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Weight Gain With Menopause: Why a Low Carb Diet Is the Best Approach to Eliminate Perimenopausal & Post-Menopausal Weight Gain.

“An Increase in Insulin Resistance is the Major Cause of Weight Gain Associated with Menopause . . . So, It Makes Sense That Techniques that Reduce Insulin Resistance Are the Best Approach to Reversing that Weight Gain. This is True for People Seeking to Lose Weight During, Shortly After, or Well After the Menopausal Period.” – Paul Kolodzik, MD FACEP, FASAM.

Weight gain occurs during menopause for a variety of reasons. A decline in estrogen levels influences body fat distribution, and lower levels lead to an increase in abdominal fat. Increased abdominal fat subsequently leads to an increase in insulin resistance, which makes it much easier for a woman to gain weight and harder to lose it. Insulin resistance is a condition where the body's cells become less responsive to the hormone insulin, leading to higher blood sugar levels and weight gain. (Note that the term blood sugar and blood glucose can be used interchangeably.) When blood sugar is elevated, blood sugar that the organs can’t absorb goes to the liver and is converted to fat. That fat is then deposited around the body’s mid-section (visceral fat) causing further weight gain. (Some of that additional fat may stay in the liver causing a condition called “fatty liver disease”, also adding additional numbers to the scale.)

Menopause is also associated with a loss of muscle mass. This causes an associated drop in metabolic rate, meaning less calories are burned per hour – either at risk or with activity. So, as body fat percentage increases (bad), lean muscle mass drops (also, bad). Often stress (physical and emotional) during this period also contribute to weight gain as increases in the body’s natural steroid, cortisol increases.

For these reasons the cards are very much stacked against maintaining a healthy weight during and after menopause. Fortunately, there is a widely accepted, medically safe, and effective approach to inhibiting weight gain, and achieving weight loss, associated with menapause. I’ve treated hundreds of women in this situation. Whether it is during menopause, shortly after, or long after menopause this very effective program reduces insulin resistance to achieve meaningful and permanent weight loss. And with reducing insulin resistance the byproduct is also better health, and of course improved energy and an improved sense of well-being.

To reverse insulin resistance, the best plan includes:

·      A low carb diet (best guided by a continuous glucose monitor, CGMs),

·      Intermittent fasting,

·      Strength training.

Low carb diets reduce blood sugar to reduce insulin resistance. We guide patients with a personalized carb intake target. Continuous Glucose Monitors are a great tool to help understand insulin resistance and guide a low carb diet. Intermittent fasting is a great associated technique to lower insulin resistance. (We help patients gradually achieve fasting periods of 12, 14 or 16 hours, and nearly all adapt very well.) Finally, strength training routines increase muscle mass to increase insulin and blood glucose absorption of the muscles, lowering insulin resistance. We start many women with a strength training routine at home, guided by health coaches, using bands and five- or ten-pound dumbbells for 45 minutes three times a week. The progress they achieve is often remarkable.

Our detailed plan achieves the following:

  1. Improved Insulin Sensitivity: By reducing carb intake, insulin levels are lowered, aiding in weight management.

  2. Reduced Appetite: Low-carb diets often lead to a reduction in appetite, possibly due to increased protein and fat intake. This can help with calorie control and prevent overeating, which is crucial for weight management. (Note that increased fat intake causes “satiety”, that is, it suppresses hunger.)

  3. Fat Burning: By reducing carbohydrate intake, the body switches to burning fat for energy as less blood glucose is readily available to the organs. This leads to more efficient fat loss. An added benefit is that on a low carb diet (as opposed to a reduced calorie intake (calories in / calories out diet approach), you can always eat something. With low carb, a food containing protein and or fat can be consumed, and you don’t have to go hungry.

  4. Improved Metabolic Health: Low-carb diets have been associated with improvements in various markers of metabolic health, such as lower blood pressure, and lower triglycerides. Better overall metabolic health supports weight management efforts.

  5. Due to reduction and stability in blood glucose levels energy and mental clarity often improve. By eliminating wide blood sugar fluctuations our patients often feel they have more energy and “brain fog” is reduced.

  6.  With the weight loss achieved with low carb, intermittent fasting, and strength training, other conditions also improve. Examples include reductions or elimination of GERD, sleep apnea, and fatty liver disease.

In a limited number of patients GLP-1 medications may be added. However, we strongly believe that medications like semaglutide should not be added unless the habits of a low carb diet, intermittent fasting and strength training are ingrained. And when using GLP-1s, we recommend lower doses and limited courses of therapy (measured in months not years) as being most appropriate. If these approaches are not taken, both muscle mass loss and long-term medication dependency will likely occur. Dependency can result from the fear of weight regain when stopping the medications.

In summary, an easily followed plan as outlined here is the best plan for weight loss sought as a result of weight gain during menopause. We believe “low carb” beats “calorie restriction”, and is the most sustainable approach to keeping weight off once success is achieved.

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