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In the Western world, we expect menopause to be an awful time with hot flashes and mood swings. For many women, their health unravels as their cholesterol levels jump, and pain and other inflammatory conditions flare up1-3. Paradoxically, in many other cultures, there is not even a name for it because the symptoms are nowhere nearly as severe4. Therefore, much of the menopause discomfort and health decline is driven by our diet and lifestyle choices.  

In this article, I will share the recent interesting science related to menopausal changes and what you can do to coast through menopause. 

How does menopause happen?

The menopausal transition (perimenopause) is the transitional period when your ovaries gradually stop producing estrogen and progesterone. As a result, the body has to adapt to the new normal of low ovarian hormones. Because estrogen controls many aspects of brain function, most menopausal symptoms are neurological as the brain seeks to adapt to a new normal of low estrogen levels5

Menopausal symptoms start in the brain

One of the lesser-known but very important roles of estrogen is that it helps cells respond to insulin and burn carbohydrates for energy, especially in the brain6. Therefore, as estrogen levels decrease, the brain cells switch their metabolic preference from glucose to ketones. Because ketones are typically not instantly available and fat molecules can’t cross the blood-brain barrier, the brain cells starve and may even cannibalize other brain cells for ketones7.

The brain’s energy starvation causes menopausal depression, mood swings, sleep disturbances, brain fog, and forgetfulness5. One of the reasons over two-thirds of Alzheimer’s patients are postmenopausal women is because these hormonal and metabolic changes often precipitate Alzheimer’s, especially in women with a genetic predisposition8

The estrogen withdrawal may also reduce serotonin function in the brain9, which may not only cause depression but also worsen carbohydrate cravings and emotional eating10,11

Insulin resistance spells disasters for menopause

All menopausal troubles get worse with insulin resistance and blood sugar imbalances. Over 80% of perimenopausal women experience hot flashes and night sweats12, and these symptoms are associated with insulin resistance and high blood sugar13. Women with more insulin resistance got hot flashes and night sweats more often. 

Menopausal women also experience other changes in their metabolism due to insulin resistance. It becomes harder to lose weight and the weight gain tends to be in the midsection, which is the most inflammatory type of body fat. Their insulin and blood sugar levels increase as their cholesterol and triglycerides worsen14. As a result, their cardiovascular risk significantly increases15.

Insulin resistance may also reduce bone building during pre-menopause and accelerate the loss of bone mass during menopause16. Type 2 diabetic individuals are at higher risk of fracture and increased insulin resistance is associated with lower bone density17.  

These findings agree with what I’ve observed clinically. Over 50% of my clients, most of whom are perimenopausal and menopausal women, suffer from insulin resistance. They experience great relief from their hormonal symptoms when they balance their blood sugar. 

The conventional treatments for many of the above symptoms are hormone replacement therapy and antidepressants12. While these treatments provide some relief, even bioidentical hormone replacement therapy is not without side effects. Also, hormone replacement does not completely resolve symptoms because they don’t address the true root causes18

Menopause should not be a dirty word

Many women in the Western world experience worse menopausal symptoms than others because they already have insulin resistance, hormone imbalances, chronic inflammation, and toxicity. They may also have been covering up symptoms of these problems with medications for decades before menopause brings them to the surface, so it appears as if their health unravels with menopause.

If you already have these underlying malfunctions, your menopausal symptoms will be worse. Conversely, the decline in estrogen and resulting metabolic changes are often the last straw that causes these malfunctions to surface as diseases like diabetes, heart diseases, dementia, autoimmunity, and cancer.

Menopause is when you have to face the truth, because the effects of your suboptimal diet and lifestyle will be more apparent than ever. Fortunately, it doesn’t have to be the beginning of the end because it is totally possible to coast through your menopausal transition and age gracefully once you address the root causes. In fact, if you are perimenopausal, now is the most critical time to do so by:

1) Balancing your blood sugar 

Even if you are eating relatively healthy, you may still have insulin resistance. The key to fixing insulin resistance involves understanding how your body’s unique responses to each food. Also, other factors like sleep quality, stress, and chronic inflammation, can make you insulin resistant. In my Sweet Spot solution program, I coach my students through a step-by-step protocol to address these factors to balance their blood sugar.

2) Trying ketosis

The menopausal brain loves ketones as a fuel7, although the keto-adaptation phase can be stressful to the body and everyone responds differently to this phase. Personally, I have done very well with a plant-based ketogenic diet and fasting. Ketosis can also help beat cravings, stabilize mood, and reduce many unpleasant menopausal symptoms. It is a good idea to try the ketogenic diet, fasting, or even exogenous ketones and see how your body responds. 

