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Menopause weight gain: why it's happening and what actually works? · No Forking Nonsense - The Nutritionist UK

• 0:00
  @paulthenutritionist: Hello and welcome to No Forking Nonsense, the second most listened to nutrition podcast in The United Kingdom. And we've got one goal to answer your nutrition questions with no nonsense. To send your question in email podcastthenutritionistuk dot com. Give me your name, what your problem is, what your question is, a little bit about yourself and we'll get your questions answered. Let's get stuck in to today's question.
• 0:24
  Right, this question is one that I've had four different versions of in the past month. It s anonymous, so we re going to call her Caroline. I m 51, I haven t changed a thing. Same food, same walking, same routine I ve had for fifteen years, but everything s gone to my middle and the scales have crept up. My GP says it just menopause, my friend says it s my metabolism, someone on Instagram tried to sell me a supplement to balance my hormones.
• 0:47
  What s actually going on and is there anything I can do about it? Or do I just accept it? Okay, that s a brilliant question and you're going to be relieved by about half of the answer because something real is happening, you're not imagining it and you're not doing it to yourself. But almost everything that you've been told is probably quite wrong. So we're going to start with the biggest study that we've got on this, it's called SWAN, the study of women's health across the nation.
• 1:18
  They followed over 1,000 women through the menopause transition and scanned their body composition properly with Dexa. So Dexa is probably the most accurate you can get in terms of accessibility to weight and body fat. The results were published in 2019 and they really are fascinating. So they found that in the run up to menopause, fat and lean maths both crept up slowly, which is normal age and stuff. Then at the start of the transition, the rate of fat gain doubled and at the exact same time lean maths started to fall.
• 1:52
  So those two things continued for about two years after the final period, then they levelled off. Now here's the bit that really matters to you, Caroline, at this question. The lead researcher is a lady called Gail Greendale and she put it like this, Weight gain didn't accelerate during the transition, fat gained it. So it's really important that you hear that again: Weight gain didn't accelerate during the transition, fat gained it. So you could be gaining fat and losing muscle at the same rate here, and the number on the scales will barely move.
• 2:27
  The scales pretty much break even, but your body doesn't. So when you say everything's gone to your middle and the scales have only crept up a bit, you are describing the swan findings almost word for word. You basically swap muscle for fat and the fat has moved from your hips and thighs to your abdomen, because oestrogen is the thing telling it to go to your hips and your thighs in the first place. And that's what's happening, it's measurable, it's real and it's documented in this study for thousands of women. The myth, and this is one that I hear most and it's one that probably does the most damage, is that your metabolism has gone to shit.
• 3:05
  In 2021 a huge study came out in the journal Science, 6,500 people, 29 different countries, ages eight days to 95, they measured energy expenditure using doubly labelled water, which is the gold standard. So it's not an equation on the website, it's like the gold standard. And what they found was four distinct metabolic life stages, So metabolism peaks at around age one, and then it declines slowly through childhood. It hits adult levels around 20, and then once you adjust your body composition, it's stable from 20 to about 60. Stable.
• 3:47
  So once your metabolism is set, nothing changes. The lead author, who is a German called Hermann Pottsner, was asked about this directly and said there's no effect of menopause that they could see in all of their studying. Absolutely none. So your metabolism has not crashed at 51, what has changed is your body composition, so you've lost some muscle and muscle is metabolically active, so your daily burn will drop a little bit, but it's a modest drop and it's a consequence of losing muscle, not that you re mysteriously shutting down hormone lymph. Which is actually good news because you can actually do something about it.
• 4:27
  There s another myth as well and this one, it kind of makes me angry, women get told that it s just your hormones, they hear therefore it s hopeless because you just your hormones, you can t do anything about it, so they just stop trying. Hormones explain where the fat goes, they don t repel the laws of thermodynamics, energy balance is still going to work, protein still works, lifting still works, sleep still works. What's changed is the margin of error. So you've got less muscle, so you're probably sleeping worse and the fat is going somewhere less forgiving. So the same habits that used to hold you steady, now will drift you in the wrong direction.
• 5:06
  Again, that s just an adjustment. Then there s another myth, and that s that HRT will make you fat. It's important that we do this one properly, because I've had this with clients and we need to kind of unpick it, because it's the question underneath the question and everyone kind of dances around it. So there's a really significant review on this of 28 randomised control trials, over 28,000 women. Its conclusion is about as clear as a concrane ever gets, No evidence that oestrogen on its own or oestrogen with progesterone causes weight gain.
• 5:46
  So no difference in BMI either. HRT doesn't make you fat directly, but what some women do get in the first weeks is fluid retention, I've seen this in my clients, because what happens then is if you are just focused on the scales, will feel and it will look like weight gain on the scales, but it usually settles within two-three months. But the other half of that is that some evidence suggests that HRT slightly reduces the shift of fat to your abdomen and the picture there is less settled than the weight finding, so I'd be honest with you and say that it's promising rather than proven. But there's another bit that I really want you to hear. The same review found that HRT doesn't prevent the weight gain that comes with the menopause either.
