Forty and beyond can be fabulous in many ways. Successful careers, changing to or maybe starting more fulfilling careers, raising good children (mostly good!), more meaningful friendships and relationships, getting rid of unhealthy relationships, greater prosperity, growing confidence, wisdom, generosity to help others and so much more.
While some might refer to this time as 40 is the new 30 and 50 is the new 40, however you imagine it, our changing metabolism certainly doesn’t agree with the younger perception. Our exercise and eating habits may not have changed much, but the wise body and brain knows that peri menopause is just around the corner with menopause quickly following.
Our younger metabolically active bodies can usually get away with eating decadent refined carbohydrates – bread, pasta, pizza, crackers, potatoes, cookies, chocolate. If we gain a few pounds, big deal. We cut back on our calories a bit, eliminate certain foods, reduce dining out, go on a special diet or cleanse, step up our exercise and those pounds are gone. Pretty straightforward, right? Not so when you’re over 40 and even tougher if you’re over 50!
Women over 40 experience a steady decline in hormones, along with a dip in energy and menstrual cycle changes along with way. We also notice that our clothes are fitting a bit tighter and that darned fat seems to be taking up residence around our abdomen and waistlines. “Muffin tops” and “love handles” are usually not desirable nor welcomed. The struggle is real!
During our youthful fertile years, our reproductive hormones – estrogen, progesterone and testosterone – have numerous benefits. These include regulating a healthy menstrual cycle, fertility to create human beings, youthful collagen rich skin, greater energy, cognitive sharpness, creativity, intelligence, multi-tasking specialist, ability to adapt to stressful situations, muscle strength, joint and tendon integrity, shiny and soft hair, strong nails, deep restful sleep and an efficient metabolism to burn fat and build muscles. Unfortunately, this fountain of youth can’t go on forever. The natural descent of hormones around mid-life happens for a biological reason. Women aren’t expected nor capable of bearing and caring for children at 80 or 90 years old!
The age of a women determines where her body fat is stored. In a pre-menopausal female, body fat is typically stored in the lower body – the hips, the buttocks, the thighs, with a lesser amount in the abdominal region. Much of this also depends on genetics, race, diet and lifestyle. In a peri and post-menopausal woman, the drop in hormones is the catalyst for the body to choose to store fat in the abdominal region and in the breasts as well. A similar metabolic and physiological change of increased abdominal and chest fat happens in men with descending testosterone levels.
Why is excess abdominal fat a concern? A little bit of fat is normal, common and usually harmless. Excess abdominal fat, also known as Truncal Obesity, may increase risk for obesity, diabetes, systemic inflammation, cardiovascular disease, elevated LDL cholesterol (adverse) and triglycerides and reduced HDL cholesterol (beneficial), sleep apnea, gastro-intestinal dysfunction, hormone imbalance and a condition called estrogen dominance.
Perimenopause and post-menopausal abdominal fat storage may contribute to estrogen dominance. This means that more estrogen is stored in the body relative to the amount of progesterone. If you are still menstruating, this might mean more PMS symptoms, heavier bleeding, cramping and painful periods, uterine fibroids, endometriosis, headaches, fibrocystic breast, irritability, tearfulness, acne, facial hair, mood swings and much more. If you are not menstruating (menopause), excess estrogen is stored in body fat with minimal progesterone produced by the ovaries and may be a risk factor for breast, uterine and ovarian cancer.
Many of our hormones synergistically work together with a cascade of communication between the hypothalamus, pituitary glands and our organs such as the ovaries, thyroid, adrenal glands and more. All of our hormones have a profound effect on how we metabolize our food and whether our body decides to burn it for energy or store it as fat.
Furthermore, our hormones are extremely sensitive to lifestyle factors like diet, stress, sleep, medications, supplements, caffeine, drugs, alcohol, extreme or little exercise, genetics and more.
Thyroid, Cortisol and Insulin Hormones
The thyroid gland produces less thyroid hormone for many women after age 40. Thyroid hormone is responsible for increased metabolism, stamina during exercise, mood, cognitive function, focus, hair growth, skin moisture and much more. Two of the most common symptoms of low thyroid (hypothyroid) is fatigue and increased body fat. A basic thyroid hormone test (TSH) might look “normal” according to the reference ranges, but in fact it may not accurately reflect what’s truly happening in the body. Best to get a comprehensive thyroid evaluation panel that looks at all markers.
