Exercise and Nutrition in Perimenopause and Menopause
Signs, symptoms and solutions
“…I was the heaviest I had ever been in my life. It was not fun. I thought maybe this was my new normal. It honestly did not occur to me that I was perimenopausal and nor did I understand at the time how my chronic sleep deprivation due to a sick child was contributing to the perfect storm”
This article will cover best exercise, nutrition and natural therapies in Perimenopause and menopause with a specific focus on
- Insulin resistance
- Weight gain
- Bone health/osteoporosis (the one thing your clients won’t care about but should)
How many of your female clients over 40 talk about how hard it is to maintain their weight? Or that they are struggling to fit into their clothes? This can be a lifelong challenge but can become more noticeable in perimenopause (it did for me!). The same things that I had always done if my weight started creeping up were providing diminishing results and those numbers on the scales just kept going up. What was worse – when I did start working out more, I could not lose weight. WHY? Because I was insulin resistant. I could feel it in my body, but I didn’t understand at the time why – I was 1 year into my nutrition training and 18 months post-partum and the heaviest I had ever been in my life. It was not fun. I thought maybe this was my new normal. It honestly didn’t occur to me that I was perimenopausal and nor did I understand at the time how my chronic sleep deprivation due to a sick child was contributing to a perfect storm.
I now understand why I had become insulin resistant:
- Changing hormones. At age 42 my hormones had already started to fluctuate.
- I had a sick child and had hardly slept more than 10 minutes at a time for nearly 18 months.
- Because of the chronic sleep deprivation, I was exhausted, depressed and and burned out (another factor leading to insulin resistance)
- I had reverted back to my old methods of weight management – exercise as much as you can and eat less – not the right approach given my age, exhaustion, hormones and insulin resistance. I was flogging myself and getter bigger!
We are going to flesh out the mechanisms for insulin resistance and weight gain so you can speak to your clients about it, adjust your training methods to fit them and help them navigate perimenopause and menopause like fierce goddesses.
What is Perimenopause?
The period of time (2-12 years) prior to menopause when women start experiencing changes in hormonal balance (especially progesterone and oestrogen) and insulin metabolism-beginning with low progesterone paired with temporarily high oestrogen and finally low oestrogen with some significant changes to our blood sugar management. Menopause is the period 1 year after your last period. That’s’ a long time isn’t it – 2-12 years. Average age of menopause is 51 so you can have clients aged 39 that could be perimenopausal.
Glucose and Insulin-Lets review Nutrition 101
Glucose is made from the digestive breakdown of carbohydrates. Carbohydrates come in 3 forms:
-Starches (complex carbs)
-sugars (simple carbs)
Simple and complex carbohydrates all breakdown into glucose (blood sugar). Simple carbs only have 1 or 2 sugar molecules where complex carbs contain 3 or more molecules. Fibre is not absorbed and travels down to your large bowel where is can be food for the bacteria living down there who make some wonderful health promoting chemicals like butyrate (a short-chain fatty acid).
An unhealthy microbiome due to a SAD (standard American/Australian diet) and inadequate fibre (which is food for your microbes) can contribute to weight loss resistance, blood sugar dysregulation and a host of other health issues.
INSULIN is a hormone that regulates metabolism and is made in your pancreas. Insulin is secreted into your blood stream primarily in response to glucose but many other hormones including melatonin, oestrogen, leptin, growth hormone and glucogon-like peptide 1 also regulate secretion of insulin. We will focus mainly on the glucose but it’s useful to know that other hormonal alterations in the body can contribute to issues with insulin sensitivity.
Insulin works by communicating with receptors on cell membranes to encourage the “unlocking” of the doors to allow glucose to enter. Insulin also acts on muscle, liver and fat cells where glucose is stored as glycogen and triglycerides for later use. Glucagon is a hormone released by the pancreas in response to low blood sugar levels, mobilising stored glucose from liver, muscle and fat cells.
A condition where cells have reduced sensitivity to insulin (imagine the cell is wearing headphones and can’t hear insulin knocking on the door), so insulin remains elevated in your blood stream. Chronically elevated insulin levels can lead to diabetes, metabolic syndrome and is a major contributor to abdominal and visceral weight gain.
Insulin resistance can also affect fat cells, as the message to continue to hold the fat is not being heard and the fat cells release stored triglycerides back into circulation, potentially causing elevated blood triglycerides (a cardiovascular risk factor).
