James Hill:

Welcome to Weight Loss And, where we delve into the world of weight loss. I'm Jim Hill.

Holly Wyatt:

And I'm Holly Wyatt. We're both dedicated to helping you lose weight, keep it off, and live your best life while you're doing it.

James Hill:

Indeed, we now realize successful weight loss combines the science and art of medicine, knowing what to do and why you will do it.

Holly Wyatt:

Yes, the “And” allows us to talk about all the other stuff that makes your journey so much bigger, better, and exciting.

James Hill:

Ready for the “And” factor?

Holly Wyatt:

Let's dive in.

James Hill:

Here we go. Holly, today we're diving into a topic that affects millions of women, but it's often misunderstood and under-discussed, menopause. And we're talking specifically about menopause and weight management. We know from our listeners that this is a hot topic, and it's one that comes with a lot of myths, a lot of mixed messages, and often confusing advice. Menopause isn't just about hot flashes and night sweats. It's a time when the body undergoes significant hormonal changes that can impact weight, metabolism, and overall health in surprising ways.

Holly Wyatt:

That's right, Jim. And while weight gain during menopause is often talked about like it's a given, you You know, a lot of doctors will tell their patients, just expect to gain some weight. I think the reality is more complex than that. We need to talk about it. It's not inevitable. I don't think everyone has to gain weight when they go through menopause. There's a lot that women can do, I think, to navigate through this experience, through midlife and beyond. So to help us sort through the science and share some practical advice, we brought in two experts. This is a first for us, Jim, I think. Two experts on this subject. We need two.

Holly Wyatt:

They have both dedicated their careers to understanding these changes and helping women drive through this period and beyond it.

James Hill:

Yeah, we have really two fabulous guests. And Holly, these are our former colleagues at the University of Colorado, and we're really excited they could join us. They both dedicated their careers to improving health and well-being of women. Dr. Nanette Santoro is a leading expert in women's health and reproductive endocrinology. Thank you. She currently serves as the E. Stewart-Taylor Chair of Obstetrics and Gynecology at the University of Colorado School of Medicine. She has been a key figure in some major studies like the Women's Health Initiative and Study of Women's Health Across the Nation, or SWAN. And these studies have really been instrumental in helping us understand menopause and its impact on women's health. Her work has earned her recognition as one of the top voices in women's health, including election to the National Academy of Medicine. And Dr. Annie Caldwell is a clinical health psychologist at the University of Colorado specializing in the mind-body connection and how psychological factors influence weight and wellness during menopause. Her interdisciplinary work bridges psychology, endocrinology, behavioral medicine, and even anthropology, providing a unique perspective on how women can thrive during this critical life stage. Annie, we're so glad you could join us. So Nanette and Annie, welcome.

Nanette Santoro:

Thank you. Happy to be here.

Annie Caldwell:

Thank you. Likewise. Happy to be here.

Holly Wyatt:

All right, Jim, let's get started. I've got a lot of questions. Do you want to throw out the first one?

James Hill:

I'll throw out the first one. It's a biggie. So what the heck is happening in the body during menopause? And why is this a time that can have a big impact on weight?

Nanette Santoro:

So from studies like SWAN, we have been able to finally look at what happens to women as they go through the menopause transition. SWAN began in 1996 and recruited over 3,000 women and followed them every single year. It's looked at weight. It's looked at body composition. It's looked at a bunch of psychological factors, menopausal symptoms, bone density, you name it. We had a very greedy group of investigators who wanted to get lots of information, and they sure did. So we have a very good idea. And the other really important thing about SWAN is that it's representative, that women from different race and ethnicities were recruited. And we have women that are African-American at four sites, Hispanic women, Chinese-American women, Japanese-American women. So, in addition to white women at all of the swan sites. So, we have a decent slice of the population. When you look at the entire population and you look at weight changes and body composition changes, because SWAN got both, one thing you see that is pretty universal on the average is that there's a small weight gain. It's only a couple of pounds.

And there's an exchange of lean for fat. And that happens right around the time of the final menstrual period. So in association with menopause per se, that is a change that happens. We've all, you know, I've lived the dream. It's just what happens. And many patients will come in and say, you know, things are getting tighter in my waistband. I'm not happy about this. Some of that is just a change that many people can live with. But for some women, and these are the women that are represented in clinical practice, and I would imagine most of the women tuned into this podcast, there's an extreme weight gain. So I think of it a little bit about the way some women react to birth control pills, because when you look at the mean of the data on birth control pills, there's no real weight gain apart from the slow, steady gain that people have with age. But some women will gain 20, 30, 40 pounds on birth control pills, so they'll gain and never stop. And there's a subset of women that do seem to do that, and that's a little bit more of what I see with my clinical hat on.