Cortisol, an important adrenal gland hormone, gradually becomes less abundant with age and can become inconsistent. One day it is skyrocketing with a crazy, stressful day, leading to anxiety, irritability and trouble sleeping. Another day it’s plummeted leading to fatigue and cravings for caffeine and decadent carbohydrates – the good stuff like sugary lattes, bread, cookies, chocolate, wine. Not only does chronic stress (and giving in to those tasty carbs) lead to weight gain, that same excessive cortisol interferes with thyroid and those reproductive hormones, further exacerbating the expansive waistline. Testing your adrenals through a comprehensive urinary cortisol panel – either 4x/day or a 24 hour urine hormone test is highly recommended.
There’s yet another fat storing sabotaging condition called Insulin Resistance. Insulin is the hormone that helps escort glucose from the bloodstream into the cells (to feed our organs), thus lowering glucose in the bloodstream. During insulin resistance, glucose can’t efficiently bind to insulin receptors located on the outside of cells. Now glucose can’t enter the cells and it rises in the bloodstream, and that excess glucose often gets converted into triglycerides (fats) for storage. When insulin resistance increases, so does body fat. Ordering a Cardiometabolic Panel for patients helps uncover that risk. That test is discussed at the end of this article.
Add more fuel to the inflammatory fire with a less active lifestyle, demanding job and children responsibilities, restaurant/take out more often than you should, over dependency on pharmaceutical medications or polypharmacy, excessive alcohol abuse, recreational drugs and other health sabotaging behaviors and you’ve got the perfect yet unfortunate recipe for weight gain!
So what can you do to burn excess fat, balance hormones and live a healthier life? Revolutionize your approach to eating, exercising, stress management, sleeping and more. Read the tips below for ways feel and look, strong and vibrant!
Tip #1: Choose Your Carbohydrates Wisely
Low Carb, No Carb, High Carb, Paleo Diet, Primal Diet, Ketogenic Diet, Whole 30 Diet? With countless, trendy diets permeating the internet every second, how do we decide which diet is best for our bodies? No two bodies are alike. Not even the same gender, age and race. While this is true, there are certain diet and nutritional recommendations that can be followed for optimal results at burning more fat.
Let’s start with our favorite macronutrient – Carbohydrates! Carbohydrates are essential for our bodies to survive and thrive. However, to burn fat and minimize fat storage, carbohydrate intake needs to be selective. It’s the type of carbohydrates that really matters the most. It’s complex carbohydrates vs simple carbohydrates.
Complex carbohydrates like vegetables, fruits and whole grains contain more fiber and take longer to break down or metabolism. They are more “complex” in biochemical structure and are released into the bloodstream at a much slower rate and are therefore better for your blood glucose and insulin levels. Insulin is the hormone that helps escort glucose from the bloodstream into the cells of our body.
Refined carbohydrates like sugars, white flour, white rice, white potatoes on the other hand contain minimal fiber and are released into the bloodstream more quickly faster and typically lead to a spike in blood glucose and insulin. Too many refined carbohydrates over a period of months to years leads to more body fat but also leads to blood sugar problems like insulin resistance and diabetes. While an excellent dietary goal here is to consume more complex carbohydrates, when you are over 40 and storing more fat, those complex carbohydrates need to be more specific.
The solution to losing or maintaining weight? Limit or avoid ALL grains – even the whole fiber ones. You can easily get your complex carbohydrates from the non-starchy vegetables and less sugar/higher fiber fruit. Vegetables and fruits come in a variety of forms.
Certain vegetables that are firm and crunchy and in many cases are darker in green (like kale, broccoli, collards, spinach) typically have more fiber and nutrients. Other vegetables like corn, peas and potatoes are less fibrous, starchy and tend to get metabolized by the body faster – faster blood glucose rise.
Certain fruits contain more fiber like apples, pears, pomegranates, plums, apricots while softer sweeter fruits contain less fiber such as honeydew melon, cantaloupe, grapes.
No one has a perfect diet all of the time. The key is always moderation. Some days you might eat that breakfast scone. Other days it might be an egg, vegetable scramble with avocado. No room for perfection here. Just balance the unhealthy with a healthier meal the next time.
