Well, after digging around looking for answers, this is what I've come up with (remember I don't have a medical degree, just a need for some answers!) This is a critical question though. Aside from vanity, weight gain increases your risk for hypertension, gallstones, kidney and breast cancer, heart attacks, diabetes, and arthritis. And the most dangerous kind of fat is the fat in your belly-right where menopause puts it. Belly fat is why the medical experts worry about waist to hip ratios (7 is ideal) and the size of your waist (should be below 29 1/2 inches). Weight is a big topic (àKathy's punß), so this article is just a part of the picture.
Buddha Belly
When estrogen drops with menopause (natural or surgical), fat no longer goes to your hips (where it's waiting to support pregnancy and nursing) but to your belly, where it becomes active in ways that don't help us at all. Some of it becomes the omentum, the fatty apron that lines the abdomen. It's extremely active chemically. It releases free fatty acids and creates higher insulin levels. The fatty acids flood the liver so it converts them to cholesterol.
And what's worse, the more belly fat you have, the more fat gets stored because the fat cells in the omentum send out lipoprotein lipases, an enzyme that goes looking for fat in the blood stream and creates even more blood vessels to bring even more fat to the omentum.
Insulin
Abdominal fat may be a cause of insulin resistance, and insulin problems are a big cause of fat. When insulin is overworked, it stops doing its job of sweeping excess glucose out of the blood so more and more insulin gets pumped into the bloodstream. High insulin is dangerous. It increases theformation of blood clots and stiffens blood vessels.
One way to avoid flooding your system with glucose is to choose low-glycemic carbohydrates, which have large particles (think broccoli, green beans, and whole wheat). High-glycemic carbs have small particles (think white bread, bananas, and potatoes) or high sugar (corn). Small-particle carbs enter the bloodstream fast, take less energy to digest, and quickly become glucose. Glucose is used right away for energy or is stored as glycogen in the liver and muscles as emergency reserves. Once the emergency reserves are full, all that glucose that's flooding in is stored as fat.
So when you eat a large meal that floods your system with glucose, even if your total calories are low, things get grim. Insulin tries to keep the blood levels steady by shoving the glucose, amino acids, and free fatty acids out of the bloodstream and into cells as quickly as possible while telling the fat already stored to stay in the cells. Insulin stays high up to five hours after a 500 to 1,000 calorie meal. So the best thing to do is to spread calories evenly throughout the day so that insulin can stay steady or even drop between meals.
Glucagon is the hormone that balances insulin. Glucagon is stimulated by proteins and a dropping glucose level and pulls fat out of the cells to keep the blood levels steady. Once glucagon is released, it stays high for four hours. So what we want is less insulin and more glucagon, less starch and more protein and vegetables.
Insulin and menopause
As estrogen decreases, thyroid levels drop, insulin is less able to lower blood sugar, so the pancreas pumps out more-it becomes more efficient at storing fat and less efficient at lowering blood sugar. That's why menopausal women can have what they're now calling Metabolic Syndrome X--insulin resistance, elevated lipids especially triglycerides, obesity, coronary artery disease, and hypertension--all from estrogen deficiency.
And women in surgical menopause have it worse. Compared with women without a hysterectomy, oophorectomized women, especially those with 20 or more years post-menopause, had increased lipids, lipoproteins, glucose, insulin, and blood pressure--even among current estrogen users, though taking some estrogen was better than taking none. Women with hysterectomies who kept their ovaries had similar risk factors as nonhysterectomized women.
What else can go wrong?
As blood sugar rises, your appetite increases. The more high-glycemic carbohydrates you eat, the hungrier you feel. On the other hand, fat slows down the rate at which your stomach processes foods and that will lower the blood sugar response to a meal. So, low fat and high carb diets may be making you fat.
With menopause, growth hormone plummets, and we lose fat-burning muscle mass. Then our ability to burn calories falls and excess food turns to fat (though there are a small percentage of women who gain fat on estrogen because they process growth hormone differently).
Lack of hormones means the lining of the intestines gets dangerously irritated, and you get gas because sugars, fats, and amino acids hang around in strange places in your system and ferment. So as estrogen levels fall, we get a higher and higher sensitivity to carbohydrates.
Hot flashes make us fat because the last stage is a release of cortisol and cortisol helps the omentum suck up fats and soaks the liver in fat, which makes more cholesterol.
Lack of sleep all by itself causes the metabolism to fall so we burn off fewer calories, growth hormone isn't made so muscle mass declines and burns off fewer calories, the glucose levels go out of whack, and cortisol rises.
In fact, stress of any kind (and the Land of Hyster is full of stress!) makes cortisol levels rise.
Quick look at what you can do
Here are the suggestions made by Dr. Larrian Gillespie, a urogynecologist and author of The Menopause Diet. She's got a lot of solid current research and a well-thought out rationale for each of the following points (I highly recommend you get the book). She's also got a cookbook.
40% of your diet should be low-glycemic carbs
25% should be fat (15% monounsaturated fat, 10% saturated-she recommends 1 T of unsalted butter)
35% should be protein
Eat 5 mini meals a day beginning with breakfast
Begin every meal with protein
Exercise 30 minutes a day (HDL rises and the insulin response drops, in addition to all the other good stuff)
Eat 1 serving of soy a day
Use sea salt
Eat 5 oz. of nuts a week
Avoid alcohol
Drink plenty of water
Reduce caffeine
Eat low- but not non-fat dairy
If you have fruit and protein, have no fat
If you eat something high glycemic, add no fat
Sleep 9 hours, preferably going to bed at 9:30
De-stress (yoga for instance)
Sources: (in addition to Larrian Gillespie's book) Appetite; Physiological Behavior; Hepatology; European Heart Journal; Gynecological Endocrinology; Diabetes; European Journal of Obstetrics, Gynecology, and Reproductive Biology; Human Reproduction; Maturitas; International Journal of Obesity and Related Metabolic Disorders; American Journal of Gastroenterology; American Jouranl of Public Health; Journal of Endocrinology and Metabolism
This content was written by staff of HysterSisters.com by non-medical professionals based on discussions, resources and input from other patients for the purpose of patient-to-patient support.
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