My mate, Karl Innes, over at CF40 Masters Blog had a question from one of his female followers regarding menopause, surgery and fat loss. Out of his area of expertise, I offered to help answer the question and thought I’d share my response here as you might find it useful and insightful as well.

The Question: So ladies as far as nutrition goes, I had been Paleo for 4 yrs lost 105 lbs now the menopausal stages are kicking in what should I be looking at to lose remaining fat? I [do crossfit] 5 days a week and will be having shoulder surgery in 10 days which will make fat loss a bit more challenging! Help!

My Response

Great Question!

Ok, first and foremost, wow, go you! Give yourself a pat on the back, and a little (ie. A LOT OF) love for how far you’ve come! Losing the weight you have and committing to 5 days of working-out every week is no easy feat!

Secondly – the Surgery

I understand you’ve come a long way and don’t want to take steps backwards with your fat-loss progress. However, when it comes to surgery, your primary focus needs to be healing from the operation. Surgery (even minor procedures and keyhole surgery) is extremely stressful for the body without also stressing about fat-loss. Your body will be using a great deal more energy and need to be properly nourished in order for it to heal. So nurture and nourish yourself during this time of recovery.

Nutritionally, look at incorporating some of the following foods to help provide your body with the nutrients you need to heal and recover:

• Bone Broths (and soups/meats/vegetables/quinoa/buckwheat cooked in bone broth). The slow cooking of bones and tendons of organic, pastured animals extracts amazing amounts of collagen and calcium which are essential to help your shoulder tendons and muscles heal (1-3).
• Liver and other organ meat. Our liver and the liver of animals is the place where we store all of our excess nutrients when consumed in excess, including riboflavin (B2), Biotin (B7), B5, B12, Vitamin A, E, K1, Phosphorous, Iron and Zinc. It therefore follows that liver is a great source of nutrients in the diet. Look at incorporating it in your meals. Personally I don’t like the texture of liver by itself but I quite like it blended and mixed with mince like in a paleo burger/bolognese/chilli/chow mien. Look at incorporating organ meat into your general diet a couple of times a month long term as well.(4)
• Antioxidants. Incorporate a variety of fresh and cooked vegetables and herbs and spices into your foods. Fresh vegetables contain a lot of vitamins, minerals and anti-oxidants that are going to help your mitochondria function at their best and overcome oxidation processes that occur with cell repair and damage. Incorporate a wide range of colour and varieties from cruciferous vegetables to sweet potatoes, spinach, bitter greens, parsley, cilantro, turmeric, ginger, carrots, asparagus and more. Eat a rainbow! (5, 6)
• Probiotics. Often when you’re in hospital, you will be given a dose of antibiotics, and if not you’ll be exposed to many anti-bacterial soaps and solutions. This coupled with the general stress of surgery on your body can often put your bowel movements out of sync. Look at incorporating a good quality, high-count probiotic and fermented foods like kimchi, sauerkraut, kombucha and kefir, for the days and weeks post-surgery (and also incorporate a small amount in your regular diet). These will help get things moving ‘regularly’ again.(7)

It also goes without saying that physically:

• Sleep. Your body repairs itself best while you sleep, because of the added load of the surgery on your body’s energy expenditure, you’re going to feel more tired so make sure you sleep when you feel tired. Tiredness is your body’s way of telling you it needs to rest and repair.
• Follow the advice of your surgeon and physiotherapist in terms of the progress of returning movement to the shoulder and listen to them! The last thing you want is to delay your return to the box or even worse, need another surgery. So be patient and do what the physio says.
• When your physio advises, begin walking and increasing the amount of low-impact activity as this helps get the blood moving which thus moves nutrients around the body and to the the region where they’re needed for healing from surgery.

Finally – Fat Loss and Menopause

When it comes to Crossfit or athletic performance in general it’s important to realise, quoting Stacy Sims here, that “Women are not just Small Men”. We have a menstrual cycle, periods (yes periods, say it out loud and get comfortable with it), associated hormone fluctuation (which is completely natural) and significant changes in these throughout our life stages (childhood, puberty, fertility, pregnancy, breastfeeding, menopause, post-menopause etc.). All of this makes women much more complicated than men and we cannot treat ourselves the same.

I HIGHLY recommend listening to this podcast interview of Dr. Stacy Sims (Environmental Exercise Physiologist, Nutrition Scientist and Expert in Hydration, Nutrition and Sex Differences) by Sports Nutritionist Steph Lowe. Stacy goes into great detail about how different we are and also talks about the changes that occur at Menopause (about 18 minutes in) and how these affect athletic performance and recovery.

http://thewellnesscouch.com/rfr/rfr-95-understanding-your-unique-female-physiology-with-stacy-sims

Does Menopause Cause Weight Gain?

Menopause occurs when a woman’s body tells itself that it no longer needs to reproduce so it ceases ovulation (over a period of time). This goes along with lower oestrogen levels, lower progesterone level and higher testosterone levels.

The Study of Women’s Health Across the Nation (SWAN) is an excellent resource should you wish to read more about women’s health.