If you are still wondering, “Well what the heck am I going to eat besides fruits and vegetables?” There are two other very important macronutrients – Protein and Fat! The simplest way to eat “smart carb” is to follow such diets as The Paleo Diet or The Whole 30 Diet or The Ketogenic Diet with 50 grams of carbohydrates. Those diets emphasize eliminating the grains, starchy and refined carbohydrates and are great to do for 30-90 days at a time.
Tip #2: Move Your Muscles: Fat Burning Machines
We know exercise is so important, right? We frequently hear its emphasis. From kids to seniors and for men and women. We can skip exercise from time to time when we are younger without a lot of consequences. Due to an abundance of hormones, our bodies can often stay lean(er) and strong. For women over 40, muscle strength decreases and body fat increases. That is usually the case unless you are exercising the smart way. It is during this phase of life that exercise now becomes essential!
While we can cut calories or change how we eat and we may lose weight temporarily, there is no substitute for exercise. We have to move our bodies regularly to have the greatest effect on fat loss. Similar to changing the types of carbohydrates we eat, we must change how we exercise to reap the most benefit of fat burning.
Cardiovascular exercise or aerobic exercise is very important for a variety of reasons. Like the term describes, it is excellent for both the muscles of your heart (cardio) and also great for your blood vessels (vascular). It is also pretty fantastic for you brain, lungs and sinuses, skin, liver, muscles, your GI Tract – every organ and every cell in the body.
Muscle strengthening exercises or muscle resistance exercises have an anaerobic effect on the body. While it can be less invigorating compared to cardiovascular exercise, it can still raise your heart rate, heat production and metabolism. As the name implies, muscle strengthening makes the muscle cells stronger with an increase in size.
For men’s bodies, their muscles become much larger with this type of exercise due to their size and mass, abundance of testosterone, thyroid hormone and human growth hormones. Women’s muscles will still get stronger with repeated exercise and slightly bigger to a certain degree but not to the capacity of male bodies. We produce a fraction of the testosterone compared to men and our thyroid hormone and human growth hormones are typically less as well.
Here’s a fascinating piece that you need to know! With repeated and increased challenging muscle strengthening exercises (along with cardiovascular exercise), our bodies burn more fat! This is true even when we are sleeping, sitting in a car during commute hour or busily working (yet sedentary) at work all day.
As our muscle cells grow in strength and size, their energy demands for fuel (mainly carbohydrates) increase. In order to build and maintain this muscle strength and size, metabolism must increase. And when metabolism is higher, fat burning is kicked on to high gear!
Other wonderful benefits of muscle strengthening exercises includes better energy, increased appetite (for healthy foods, right?), confidence, less risk of injuries, enhanced sex drive (due to slight boost in testosterone) and a beautifully strong female body.
Tip #3: Intermittent Fasting: The Faster Way to Burn Fat
While intermittent fasting has recently become a very popular “diet” method to losing or maintaining weight, this physiological process has been around since humans have existed. The human body is biologically designed to fast. It inherently knows that when food is scarce during times of famine or starvation that it needs to metabolize excess glycogen and adipose (fat) reserves to provide nourishment and energy to our crucial organs, the heart, the brain, the lungs, the gut and more. While this miraculous process ensures survival, fat loss is the result.
Fortunately for many people on this abundant planet, we don’t have to endure unpredictable starvation. Food is more than plentiful and in the majority of situations, humans eat far beyond what the body needs. Add a sedentary lifestyle or minimal fat burning physical activities, and we have excess fat storage and increased risk of many chronic (yet preventable) diseases.
A simple and free solution to burning fat more efficiently is to get back to our biological roots with organized intermittent fasting.
Intermittent fasting is known as cyclic periods of fasting alternating with non-fasting or eating meals and snacks often in the same day or week. This is different than more temporary or food restrictive programs like the Paleo Diet, the Ketogenic Diet or the Whole 30 diet (though all of those are effective for weight loss too!), intermittent fasting is more of a consistent, long term lifestyle habit that can easily be incorporated into most people’s lives each day, week, month and all year long.
There are three main types of intermittent fasting: 1.) Alternate day fasting, 2.) Periodic fasting, 3.) Time restricted feeding
Alternate day fasting involves eating 25% less calories one full day and your usual amount of calories the next day.
Periodic Fasting (most commonly 5:2) usually involves eating 500-600 calories or 25% less calories 2 days a week and the other 5 days you are eating as you normally do.