High Cortisol and Insulin Resistance
In “Rushing women’s syndrome” Dr Libby discusses the interplay of cortisol and stress. When we are stressed our “fight or flight” system is engaged. This is meant to mobilise many systems in our body for the purpose of RUNNING from imminent danger (Tiger). When the danger passes that system should switch off and we should return to a parasympathetic state (rest and digest).
Unfortunately, many of us live with chronic stress which impacts many systems including digestion Poor digestive function=digestive inflammation and alterations to our microbiome=systemic inflammation and immune dysregulation=a whole lot of problems.
Chronic Stress=chronically elevated cortisol (the mechanism never switches off) =glucose mobilised from storage but there’s no animal to run from so the glucose is not needed so more insulin is released to get rid of the sugar back to storage and around and around we go-decreasing cell insulin sensitivity and increasing systemic inflammation. A very damaging cycle.
Over time the whole process becomes dysregulated but can also lead to fat loss resistance. Fat cells are metabolically active tissue (did you, like me, think they were just useless bits of tissue?) Fat tissue is considered an endocrine organ capable of exerting body wide metabolic influence making hormones and cytokines called adipokines. The most well known one is Leptin with its effect on appetite regulation, but many others are indicated in the development of insulin resistance, obesity and type 2 diabetes.
CORTISOL AND PROGESTERONE-The Great Progesterone steal
Progesterone is a steroid hormone (made from cholesterol – yes, we need cholesterol) and it’s made in the Corpus luteum (eggshell), adrenal glands and by your placenta from 8-12 weeks of pregnancy.
Progesterone is mainly secreted by the corpus luteum (The Egg Shell) in the second half of your menstrual cycle. If you are not ovulating or have an anovulatory (no egg released) cycle, then there is no corpus luteum to make progesterone. You won’t necessarily notice this as your period may come in a similar manner.
Perimenopause and anovulation (no egg released) = less progesterone AND if you’re already more agitated/stressed = the progesterone that is being made by other sources is being STOLEN to be turned into cortisol. That is NOT helpful. Progesterone is a pre-cursor molecule to cortisol. This explains why so many women have low progesterone. I find it’s an epidemic amongst my patient group (the over 40’s lady) What kind of symptoms can be cause by low progesterone?
THE cortisol/insulin/cortisol problem
When you have chronically elevated cortisol this can lead to insulin resistance as discussed earlier but, here’s another twist, insulin resistance can lead to increased cortisol release as it is perceived as a stress by the body. Can we get off this roundabout already?
SO BACK TO OESTRADIOL (oestrogen)
As we try and reduce very complex metabolic processes (think hundreds of chemicals, receptors, interactions) to very simple explanations - we can say that a loss of circulating Oestradiol induces rapid changes in whole body metabolism, fat distribution (did anyone say belly fat?) and insulin action. It’s good to understand the way things work and to apply the common sense approach initially as this will help a lot of people and symptoms, but that person may still require some individual help.
EXERCISE PROFESSIONALS TO THE RESCUE!
This is where you can be of enormous value. Appropriately delivered exercise to your client understanding the above has the potential to help mediate symptoms, help them to lose the excess weight, protect their brain health, reduce metabolic disease risk (including dementia) and minimise bone loss during menopause (the riskiest time) – Next time part 2 will be about osteoporosis/bone loss.
Exercise wins again! All exercise is great but specifically:
Resistance Training-amazing for so many reasons but specifically for improving insulin sensitivity. How? Well having more muscle cells increases the amount of energy you need expanding your storage capacity and while you are exercising your cells are able to remove glucose from the blood stream independent of insulin as a mediator. Less glucose in circulation means less insulin means the cells can take off their headphones because it isn’t so noisy.
A 2000 study from the Int Journal of Sports medicine identified that there are improvements during exercise itself via insulin independent mechanisms including membrane transporters and but that a SINGLE bout of exercise itself can improve insulin sensitivity for up to 16 hours. How awesome is that! Exercise also improves insulin stimulated GLUT4 movement to the cell membrane. GLUT4 is the main cell membrane protein that facilitates entry of glucose to the cell and exercise induces movement of that protein from inside the cell to the surface.