Anecdotally, many women blame menopause for unwanted weight gain. However, according to the SWAN study, the 2000 Cochrane Review and Davis et al. the weight gain is not actually caused by menopause itself, rather it’s due to:

• the normal slow-down in metabolism associated with age (which slows by about 5% every 10 years after age 30). For example, a 30 year old woman may have a BMR of 1550 calories but by the time she is 55 it may fall to around 1360. Which means she’ll gain weight just by eating what she always has.
• lower activity levels associated with older age.

This is good news! Because it means that menopause doesn’t have to be this ominous monster lurking after us women!

Menopause does cause change in Body Composition

SWAN found that the oestrogen in women of reproductive age prompts fat to be stored around the hips and thighs which is subcutaneous fat (or good fat) to help the woman prepare for the physical nature of pregnancy and breastfeeding. However, when oestrogen falls during menopause, and testosterone rises, we see a more masculine deposition of fat, around the central region. Which is visceral fat and dangerous because of its proximity to critical organs.

We have also seen changes (and drops) in insulin sensitivity associated with menopause as well which can also have an effect of body composition. Drops in insulin sensitivity leads to more fat being deposited in adipose tissue rather than being used for hormone production or energy or just passing through.

What to do about it?

1. Continue to stay active, in particular do weight bearing exercise, power-based exercise as well as some cardio. This preserves muscle mass which not only keeps you strong, protects agains metabolic slowdown but improves cardiovascular health and helps maintain insulin sensitivity.
2. When it comes to your workouts. Consider taking a branch-chain amino acid supplement pre and post workout (or some protein that is high in leucine) then wait for 2-3 hours before having your post-workout meal. This helps promote the mobilisation and utilisation of fat as fuel. Again, This podcast goes into great detail about menopause in athletes from about 18mins, but the whole podcast is really worth listening to.
3. Re-evaluate your carbohydrate tolerance (associated to the changes in insulin sensitivity). Some women become less tolerant of carbohydrates, that is less insulin sensitive, after menopause, while others notice no change at all. So if you’re doing fine on your current diet then there’s no need to change but if you start experiencing energy highs and then crashing after eating certain carbs then you may want to experiment with not just your intake, but timing.
4. Eat protein and natural fats. Our hormones are made of proteins and fats and our muscle mass needs to be supported by adequate intake of protein. Include a variety of free-range, pastured, wild-caught poultry, red meat, game and fish as well as unrefined fats like extra virgin olive oil, fatty fish, coconut oil, grass-fed butter and ghee, avocados, nuts and eggs.
5. Eat plenty of vegetables. I’m not going to harp on about the importance that vegetables play in the diet. It goes without saying that we need our greens, and all other colours and vegetables should form the basis (2/3 – 3/4 of your plate) of every single meal you make.
6. Other symptoms (like hot flushes etc.). To help balance out the other symptoms associated with the drop in oestrogen look at incorporating more foods with phytoestrogens (these are components that, to the body, look a bit like oestrogen on a molecular level and can help ease some symptoms). Foods like flaxseed, chia seed, organic, non-gmo, fermented soy like tempeh and miso, sesame seeds, alfalfa sprouts, grapefruit, organic & fermented legumes and nuts. Some of these foods are typically avoided on a paleo diet or for their oestrogen effect but when prepared appropriately (fermentation not only eliminates anti-nutrients but improves the beneficial nutrition profile and availability), they can be very beneficial during menopause and as part of a healthy diet overall.
7. Get some sunlight (vitamin D) every day.
8. Smile! A lot can be said about the effect your state of mind has on your experience with menopause. Enjoy time with friends and family, try things you haven’t tried before, treat yourself with a pedicure or new shoes. And just because you’re at the end of your reproductive life, doesn’t mean you can’t/shouldn’t enjoy romantic evenings and endorphin release with hubby ;).

Resources

1. Doillon CJ, Silver FH. Collagen-based wound dressing: Effects of hyaluronic acid and firponectin on wound healing. Biomaterials. 1986;7(1):3-8.

2. Liu SH, Yang R-S, Al-Shaikh R, Lane JM. Collagen in Tendon, Ligament, and Bone Healing: A Current Review. Clinical Orthopaedics and Related Research. 1995;318:265-78.

3. Council) NNHaMR. A Review of the Evidence to Address Targeted Questions to Inform the Revision of the Australian Dietary Guidelines 2011. Canberra, ACT, Australia: NHMRC (National Health and Medical Research Council); November 2011. Report No.: ISBN 1864965304 Contract No.: ISBN Online: 1864965304.

4. Data SN. Beef liver Nutrition Facts & Calories 2016 [Available from: http://nutritiondata.self.com/facts/beef-products/3469/2.

5. Van Duyn MAS, Pivonka E. Overview of the health benefits of fruit and vegetable consumption for the dietetics professional: selected literature. Journal of the American Dietetic Association. 2000;100(12):1511-21.

6. Whitney EN, Cameron-Smith D, Crowe T, Walsh A, Rady Rolfes S. Understanding nutrition: 2nd edition.; 2014.

7. Eskicioglu C, Forbes SS, Aarts M-A, Okrainec A, McLeod RS. Enhanced recovery after surgery (ERAS) programs for patients having colorectal surgery: a meta-analysis of randomized trials. Journal of gastrointestinal surgery. 2009;13(12):2321-9.