For some easy, nutrient-rich keto recipes to get you started, check out my free Plant-Based Keto Recipes Guide.

3) Fasting or caloric restriction

Fasting can be a powerful medicine to improve health during middle age19. It helps with insulin resistance and fat burning. It also slows down age-related diseases such as cardiovascular diseases, cancer, obesity, Alzheimer’s, and osteoporosis20. It may even help with autoimmunity and inflammation21. However, because it can be stressful to the body, individual responses to fasting may vary depending on your current reserve. To learn more about fasting and different ways of doing it, read this article

References:

1. Derby, C. A. et al. Lipid changes during the menopause transition in relation to age and weight. Am. J. Epidemiol. 169, 1352–1361 (2009).

2. Mitchell, E. S. & Woods, N. F. Pain symptoms during the menopausal transition and early postmenopause. Climacteric 13, 467–478 (2010).

3. Desai, M. K. & Brinton, R. D. Autoimmune disease in women: Endocrine transition and risk across the lifespan. Frontiers in Endocrinology vol. 10 (2019).

4. Avis, N. E. et al. Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic groups. Soc. Sci. Med. 52, 345–356 (2001).

5. Brinton, R. D., Yao, J., Yin, F., Mack, W. J. & Cadenas, E. Perimenopause as a neurological transition state. Nature Reviews Endocrinology vol. 11 393–405 (2015).

6. Ulhaq, Z. S. Estrogen – serotonin interaction and its implication on insulin resistance. Alexandria J. Med. 55, 76–81 (2019).

7. Yao, J., Rettberg, J. R., Klosinski, L. P., Cadenas, E. & Brinton, R. D. Shift in brain metabolism in late onset Alzheimer’s disease: Implications for biomarkers and therapeutic interventions. Mol. Aspects Med. 32, 247–257 (2011).

8. Scheyer, O. et al. Female Sex and Alzheimer’s Risk: The Menopause Connection. J. Prev. Alzheimer’s Dis. 5, 225–230 (2018).

9. Epperson, C. N., Amin, Z., Ruparel, K., Gur, R. & Loughead, J. Interactive effects of estrogen and serotonin on brain activation during working memory and affective processing in menopausal women. Psychoneuroendocrinology 37, 372–382 (2012).

10. Schreiber, D. R. & Dautovich, N. D. Depressive symptoms and weight in midlife women: The role of stress eating and menopause status. Menopause 24, 1190–1199 (2017).

11. Wurtman, R. J. & Wurtman, J. J. Brain serotonin, carbohydrate-craving, obesity and depression. Obesity research vol. 3 Suppl 4 (1995).

12. Bansal, R. & Aggarwal, N. Menopausal hot flashes: A concise review. J. Midlife. Health 10, 6 (2019).

13. Thurston, R. C. et al. Vasomotor symptoms and insulin resistance in the study of women’s health across the nation. J. Clin. Endocrinol. Metab. 97, 3487–3494 (2012).

14. Tchernof, A., Calles-Escandon, J., Sites, C. K. & Poehlman, E. T. Menopause, central body fatness, and insulin resistance: Effects of hormone-replacement therapy. Coronary Artery Disease vol. 9 503–511 (1998).

15. Pardhe, B. D. et al. Elevated Cardiovascular Risks among Postmenopausal Women: A Community Based Case Control Study from Nepal. Biochem. Res. Int. 2017, (2017).

16. Choo, M. S., Choi, S. R., Han, J. H., Lee, S. H. & Shim, Y. S. Association of insulin resistance with near peak bone mass in the femur and lumbar spine of Korean adults aged 25-35: The Korean National Health and Nutrition Examination Survey 2008-2010. PLoS One 12, e0177311 (2017).

17. Srikanthan, P. et al. Insulin resistance and bone strength: Findings from the study of midlife in the United States. J. Bone Miner. Res. 29, 796–803 (2014).

18. Vigesaa, K. et al. Efficacy and tolerability of compounded bioidentical hormone replacement therapy. Int. J. Pharm. Compd. (2004).

19. Nair, P. & Khawale, P. Role of therapeutic fasting in women’s health: An overview. Journal of Mid-Life Health vol. 7 61–64 (2016).

20. Martin, S., Hardy, T. & Tollefsbol, T. Medicinal Chemistry of the Epigenetic Diet and Caloric Restriction. Curr. Med. Chem. 20, 4050–4059 (2013).

21. Hafström, I., Ringertz, B., Gyllenhammar, H., Palmblad, J. & Harms?Ringdahl, M. Effects of fasting on disease activity, neutrophil function, fatty acid composition, and leukotriene biosynthesis in patients with rheumatoid arthritis. Arthritis Rheum. 31, 585–592 (1988).