add a little exercise or cut back a little to manage my weight. Now I have to exercise at least three or four times a week and watch what I eat all the time. It's a real struggle!"

7

For many women (myself included), weight control is a major concern. Since I was a teenager I've had to watch what I eat and exercise regularly in order to maintain a healthy weight. Some women, on the other hand, find that staying trim comes naturally and they don't have to work very hard at it. But as menopause approaches, many of these same women find that for the first time in their life, it becomes more difficult to take off a few unwanted pounds. Or they complain about a "softening around the middle" despite their best efforts at weight control. Many of my clients have also found that weight gain is an annoying side effect of hormone replacement therapy. One reason is that hormone replacement therapy causes fluid retention. Yet, despite its uncomfortableside effects of bloating and fluid retention, hormone replacement may actually prevent the accumulation of body fat around the middle that's often reported by post-menopausal women.

Israeli researchers studied 63 early post-menopausal women for one year; one-half of these women took estrogen and progestin replacement therapy and the other half refused hormone therapy. At the end of 12 months, body weight and body fat had increased significantly in both groups. However, there was a significant shift from lower body fat to abdominal fat in the women who did not take hormones. This redistribution of body fat from the hips to the waist was not seen in the women taking hormone replacement therapy! It would seem that at menopause, some women see a shift in their weight, not necessarily an increase on the scale. Others definitely experience weight increases and difficulty keeping the extra pounds off.

perimenopausal weight gain

There are a number of reasons why women have a difficult time controlling their weight during the perimenopausal years. It's not true that menopause itself makes women gain weight. In fact, no evidence supports the notion that a deficiency of estrogen causes body fat to accumulate. However, as the Israeli study above demonstrates, hormones may affect the activity of our fat cells and influence how our fat is distributed. Recently, scientists from the University of Maryland in Baltimore discovered that enzymes needed to store fat are more active in post-menopausal women compared to perimenopausal women. What's more, the breakdown of stored fat may be reduced after menopause.

What are some other factors that contribute to perimenopausal weight gain? We know that our metabolic rate, which determines the speed at which our body burns calories, slows with aging. I have always maintained, however, that regular workouts, consisting of aerobic exercise and weight training, can prevent much of this age-related slowdown. In fact, the most common cause of weight gain-at any age!-is inactivity. But here's something that you might not have known-a woman's metabolic rate increases during the last 14 days of her menstrual cycle (just in time to help us handle those chocolate cravings!). With menopause, then, comes a loss of this cyclic increase in metabolic rate, and this may account for some weight gain.

For the most part though, mid-life weight gain is a result of poor eating habits and too little exercise. The most common dietary mistakes include the following:

Eating too much starch-bagels, pasta, bread, low-fat muffins, and the like.

Enjoying desserts and sweets too often.

Drinking too many alcoholic beverages.

Not eating at regular intervals throughout the day.

All of these habits will impact your ability to manage your weight. I have helped scores of peri- and post-menopausal women lose weight, both women taking hormone replacement and those not doing so. Making smart changes in what you eat, how you eat, and how you exercise can help you fit comfortably into your clothes once again.

CALORIES OR FAT?

I'm sure you're familiar with the notion that if you cut back on fat and don't worry about counting calories, you'll lose weight. Cutting back on fat isn't all you need to do to lose weight, but there is some truth to this idea. The foods we eat contain three basic nutrients: carbohydrate, protein, and fat. All three provide our bodies with calories. Some foods, like milk and yogurt, are made up of a combination of all three nutrients, while other foods-oils or grains for instance-are mostly made up of one nutrient (in this case, fat and carbohydrate, respectively). One gram (less than a teaspoon) of protein gives your body four calories, one gram of carbohydrate also provides four calories, and the same amount of fat packs nine calories, more than double. That's the rationale for cutting back on fat to help oneself lose weight. Calories from fat add up quickly and reducing the amount of fat you eat can make a big impact on your calorie intake. So, at the end of the day, it still comes back to eating fewer calories. Note also that the cutting back on fat strategy will only work if you're actually eating a high-fat diet; these days many of us are careful when it comes to fat.

