Belly Fat in Menopause
Originally posted Oct 18 2022
Recently, several frustrated patients, all middle-aged women, have asked me what in the sweet hell is happening to their bodies. They’ve had flat or flat-ish tummies their entire lives, and suddenly their waistlines are growing exponentially without them changing their diet or exercise routines. What’s going on? Is there anything they can do?
This isn’t a piece to shame you and tell you that your changing body is unattractive and that you should “do something” about it. I researched because these lovely women are seriously puzzled, and I wanted to see what science had to say. Much of the research is on mice and men, sigh, but I did find a few that focus on us older women.
Most of the new belly fat happens in the few years before menopause and up to one year after your periods stop. It feels like it happens overnight.
Our hormones shift during perimenopause, and fat distribution changes significantly. Findings from a 2021 study found that yes, menopause brings belly fat. Over the twelve-year study, hip and thigh fat stayed the same, but belly fat increased up to 24%. Well isn’t that a kick in the teeth.
According to a 2020 study, the decline of estrogen is the primary cause of belly fat, no surprise there, but it can also cause fatty acid metabolic alterations, leading to insulin resistance or metabolic syndrome.
Metabolic syndrome is a cluster of conditions caused by impaired glucose (sugar) metabolism, leading to high blood pressure, central obesity (belly fat), and high triglyceride levels. And then, to add to the pile of crap, this dysregulated fatty acid functioning can lead to cardiovascular disease. Excess abdominal fat is linked to heart problems, so yes, we do need to pay attention to it for our health, beyond aesthetics.
The study also mentions the loss of lean muscle that happens as we age. This is called sarcopenia. The loss of muscle happens at a rate of 3%-8% every 10 years after the age of 30 and accelerates like a damned freight train as we get older. Lack of muscle leads to fractures and falls, as well as speeding up the final destination. Guess what else? It also means you don’t burn as much fat. Hello, muffin top.
Is there a damned thing you can do?
In the 2020 study, the authors suggest adding Omega-3 fatty acids to the diet, and spend a fair amount of time discussing why they are beneficial. Omega-3 fatty acids exert anti-inflammatory, cardioprotective, and insulin-sensitizing effects. There’s also the suggestion that they can help with reducing breast cancer risk, diabetes, and rheumatoid arthritis.
An older study from 2015 showed that dietary intervention plus Omega-3 supplementation resulted in a decrease in triglycerides, blood pressure, and inflammation plus an improvement in insulin resistance.
Omega-3 fats have a protective impact on the body as a whole. Visceral fat, the fat found around internal organs, seems to shrink with the addition of Omega-3 fats. This is powerful protective nutritional medicine. These fats are found in little, oily fish like mackerel and sardines, or you can supplement.
What other foods can help?
If you go to the 2020 study, here’s the link again, scroll down to point 4.2.7. Phytochemicals and Probiotics, for a full list of suggested foods that can help. If you want me to summarize it, here it is:
To reduce menopausal belly fat, eat a whole foods diet of unrefined grains, garlic, vegetables, add in chilis and turmeric, enjoy berries and tea, soy and legumes, loads of cruciferous veg such as broccoli, cabbage, kale, and cauliflower, add some lemon or orange zest to your foods, and eat fermented foods for probiotic support.
Apparently, eating one fresh Hass avocado changed abdominal fat distribution in women. That’s tasty.
What else?
The blood sugar issue is a big one. You don’t metabolize sugar as well as you do when you’re young. The excess sugar in your blood lays down fat around the middle.
Reducing highly processed foods cuts out your exposure to sugar and trans-fats. These are added to foods for shelf stability. Think muffins, crackers, and cake frosting. These create inflammation which leads to insulin resistance (there it is again), heart disease, and yup, belly fat.
Secondly, and related to the above, alcohol suppresses your body’s ability to burn fat, it makes you want to eat shit foods, and languish on the couch all day. None of those are going to help.
Sedentary lifestyle. This should be obvious. Maybe not. Get up and go for a walk. Lift weights or do weight-bearing exercise. Do everything you can to preserve the muscle you still have, and even better, aim to increase it. I go into detail on weight-lifting for older women in this piece.
Eat enough protein. You’ll be less likely to overeat as protein is satiating, and it helps you build muscle, which helps you burn fat. We need more protein as we get older. Here’s a piece on protein needs.