• 6:33
  So it isn't necessarily making you fat and it isn't going to make you lean, it's a symptom treatment and it's a really good one, but it is not a body composition intervention. So if anyone sells it as either one of those, it's probably wrong in one direction or the other. The final myth I want to unpick and it is that there is a supplement that you can consume which will balance your hormone, unfortunately there is absolutely no supplement that balances your hormones. The same goes to cortisol as well and adrenal fatigue. If a product is aimed at women 45 and the pitch is about hormones rather than about specific nutrient that you are short of, unfortunately you are essentially the product.
• 7:21
  You don't need to go out of carbs, you don't need keto and you don't need to fast until two in the afternoon. There is nothing about menopause that is going to make consuming a certain amount of carbohydrates the problem. The thing that often happens, I see in clients is that what will happen when you are going through that kind of change is you will hold on to more water and at the same time we also know that if you take HRT, you are going to hold on to some water. So there are some things that actually work, and I'm going to list them all in order of how much they matter. So the first thing you can do is resistance train, or lift something heavy twice a week.
• 8:01
  Because you are losing lean gas, lean gas, lean mass, resistance training is the only thing that reliably tells your body to keep it. It also does morphine for bone density than anything else that you can do and bone loss is going to be running alongside the muscle loss at the exact same time. So if you can do two full body sessions a week, that is enough to change what I've just said and it doesn't even have to be the gym, can do classes, can do body weight things, youtube, whatever. Secondly, really important, and it will be absolutely no surprise, you need to be consuming enough protein. Most women that I see in this bracket are eating half of what they need.
• 8:38
  Muscle is a thing that you are trying to defend more than ever, and protein is the raw material. So we want to aim for a proper serving of protein every meal rather than thinking about oh I need to get x amount for the day. If you get it at breakfast, lunch and dinner, then it's very likely that you will be consuming enough protein, but remember we want to have a fist of protein. Sleep is so underrated, if you are waking up at three with duvet off, this isn't a side issue, broken sleep is going to drive your appetite up and it will make everything harder the next day. If night sweats are wrecking your sleep, that's again something that you need to speak to a GP about and he can hopefully or she can hopefully help you with something.
• 9:25
  And it's a weight conversion as much as a symptom one. Alcohol, so this isn't a lecture, but two glasses of wine that we're fine at 40 are going to have more of an impact now, specifically when it comes to sleep and the additional calories as well. The final final thing that's really important is that the scales are going to lie to you. If you're swapping muscle for fat, the scales are the one measurement that is going to overlook that. As I've said to you, I've had clients who are going through menopause, are on HRT, and the scale is kind of irrelevant.
• 9:58
  So get a tape measure, measure your waist, write it down and do that once a month and that is your measure from now on. So what I want you to take from this is four things. First thing, something real is happening. Your fat is going up, your muscle is going down and it's going to shift into your middle. That is absolutely categorically going to happen.
• 10:19
  Second, your metabolism has not crashed, you haven't got a broken metabolism. The best data that we have say that it's pretty stable right through this whole decade. Third, HRT isn't making you fat, but it's also not going make you lean. You take it for the symptoms and if the symptoms are subsiding then you continue taking it, but you've got to ride out the first two to three months because that's going to impact how kind of water situation your body. If it's right for you, you judge it on the symptoms being reduced and then you can make a decision after a couple of months.
• 10:53
  Number four, the things that work are unglamorous and nobody can sell them to you. You need to lift, you need to eat enough protein, you need to sleep and you probably need to watch the alcohol and you also need to find a measure that works, so weighing as I say, your hips and your waist. So you ask Caroline in this question whether you just have to accept it and the answer is no. You have to change what you're doing. Because your body has changed and the odd routine no longer covers it, we have to adapt with it and that is not the same as accepting it.
• 11:27
  The next version of you just has to do the things that I've said above and if you do that, then you're going to feel in a much better place. Aside from all of this, it's really important that we're covering those basics, so we're eating regular intervals, we're drinking enough water, we're covering those basics so that we are never hungry, we're never low on energy, our sleep is optimum, we're recovering better but essentially we want to be able to have enough energy to lift our weight, want to have enough energy to function through the day. You're basically trying to give your body the best chance to function as we want to function as long as possible and if you do everything that I have said in this episode, then hopefully, hopefully you will find that things are a little bit more manageable. I hope you found this episode useful. If this doesn't apply to you, please share it with somebody who is perhaps going through the change, share it with a friend, share it with a sister, share it with your mum, whatever it may be, share it with somebody and hopefully it can happen.
• 12:29
  On Friday, we've got a really special episode, so tune in then, but I will speak to you next week. Thanks, listen. Thanks for listening to this episode of No Forking Nonsense. If you would like to get your question on a future episode, email podcastnutritionistuk dot com. If you would like a free meal maker resource, click the top link in the description and don't forget to follow me on Instagram PaulTheNutritionist.
• 12:53
  Chat to you next week.