Indeed, you've probably heard nutritionists quoted in the media, lamenting that we are heavier than ever, despite the fact that we eat less fat than we did 20 years ago. Besides not exercising enough, what are we doing wrong? It seems we are eating more carbohydrate than ever. In our state of fat phobia, whether in an effort to shed a few pounds or to lower our cholesterol, we're eating baked potato chips, fat-free cookies, and muffins, bagels, and plenty of pasta with tomato sauce. We seem to think that as long as it doesn't contain fat, it's free for the taking. Well, all nutrients, be it fat, carbohydrate, or protein, have calories and if you eat too much of any of them, your body stores the excess as fat. For instance, eating that low-fat bagel (it certainly seems like a better choice than a fat-laden muffin) is actually the same thing, calorie-wise, as eating four or five slices of bread. When's the last time you sat down to five pieces of toast for breakfast? By the time you've finished your Italian meal of pasta and bread, you've probably had the equivalent of six (or more) slices of bread! In other words, even though your calories aren't coming from fat, they are still adding up.

dietary approaches

FOURTEEN FAMOUS WEIGHT LOSS BLUNDERS

1 Not exercising regularly. 2 Going on a binge the week before going on a "diet." 3 Fasting to lose weight. 4 Skipping a meal in an effort to save up calories for the next. 5 Going to a salad bar and heaping on cheeses, meats, pasta mixed with mayonnaise, marinated vegetables, and salad dressing. 6 Having an "on-a-diet" or an "off-a-diet" mentality, rather than eating moderately and carefully all the time. 7 Thinking of higher-calorie foods as "bad" or "forbidden," rather than as something that can be enjoyed now and then. 8 Expecting to lose more than two pounds per week. 9 Losing weight to look good for someone else. 10 Losing weight so that you can become a wonderful person-you've forgotten that you already are a wonderful person. 11 Thinking of losing weight as something you have to do, rather than as something you're choosing to do. 12 Thinking you're overweight when you're not. 13 Not giving yourself enough time to buy, prepare, or eat your meals. 14 After reaching your desired weight, not taking charge the moment you discover that your weight has crept up a few pounds.

TODAY'S FAD DIETS

The question remains, how should you eat to successfully lose weight? Should you eat a high-carbohydrate, low-fat diet? Or should you try one of the high-protein, low-carbohydrate diets? Is there any truth to food combining? To choosing foods based on your blood type? Well, I can understand if you're confused. These days there is certainly no shortage of diet books on the market, each claiming that its own special formula is guaranteed to make those readers who diligently follow the protocols given become thin and healthy. To help you sort out the useless from the useful, I've summarized today's popular (but not necessarily sound) weight loss diets. And in Appendix 1, I'll give you my own weight loss diet plan. Now, let's take a look at some of the most popular diets on the market today.

Dr. Atkins' Diet and The Protein Power Plan

Both of these diets are high in protein, fairly high in fat, and contain almost no carbohydrate. They don't allow you to eat more than 20 to 30 grams of carbohydrate each day-the amount found in one and one-half slices of bread or one-half of a medium-size banana. These diets promote "ketosis," an abnormal metabolic state. The brain and central nervous system rely on carbohydrate as a fuel source and after two days without carbohydrate, they must adapt to a new energy source. That adaptation is called ketosis. In this state, the body breaks down fat into ketones, which are then used by the brain and central nervous system as fuel.

These diets are intended for short-term use only. Studies suggest that being in ketosis for a long period of time increases the risk of heart disease by damaging your low density lipoprotein (LDL) cholesterol. Once LDL cholesterol is damaged, it is more likely to stick to artery walls. You'll find more detailed information on LDL cholesterol in Chapter 9, "Reducing Your Risk of Heart Disease."