Time Restricted Feeding (most commonly 16:8) involves eating during certain hours of the day like 16 hours of fasting and eating during the 8 hours that you are awake. Time Restricted Feeding seems to be the most common with many of my patients and other people I’ve spoken with. First meal is around 11am or 12pm and you stop eating at 7 or 8pm.
Health advantages of intermittent fasting include weight loss or maintenance, improved insulin sensitivity to lower blood glucose, less aches and pains, lowered triglycerides and LDL cholesterol, improved energy, mind clarity, easier digestion, better mood, deeper sleep and many other benefits.
Many of my peri and post-menopausal patients have found that regular fasting can also improve their menstrual cycle (less pms, bleeding, cramping) and less severe or frequent menopausal symptoms like hot flashes and night sweats.
Tip #4: Take Control of Your Stress & Your Weight
Stress – it’s as human as a heartbeat. Who doesn’t have some type of stress in their lives? It’s the constant demands of life’s responsibilities piling on our plates that cause us to feel frazzled at times. Our lives are busier than they’ve ever been so we need to do our best to respond differently to stressful situations when they arrive. When stress arises, so does cortisol. Excess stress and therefore excess cortisol can have catastrophic and interfering effects on our estrogen, progesterone, testosterone along with other hormones, leading to a variety of frustrating symptoms.
If you are peri or post-menopausal, symptoms of too much stress might be worsening hot flashes, night sweats, interrupted sleep, weight gain, headaches, fatigue, anxiety, from low libido to non-existent libido, hair loss, aging skin and more. If you are still menstruating, these symptoms include worsening PMS symptoms, irritability, tearfulness, headaches, heavier bleeding, uterine fibroids, fibrocystic breasts, reduced libido, shorter or longer cycles than the typical 28 days, intermittent ovulation, skipping periods. In some cases, your menstrual periods stop for months or years (aka secondary amenorrhea.) With proper naturopathic or functional medicine treatment, alleviation of stressors or healthier adaption to stress, the menstrual periods usually return.
Fortunately, there are many healthy things that you can do to adapt to stress in a healthier way. Engage in methods and activities that help release those stress hormones, reduce the sympathetic nervous system (fight or flight mode) and favor the parasympathetic nervous system (calm and rest mode). Many of these are free and immediately accessible within seconds to minutes and they all help to hit the “reset button” on worries.
- Pray to your Higher Power: ask for guidance, help, support, clarity, calm, peace or to send the right people into your life to help you.
- Meditation for stillness, guidance, clarity, peace
- Some form of exercise whether it’s a fitness class, YouTube exercises, running, walking, biking or yoga, whatever you enjoy that invigorates you to release stress hormones yet relaxes you when you are finished.
- Surround yourself in nature and/or near water: river, lake, beach, stream, hiking amongst the trees and other safe wildlife animals
- Gardening or yard work
- Call or meet a friend/family member that is caring and supportive for coffee or a meal
- Drink Tulsi (holy basil) tea during the day to calm the nervous system
- Write down your emotions and release them, journaling, gratitude list, create sticky notes with positive affirmations on them and post them around your home
- Nurture your favorite hobby: cooking, arts and crafts, sewing, musical instruments
- Listen to calming music that supports alpha brain waves and encourages serotonin production (the good mood neurotransmitter and hormone)
For botanical support of helping your adrenal glands and brain adapt to stress a bit easier, there are a few herbs that I really like. One of my favorite herbs is Withania somnifera, commonly known as Ashwagandha. Somnifera means “sleep inducing” and although it’s more for stress during the day, it can also help with trouble sleeping due to stress and worry. It’s very calming, stabilizing and yet mildly uplifting so you can still be productive and stay focused with less jitteriness of those stress hormones. If you are looking for something more uplifting and energizing, yet stabilizing for mood, you might consider Rhodiola rosea or Eleutherococcus senticosus, commonly known as Siberian Ginseng. All of those are great on their own or often they are found together in various products. All of the professional grade products I recommend to patients are available on Fullscript – https://us.fullscript.com/welcome/ktompkins.
Tip #5: Sleep Your Worries Away Along with Those Extra Pounds
It’s not so much the number of hours that you’re in bed that matters. It’s the quality and depth of sleep that is paramount. Compared to men, women are much more likely to struggle with sleep problems in general, but especially after the age of 40. Women’s sleep often becomes interrupted with difficulty falling and/or staying asleep. Aside from stress and cortisol interfering with sleep, sleep interruption during this time is often related to a dip in progesterone with estrogen falling a few years after that. As menopause approaches, estrogen significantly declines and that is when hot flashes and night sweats (among many other symptoms) tend to interrupt women’s sleep. And poor sleep (stressor to the body) leads to an increase in cortisol and that often exacerbates the problem.
