It's a rather sad fact of life that very few women look forward to menopause. Most approach it with trepidation at best, and outright fear at worst!
Amongst the laundry list of health problems attributed to menopause, two that many women fear the most are hot flushes and unwanted weight gain, especially the dreaded 'spare tire' of menopause belly fat. While these two troublesome symptoms might appear to be unrelated, research has revealed that the same diet and lifestyle strategies work for both of them. But before we get to the solutions, let's discuss the problems in a bit more detail.
Hot flushes (or 'hot flashes', for our American friends) and night sweats are the bane of most women's lives during the menopausal transition.
Up to 80% of US women experience these episodes of profuse heat accompanied by sweating and flushing, predominantly around the head, neck, chest, and upper back, at some point in their passage through menopause. A sizeable minority are still suffering well into their 70s.
Various theories have been put forth as to what causes hot flushes and night sweats – collectively known as 'vasomotor symptoms' – but amazingly, the physiology of these bothersome events is still not fully understood by researchers.
Hot flushes and night sweats are not simply a nuisance, an inconvenience or a source of embarrassment. The severity of vasomotor symptoms is strongly correlated with reduced health-related quality-of-life, impacting significantly on sleep, mood and cognitive function:
- Sleep quality and quantity are adversely affected by vasomotor symptoms; some women suffer night sweats so intense that they drench the bed multiple times each night. These cause interruptions to sleep that wreak havoc on women's mood, capacity to cope with stress, energy level, immune function and food choices.
- Perimenopausal women who experience vasomotor symptoms are more likely to develop depression than those who aren't plagued by hot flushes and night sweats.
- Cognitive function (for example, the ability to think clearly, remember important information, and find the right word to use) is also adversely affected by vasomotor symptoms.
And on top of all that, hot flushes and night sweats are also associated with an increased risk of cardiovascular disease and reduced bone density, which in turn increases the risk of bone fractures.
Even women who have been slim their whole lives may suddenly find they're growing a pot-belly once they hit menopause, while those who've been fighting the battle of the bulge for as long as they can remember, often reach the point of simply giving up because nothing seems to work anymore.
There are several reasons why aging women gain weight more readily, especially around the midsection. Firstly, our basal metabolic rate (BMR) – the number of calories or kilojoules our bodies burn each just to maintain basic functions – declines about 1-2% each decade after we hit 20. This decline in BMR, along with decreased physical activity, causes total energy expenditure to drop by roughly 150 calories per day per decade. What this means is that a 60-year-old woman needs around 600 fewer calories per day than she did when she was 20, and if she doesn't cut back on her calorie intake, she will inevitably gain weight.
The decline in metabolic rate is believed to be due to
- Declining muscle mass and increased fat mass; and/or
- Decreased metabolic rate within muscle tissue, and/or
- An unavoidable loss of our metabolically active organ tissue.
Secondly, when women are in their fertile years, the estrogen produced by their ovaries deters fat deposition around the midsection but causes fat to accumulate in their hips and thighs. This so-called gluteofemoral fat is stubbornly resistant to being shifted, as countless women who have tried to alter their 'pear shape' through diet and exercise, know only too well. But as the ovaries wind down their estrogen production, the ratio between estrogen and testosterone shifts, causing women to store fat more readily around their abdomens. The 'pear shape' of the premenopausal women morphs into the 'apple shape' typically seen in overweight men. And unlike gluteofemoral fat, which plays a protective role against metabolic and cardiovascular disease, abdominal fat is flat-out dangerous to health, raising the risk of diabetes and heart disease.
OK, that's enough bad news. Now for the good news:
A whole food plant-based diet: good for hot flushes and weight loss
Diets rich in fruits, vegetables, whole grains and legumes (dried beans, peas and lentils) encourage a diverse, health-promoting gut microbiota. These beneficial gut bacteria repay us for feeding them healthy plant foods by metabolising estrogen-like compounds in these foods into substances that help to reduce fat storage, and also keep hot flushes at bay. What a deal!
For example, in the Women's Health Initiative Trial, women who were advised to eat more fruits, vegetables and whole grains lost more weight than women in the control group, who maintained their usual eating. Those who lost over 4.5 kg, or 10% or more of their baseline body weight, were significantly more likely to reduce or eliminate their hot flushes and night sweats after one year of follow-up.
Diets rich in phytoestrogen-rich foods, such as soy and flaxseeds, result in higher levels of oestrogenic plant lignans in the blood, which are associated with a lower risk of being overweight or obese.
A survey of over 600 peri- and post-menopausal women found that those following a vegan diet suffered significantly less vasomotor symptoms of menopause than women who ate flesh foods (including fish), eggs and dairy products. Vegan women also reported less menopausal weight gain and fewer physical symptoms, including muscle and joint aches, fatigue, sleep difficulties, neck, head and backaches, reduced strength/stamina, lethargy, skin changes, facial hair, bloating, frequent or involuntary urination and flatulence. Vegetables, fruit, soy products and high omega-3 plant foods such as flaxseed, chia seed and leafy green vegetables were the most protective foods against menopausal woes, while the more flesh food, dairy products and high omega-3 fish women ate, the worse was their vasomotor and physical symptoms.
Muscle up to beat hot flushes and weight gain
While our muscle mass declines as we get older, we can buck the trend by staying physically active, and in particular by engaging in strength training - such as bodyweight exercises, resistance bands, weight training and wearing a weighted vest - to maintain and even build our muscle mass. Women who put in the effort to hang onto their muscle mass are rewarded richly.
For example, in the Study of Women's Health Across the Nation (SWAN), which has been tracking the health of over 3000 American midlife women since 1996, those with the highest proportion of muscle mass had the lowest risk of experiencing those dreaded hot flushes and night sweats. The effect was striking: almost 70% of women who had the lowest proportion of muscle mass index developed vasomotor symptoms, compared to less than 10% of women with the highest proportion.
And in another Women's Health Initiative Trial study, physical activity was found to cancel out the weight gain-promoting effect of 'fat genes' on older women. Researchers identified 95 single nucleotide polymorphisms (SNPs), or gene variants, that were strongly and consistently associated with weight gain. They discovered that among women who were physically active, the effect of these 'fat genes' was effectively neutralised. That is, older women whose genes predisposed them to menopause weight gain weighed much the same as their skinny-gene sisters as long as they participated in regular recreational physical activity, including brisk walking. And the more active they were, the lower their body mass index (BMI).
Menopause absolutely does not have to be a horrible experience! Quite apart from the research I've referred to above, my personal and professional experience has given me ample proof that the combination of a wholefood plant-based diet and regular physical activity (especially muscle-strengthening exercise) is the key to allowing women to actually enjoy the third stage of their lives without the debilitating symptoms so often associated with menopause. If you need help with making these lifestyle changes, feel free to reach out to me.