Dr. Atkins' New Diet Revolution

This diet involves a strict 2-week "induction" (induction of ketosis) then a gradual reintroduction of carbohydrate. Most people who come off this diet gain weight quickly. That's because when you start eating carbohydrate again your body rebuilds its glycogen (carbohydrate) stores in your liver and muscles. For every gram of carbohydrate stored, you store three grams of water. The net result? Rapid weight gain. The Atkins diet is not the answer for long-term weight control. It's a diet you go "on and off" of. It doesn't change your eating habits over the long term. Furthermore, no studies have been published on the long-term success of high-protein, very low-carbohydrate diets.

Protein Power

Written by medical doctors Michael and Mary Eades, Protein Power is another plan that puts you into ketosis. The first phase of the diet allows you to eat no more than 30 grams of carbohydrate each day (the equivalent of two small slices of bread) and lasts for four to six weeks. Then you enter the second phase, in which you're allowed to eat a little more carbohydrate (a whopping 55 grams a day). This level of carbohydrate intake is followed until you reach your weight and health goals. Then the maintenance phase has you gradually increase your carbohydrate intake at each meal. So once again, the Protein Power diet is not a diet for life. It does, however, encourage you to eat more fiber and healthier types of fat than the other protein-based diet discussed above and recommends a multivitamin and daily potassium supplement. That's because the authors recognize that ketosis is a powerful diuretic and causes your body to lose fluid and minerals, especially potassium and sodium. Not replacing lost potassium can have serious health consequences. While a pill might take care of your potassium needs for a time, does this high-protein approach sound like a healthy way to lose weight?

There are other health risks associated with high-protein diets. In order to prevent dehydration while on these diets, you must drink plenty, and I mean plenty, of water. As just mentioned, ketosis causes your body to excrete large amounts of water, sodium, and potassium. If you choose fatty meats and cheese as your main protein foods you run the risk of high blood cholesterol levels. Your liver uses saturated fat in animal food to manufacture blood cholesterol. And because you're allowed virtually no fruit or dairy products on these diets, you won't be meeting your needs for certain nutrients, especially vitamins C, D, and folic acid, and the mineral calcium. What's more, these diets often cause constipation due to a lack of fiber. If you take medication for high blood pressure, high cholesterol, or diabetes, and you decide to try a high-protein diet, your doctor should monitor you. These diets are definitely not appropriate for people with kidney problems, since high amounts of protein stress the kidneys. And if you're someone who exercises regularly, these diets won't provide fuel for your muscles. Whether you are a weight trainer, a jogger, or a tennis player, it's carbohydrate that fuels your workouts.

The Zone

The Zone describes a low-carbohydrate, moderate-protein, low-fat diet developed by Dr. Barry Sears. The Zone diet does not cause ketosis because it doesn't eliminate carbohydrates (I'll give it points for this). Rather, Dr. Sears advocates eating meals and snacks that are made up of 40 percent carbohydrate, 30 percent protein, and 30 percent fat. Supposedly this combination of nutrients promotes the right balance of two hormones important in blood sugar regulation, called insulin and glucagon. If your diet encourages you to produce less insulin, says the author, your body will burn your fat stores and cause you to lose weight.

While no clinical study has proven that the Zone diet results in weight loss attributable to achieving a certain balance of hormones in your bloodstream, the plan does have a few nutritional merits. For one, the diet recommends you eat those starchy foods that are slowly converted to blood glucose. (Eating such foods results in lower insulin secretions after a meal.) And researchers are finding that the type of carbohydrate you eat just might affect your ability to lose weight.

Nutritionists are now classifying carbohydrate foods according to their ability to cause a rise in blood sugar, something referred to as a food's "glycemic index." A high glycemic index food (white bread, sugar) is converted to blood glucose quickly. A rapid rise in blood glucose causes your pancreas to secrete a large amount of insulin into your bloodstream. Insulin's job is to lower your blood sugar and store carbohydrates as glycogen, or if you've overeaten, as fat. The end result of high insulin production is that your blood sugar will drop off sooner and you'll soon feel hungry again.

Continues...

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Excerpted from The Ultimate Nutrition Guide for Menopause by Leslie Beck Excerpted by permission.
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