Another interesting aspect of sleep is that if you follow all of the other 4 tips explained in this article, your sleep often improves. A healthier (smart carb) diet, muscle strengthening exercises, intermittent fasting, stress management helps to support the entire body so that it can relax and sleep better at night.
During this time of life, women can find relief in a myriad of supplemental sleep support products. Fortunately, there are so many natural, safe and effective plant or nutrient based products that can help with falling asleep and if awakened can help them get back to sleep more quickly. Pharmaceutical medications often have terrible side effects and withdrawal symptoms that can make them more harmful than beneficial.
There are several very effective products that I have recommended to my patients over the years that have worked well to induce and maintain better sleep. Two of my favorites are Cortisol Manager by Integrative Therapeutics and EcoSleep by Econugenics. Cortisol Manager is best for people who have trouble falling asleep due to worry, stress and increased cortisol in the evening when it should be the lowest at that time of day. EcoSleep is great for people who need help staying asleep. Both products are available on Fullscript – https://us.fullscript.com/welcome/ktompkins
Additionally, many of my female patients find that after coming to see me for health and hormone evaluation, hormone testing and specific bio-identical hormone dosing for them, their sleep improves beautifully. Which bring me to the next topic – a bonus tip!
Tip #6: A Bonus – Get Your Hormones Tested & Evaluated!
Our complete health, including our hormones, largely depends on our diet, exercise and stressors in life, our job, personal history, family history, our relationships, environment and genetics. Getting the appropriate lab work to evaluate what’s happening physiologically is really important for the most optimal treatment.
Here are the most common and comprehensive tests that I order for my patients:
- D.U.T.C.H. Hormone Test: Dried Urine Test for Comprehensive Hormones. This detailed test evaluates hormones by way of collecting urine 4x per day during the waking hours of the day – morning, midday, evening/dinner time and bedtime. Specifically, this test measures the adrenal and sex steroid hormones (i.e estrogen, progesterone, testosterone, cortisol) along with nutritional organic acids and important hormone metabolites – the broken down version of those hormones. Such hormone metabolites provide us with greater and deeper insight into how well (or poorly) the hormones are absorbed and utilized in the body as well as how effectively (or not) they are excreted from the body. Importantly, this test can provide insight into hormone imbalance, adrenal stress and help to customize individualized hormone treatments such as bio-identical hormones and botanical/nutritional therapies aimed at supporting hormones.
- Blood Testing for Hormones: Blood or serum testing for hormones has been the universally accepted “gold standard” of testing hormones for many years. This method of testing is the most convenient, least expensive and commonly covered by most health insurance plans. Blood draws are routinely done in the morning as a one time collection requiring the patient to fast for 10-12 hours. As with any diagnostic lab test, there are limitations to blood testing of the adrenal and sex steroid hormones. Hormone levels fluctuate throughout the day and evening and if women are still menstruating, those hormones will change based on where she is in her menstrual cycle.
- Blood Testing for Thyroid: The best way to evaluate for thyroid hormones is through blood or serum and it continues to be the Gold Standard of testing. The comprehensive test panel that I order includes: TSH, Free T3, Free T4, Reverse T3, Anti-Thyroglobulin Antibodies and Anti-Thyroperoxidase Antibodies. The latter two are significant for evaluating autoimmune thyroiditis such as Hashimoto’s Disease. This test is really beneficial for proper diagnosis and to better monitor thyroid dosages.
- Cardiometabolic Blood Panel: This excellent detailed test examines the risk for diabetes, insulin resistance, metabolic syndrome, inflammation, cardiovascular disease and includes several markers such as glucose, insulin, hemoglobin A1c, many lipids beyond your basic cholesterol panel, leptin, adiponectin, C-Reactive Protein and much more. This test notifies you whether changes in diet and exercise changes need to be implemented fairly quickly.
So, if you are female and 40 (ish) years of age or older, need help with weight loss, follow these very effective tips, schedule an appointment with me and get your hormones testing, an individualized treatment plan and hormone prescriptions (if needed) to help you feel fabulous and empowered!
Dr. Kristi