The other mechanisms by which insulin sensitivity is improved are more complicated (aren’t they always) but include:
- The fat loss itself achieved through exercise and diet changes reduces the need for gluconeogenesis meaning less circulating glucose
- Changes in signalling proteins like APPL1 altering glucose metabolism
- Upregulation of GLUT4 transport protein
A 2001 Study on menopause and exercise in the Journal of midlife health found what you all probably know. Women should be doing
- Resistance Training
- Aerobic exercise
- Balance training
- Stress management
What about Nutrition?
Again, common sense mostly prevails here:
- avoid refined carbohydrates that breakdown quickly into glucose and are high in glucose with low satiety meaning you eat a lot more of them and you will likely be “hungry” again quickly.
- Focus on eating whole food, high fibre complex carbohydrates
- Low GI foods and a low Glycaemic load diet overall
- Eat protein with every meal and snack
- Focus on the “healthy plate” – ½ plate non starchy veg, ¼ protein and ¼ starchy carbs with a good dollop of healthy fat
- don’t graze “all day” – our digestive system needs a break. Unless snacks are needed try and stick to eating around every 4 hours to give our body a break from food and insulin production.
- Increasing foods high in B vitamins, zinc and vitamin C including lean read meat, lentils, chickpeas, pumpkin seeds, sunflower seeds, almonds, salmon, green vegetables, dark chocolate.
- -Minimise caffeine – 1-2 cups or equivalent max per day. If you are an overresponder then reduce even more
- keep alcohol to minimum-the evidence is not favourable for perimenopausal and menopausal women and alcohol.
Natural Therapies to optimise progesterone
- Stress management-this makes for a whole topic but can include Yoga, regular exercise, managing your blood sugar, getting out in nature, meditation, breath practices etc.
- Stress management has a mindset component – if the above techniques aren’t providing relief refer for counselling or psychology
- Vitamin B6. Therapeutic dosing range is 200-800mg-I recommend this to be undertaken in partnership with a qualified nutritional practitioner as with everything some people can suffer adverse effects of specific B6 dosing. Foods high in B6 include turkey breast, grass fed beef, pistachios, tuna, pinto beans, avocado, chicken breast, sunflower and sesame seeds.
- Increasing fibre intake to optimise oestrogen/progesterone balance (by ensuring oestrogen detoxification). Minimum 30grams per day. There are many food tracking apps that now track fibre too – consider doing a fibre challenge with your clients.
SLEEP-Unfortunately, perimenopause and menopause are a time that commonly introduce sleep dysregulation to women that may have never had any issues. Sleep disturbance is the second most common symptom reported after hot flushes. The problem can be both with falling asleep and staying asleep. What are the causes?
-high histamine during the high-oestrogen stage and disruption (change) of the sleep centres of the brain due to the drop in progesterone and estradiol (oestrogen).
-altered circadian rhythms due to a drop in estrodiol.
-reduced melatonin production
-impaired stress tolerance
-sleep disturbing symptoms like hot flushes, increased need to urinate, fibromyalgia and restless legs syndrome
This is an area that your clients should seek help with. Nutritional and naturopathic medicine have many low intervention options for managing sleep disturbances. Sleep apnoea should be evaluated by a qualified medical professional so refer to their GP if you suspect sleep apnoea.
Sleep hygiene is the best place to start and should include:
-getting light exposure first thing in the morning (without sunglasses) – this help to regulate your circadian rhythm and contributes to better sleep.
-Reduce blue light exposure for a couple of hours before bed. If you can’t get off your computer or tablet, consider wearing blue light blocking glasses. Blue light interrupts melatonin production.
-consider stimulants like coffee and alcohol – they can both interrupts sleep. Remembering that what you could get away with prior to perimenopause may no longer apply.
-Consider a low histamine diet if you are showing signs of poor histamine tolerance
-consider eating adequate good quality carbs with your evening meal as this can be calming to your nervous system.
Some articles and books to read if you want more info
Lara Briden: The Hormone Repair Manual
Dr Libby: Rushing Womens syndrome
Google Scholar has lots of great articles. You can find more info about a specific aspect using your search function i.e., “effects of resistance training on insulin sensitivity” or exercise and perimenopause etc
About the Author
Bek Di Mauro is a Functional Nutritionist and Personal Trainer based in Adelaide, South Australia. Bek uses a variety of skills to pin point the reason you are feeling unwell or not getting the results you want. These skills include personalised nutrition advice, use of specific dietary protocols, lifestyle choices to support your bodies innate healing potential and mindset coaching to help you get the best results in your healing journey.
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