How Perimenopause Affects Metabolic Health
How Perimenopause Affects Metabolic Health
Pushing back against hormone-induced weight gain and other consequences for brain health
Hello, everyone. It’s not often I get to say I am writing to you from a geodesic dome in Costa Rica. The “dome” is my casita in the jungle, tucked along a river amongst a canopy of trees. I am here to check out the site of our upcoming Brain Health Retreat in January 2025.
This jungle oasis will welcome retreaters with cozy rooms (some down by the river and others up high overlooking the ocean), incredible plant-based meals, and plenty of “incidental exercise” throughout the day. For me, drifting off to the din of jungle birds and bugs under the dome’s tree-filled skylight has been a recipe for a good night’s sleep. You can check out my dome and the other rooms here. Visit the retreat page here to learn more about this immersive “educational vacation,” and to reserve your spot. As always, if you have questions you can reply to this email and I will get back to you.
Today, we are continuing our metabolic health series
We’ve covered a lot! If you are just joining us or you want to catch up:
Start here: Why chronically high blood sugar is bad for the brain + new thinking about controlling blood sugar.
Next, read what to eat when: foods that stabilize blood sugar, intermittent fasting, glycemic index, and food order.
How to pick a blood sugar-friendly pasta: plus my recipe for Brain-Healthy Penne alla Vodka
High protein vegetarian eating for metabolic and brain health: a guest post by
about her metabolically-friendly approach to vegetarian cooking. Don’t miss her special offer for BHK subscribers—a 90-day free trial to her Weeknight Simple meal plan with recipes!
Today I’d like to expand on what happens to metabolic health during perimenopause and after. What can you do to push back against the weight gain, rising lipids, and prediabetic tendencies that come with this stage of life?
The first newsletter of the month is always free.
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Estrogen is an anti-diabetes hormone
We’ve talked about how estrogen is neuroprotective, and how taking hormone replacement therapy (HRT) may help women fend off dementia. But did you know that estrogen also has a protective effect on insulin sensitivity and blood sugar control? In fact, estrogen has anti-diabetogenic properties—it helps fend off metabolic changes that lead to diabetes. That’s because estrogen regulates how the body deals with glucose.
In the liver, estrogen helps slow down the conversion of nutrients into glucose thus reducing the body’s glucose production. It helps sensitize muscles so they can take up glucose, mopping up what’s free in the bloodstream. Progesterone, the other key female hormone, kicks in to make tissues (like muscles and liver) more able to absorb and utilize glucose. All this serves to keep excess glucose out of circulation where it can wreak havoc on blood vessels and organs.
Estrogen is a crucial factor in preventing the body’s cascade from hyperglycemia to insulin resistance to prediabetes to type 2 diabetes, all of which are bad for the brain.
Perimenopause puts women in a prediabetic state
The estrogen/progesterone milieu serves a woman well throughout her reproductive years. A woman has a lower risk of developing diabetes than a man in this life stage. During the transition to menopause (aka perimenopause), however, diabetes risk rises steeply to catch up and surpass that of a man the same age. With both female hormones on the downslope in the perimenopausal years, metabolism takes a hit. Blood sugar trends up and insulin sensitivity goes down. Women tend to gain weight even though their diet and exercise routines have not changed. To make matters worse, estrogen’s ability to keep cholesterol in check goes away. LDL-C drifts up and HDL goes down, posing more cardiometabolic risk.
In the 10 years after menopause, women catch up to the same heart attack and stroke risk of men.
Weight gain at menopause impacts visceral fat
By the time a woman is menopausal (defined as one year from the last menstrual period), she has usually gained an average of 12 pounds. The fat she has accumulated around her vital organs has gone from 5 to 8% to 15 to 20% of total body fat. This visceral fat is itself an independent risk factor for hypertension, diabetes, and heart disease. Not only that, visceral fat has been associated with structural changes in the brain.
If you haven’t heard this before, I am really sorry to report that the type of weight women gain at menopause is associated with greater cognitive decline and increased risk of dementia.
How do you know if you may be gaining visceral fat?
The simplest way to detect visceral fat gain is to measure waist circumference. Here’s how: Get out a tape measure. Stand up straight and breathe out. Wrap a tape measure around the smallest part of your waist just above your belly button. This is your waist circumference. You may be accumulating excess visceral fat if your waist circumference is over 31.5 inches for women, or 37 inches for men (based on International guidelines) or 35 inches for women and 40 for men (based on U.S. guidelines).
The waist hip ratio (WHR) is an even more accurate predictor of visceral fat stores. In addition to checking your waist circumference, measure the distance around the largest part of your hips. Calculate WHR by dividing waist circumference by hip circumference. According to the World Health Organization, you are at low risk for problematic visceral fat stores if your WHR is less than 0.9 inches for men or 0.85 inches for women. In both men and women, a WHR of 1.0 or higher increases the risk of type 2 diabetes and heart disease.
An elevated waist hip ratio is associated with poor cognitive health, too. In this study of adults over 70, a high WHR was a better predictor of cognitive impairment than just waist circumference or body mass index.