Stress causes an increase in cortisol, and that goes straight to your waistline. Add in emotional eating or bingeing on top of that and you may find yourself wearing your stress around the middle. You’re the best expert on what lowers your stress. Maybe it’s meditation, yoga, or a walk. Maybe you need to set better boundaries with your children and tell them to leave you in peace for half an hour. Maybe it’s giving yourself a foot massage. I don’t know your life circumstances, but if you’re stressed out all the time, it’s part of the reason your pants feel tight.
Lack of sleep is stressful for your body. Well, thanks, that’s all great, but sleep goes out the damned window with insomnia and hot flushes. Do your best to establish a normal, regular sleep cycle. It isn’t easy when you’re sweating like a pig in the desert, I know, but resist the urge to get up and eat ice cream. Have a sleep meditation on your phone when you wake up at 3 am and think, oh f it, I’ll just get up. Don’t. Try to go back to sleep, or just let your brain wander in a meditation.
I’ve recommended CBD gummies for sleep to some of my patients. Ideally, you’ll live in a state where weed is legal and you can get it with a tiny amount of THC, which activates the CBD. If not, try the straight CBD and see if it helps you sleep through the night.
Gut microbiome imbalance - if your bacteria are out of balance, you’re at a higher risk of developing heart disease, type 2 diabetes, and… belly fat. This study suggests that probiotic yogurt improved anxiety, stress, and quality of life in postmenopausal women. This meta-analysis of randomized control tests “cautiously concludes” that probiotic supplements were associated with significantly higher bone mineral density in the lumbar spine. It works for me.
You can increase your fermented foods like yogurt and sauerkraut, or take a probiotic supplement.
What’s my takeaway?
eat whole foods diet emphasizing protein and veg,
minimize processed foods and booze,
build muscle and move your body,
reduce stress,
get as much sleep as possible, and
take an Omega-3 and probiotic supplement.
So far, it’s been working well for me.
Oh, and get some clothes that fit. To hell with your “skinny pants” and anything else you look at longingly in your closet. If your body has changed significantly, then work with it while you make healthier choices. You’re not a failure for needing a bigger size. You’re a badass woman whose body is changing thanks to hormones. That’s it.
A great book on staying fit during menopause is Next Level: Your Guide to Kicking Ass, Feeling Great, and Crushing Goals Through Menopause and Beyond by Stacy T. Sims and Selene Yeager.
Personally, I don’t like fish, so I supplement. I’ve just started taking Nordic Naturals ProOmega 2000 because, with my family history (Alzheimer’s all around), I need all the help I can get. This is a high potency formula though, so don’t use it if you’re on blood thinners or getting surgery soon.
References:
Greendale GA, Han W, Finkelstein JS, Burnett-Bowie SM, Huang M, Martin D, Karlamangla AS. Changes in Regional Fat Distribution and Anthropometric Measures Across the Menopause Transition. J Clin Endocrinol Metab. 2021 Aug 18;106(9):2520-2534. doi: 10.1210/clinem/dgab389. PMID: 34061966; PMCID: PMC8372653.
Tardivo AP, Nahas-Neto J, Orsatti CL, Dias FB, Poloni PF, Schmitt EB, Nahas EA. Effects of omega-3 on metabolic markers in postmenopausal women with metabolic syndrome. Climacteric. 2015 Apr;18(2):290-8. doi: 10.3109/13697137.2014.981521. Epub 2014 Dec 26. PMID: 25394692.
Ko S-H, Kim H-S. Menopause-Associated Lipid Metabolic Disorders and Foods Beneficial for Postmenopausal Women. Nutrients. 2020; 12(1):202. https://doi.org/10.3390/nu12010202
Khan NA, Edwards CG, Thompson SV, Hannon BA, Burke SK, Walk ADM, Mackenzie RWA, Reeser GE, Fiese BH, Burd NA, Holscher HD. Avocado Consumption, Abdominal Adiposity, and Oral Glucose Tolerance Among Persons with Overweight and Obesity. J Nutr. 2021 Sep 4;151(9):2513-2521. doi: 10.1093/jn/nxab187. PMID: 34191028; PMCID: PMC8417923.
Shafie M, Homayouni Rad A, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M. The effect of probiotics on mood and sleep quality in postmenopausal women: A triple-blind randomized controlled trial. Clin Nutr ESPEN. 2022 Aug;50:15-23. doi: 10.1016/j.clnesp.2022.06.005. Epub 2022 Jun 9. PMID: 35871917.
Yu J, Cao G, Yuan S, et al Probiotic supplements and bone health in postmenopausal women: a meta-analysis of randomised controlled trials. BMJ Open 2021;11:e041393. doi: 10.1136/bmjopen-2020-041393