What you can do to push back against perimenopause
I know this all sounds overwhelming and difficult but there’s good news, too. While the body is conspiring to put women into a diabetic state, there are strategies that work to fend it off. Just like we have science-based ways to prevent Alzheimer’s and dementia later in life, there are proven lifestyle strategies to buck the trend towards diabetes. And the good news is that many of the things you may be doing to protect your brain will also protect your metabolic health. Here’s how to push back:
Know your numbers. Keep track of your lipid profile, fasting glucose, and hemoglobin A1c on an annual basis. If numbers are drifting up, ask for a fasting insulin level, too. Pay attention to results that increase from year to year. Don’t hesitate to get out the tape measure and keep track of your waist/hip circumference.
Double down on your brain healthy dietary pattern. All the key components for your metabolic health are here: a diet that is low in sugar, packed with fiber, rich in protein, and includes the right balance of brain-friendly fats. Is there an aspect of brain healthy eating you could improve? The trick is to be mindful yet not overly obsessive about what you eat. Remember to enjoy your meals and that you don’t need to be a perfect eater to get results.
Get strong. Fighting back against prediabetes means resisting the tendency to lose muscle with age. For women at mid-life, strength training is no longer optional—it is essential to protect metabolic health, bone health, and brain health. Even two 30-minute sessions each week can help maintain the muscle mass needed for healthy aging.
Gather a team. You don’t have to muscle through perimenopause alone. Enlist the help of a registered dietician well-versed in this life stage. Jump start your exercise program with the help of a fitness specialist. These professionals are a woman’s best friend at perimenopause and many provide complimentary initial consultations and free resources to get you started. Check out a few of my favorite fitness gurus here: Creating a Brain-Healthy Exercise Program That Sticks.
Consider HRT. One of the little-known facts about taking menopausal hormone therapy: it reduces the risk of developing type 2 diabetes. Not only does it help keep the body sensitive to insulin, it helps prevent the accumulation of visceral fat. Women can add metabolic health to their list of concerns when talking to their health care providers about HRT (I give you a guide for doing so here.)
Learn more. I just had a detailed conversation with an expert in women’s health at mid-life: registered dietician Barbie Boules. Listen here as we go into what you can do to protect metabolic and brain health at menopause: Instagram Live with The Cognition Dietician.
We’ll wrap up the metabolic health mini-series next time with a robust list of takeaways to help you keep the most important concepts top of mind. Plus, I’ll be answering your questions about artificial sweeteners and the latest weight loss drug—GLP-1 inhibitors.
Questions about metabolic health?
There’s still time to get your question answered in the next newsletter.
What brain-healthy eating means to me
If you’re new here (welcome!), this Q and A will help you dip your toes into brain-healthy eating. I had the pleasure of being a guest on
, a Substack by Nicola Fairbrother. Nicola is a former Olympic athlete and a chef with a fresh approach to eating healthfully. I answer questions about what brain-healthy eating means to me, some of the biggest obstacles I see when people start eating this way, and the foods that are always on my weekly shopping list. Don’t miss Nicola’s genius addition to the Protein-Packed Pancakes recipe I shared with you last month!Talking about mushrooms in this month’s REAL SIMPLE magazine
It’s no secret that I am a fan of mushrooms. I love foraging for them, cooking with them, and dreaming up recipes for you to enjoy them. (I wrote to you here about how mushrooms are emerging as an important brain-healthy food.) So I was thrilled to share my thoughts about how to cook with mushrooms with Real Simple. Find the article by superstar RD Katie Morford in the March REAL SIMPLE.
It’s Brain Health Retreat Season
It’s spring somewhere which means I will be traveling for the next few months to host brain health retreats in Tecate, Mexico and Puglia, Italy. If you have ever wanted to join me on one of my retreats, there has never been a better time! I just opened up spots in these weeklong learning vacations:
Ortigia and Eastern Sicily: October 13 to 19, 2024
Palermo and Western Sicily: October 27 to November 2, 2024
Brain Health Kitchen Group at Rancho La Puerta: November 9 to 16. 2024
The Brain Health Retreat in Costa Rica: January 9 to 14, 2025
That’s all for today. Thank you for being a part of this food-loving, brain-healthy community. I appreciate each one of you.
Love,
Annie
Thanks for making sense of this confusing time. I found I put on weight during menopause, I think down to eating more, which spiralled from not sleeping so well, feeling tired, less energetic etc and eating more. Once I got the sleep back in order, my eating returned to being more balanced. Also I wholly agree with the part on exercise, and specifically resistant training, getting in the gym really helped me regain muscle and lose the weight.
Thanks so much! I am at this point of my life. This helps to know what to look out for. The weight gain is real as are the mood swings etc which is all too hard to manage while you raise teens and care for parents. HRT worries me and the information from care providers makes it sound so risky that you just don’t know where to turn and even when to begin. I continue to try my best on a daily basis. I love getting your new posts and hope I can lose this weight before menopause actually happens.