Now, the extent to which that's directly related to the hormone changes at menopause, apart from what I've just told you with SWAN, is still not known. The interesting things that we know is that the metabolic rate doesn't really change in this age range. There was a widespread belief that it did, that your metabolic rate drops. So current investigators, including Ed Melanson at Colorado, are looking at other explanations and how estrogen ties in here, because we always think that's the central hormone that's changing the most at menopause. So with that estrogen tie-in, his hypothesis is that the lack of estrogen or the drop in estrogen takes away your metabolic flexibility. And I have to say that it's a satisfying explanation, and he's about to prove it, and I hope it's true, because it really does explain for my patients and for myself what seems to happen. So you overindulge when you're younger, your body corrects. It'll correct it for you. If you eat too much on the holidays and you're menopausal, you ate too much on the holidays and your weight's going to go up and stay up. It's not going to correct. So that kind of resilience that you had earlier seems to go away.

Holly Wyatt:

We love this. We talk about metabolic flexibility all the time. So our listeners totally get that. So I love that you're bringing that in. And I really haven't heard that talked about with menopause. So very interesting that that could be playing a role.

James Hill:

But it does make sense because with metabolic flexibility, your body is helping you out a little bit. You overeat, it helps a little bit. And over time, that's very important. And if that goes away, it could totally explain why there's a tendency to gain weight because we all overeat occasionally. It's just if you overeat after menopause, it may be more negative for your weight than before because you're losing that metabolic flexibility.

Annie Caldwell:

Right. And while population studies do show that there's not a decrease in metabolic rate or like we see in rodent studies. Ed has done some studies that have shown that when you induce menopausal hormone milieu by blocking women's hormones, you do get a reduction in resting metabolic rate. And also that transfer of lean mass to fat mass will also reduce your resting metabolic rate because a lot of your metabolic rate is determined by your fat-free mass or your muscle mass. And so if that is decreasing, and another great point that Nanette made was sometimes you don't see these things on the average, but that average is hiding individual differences. And so some women do get a big response and some women don't. And again, there's so much that we don't know in this space that we're still trying to figure out and learn from. But that reduction in lean mass is going to have an effect on your resting metabolic rate and how many calories you need every day in order to keep going. And when that reduces, it's hard to pull back on how you've been eating your entire life and how you are eating in a setting where everyone's eating the same portion sizes. It makes it that much harder to reduce your intake when eating is such a social activity that we do.

Holly Wyatt:

Yeah, I think it's important, though, for the listeners to realize, I think this is a great message, the average one to two pounds, not very much. It's not inevitable. Not everybody is gaining a lot of weight during this time period, but some individuals do. And that's really what, you know, we talk about all the time, that there's a lot of variation in all of the reasons why people either can't lose weight or have trouble maintaining weight. And this seems to be falling under that. It's not inevitable. It's not in everyone, but it could be in some individuals.

Nanette Santoro:

And there's also extra vulnerabilities that menopause itself introduces because along with symptoms, there may be mood changes. So especially right before a woman's final menstrual period. So even before she's fully menopausal, that's when she's really the most vulnerable to adverse mood, both anxiety and depression. And who doesn't stress eat and who doesn't eat more when you're feeling down a little bit than when ice cream and chocolate seem like the best ideas. So it may also be harder to control some of those impulses and food noise may go up for some people. The other things that happen are if you're having hot flashes and you're not sleeping. One great way to help people gain weight is to assassinate their sleep. And sleep issues go up pretty dramatically with menopause. So if you know that you're having bad symptoms and you're not sleeping, these things are going to make you much more susceptible to the things that are going to bedevil you in terms of weight gain.

James Hill:

So Nanette, the patients you're seeing are probably enriched in those that are maybe more prone to gain weight. Are there things you can advise them that might help them limit weight gain?

Nanette Santoro:

Well, I think picking up early. If you are one of these people who seems to be spiraling up, don't wait till you've gained 30, 35 pounds. If you started gaining 10 pounds, and quite often I'll see people who are slender their entire adult lives, and now all of a sudden. So this is a challenge they've never faced before. Then it needs to be addressed because the other things that happen, and one of the things we tend to forget when menopause is looking at us in the face with a capital M, is that there are age-related changes as well. And some people will be developing insulin resistance, a tendency to type 2 diabetes, the metabolic syndrome. They may have this in their family. This is exactly the time in life when those things become manifest. So if you're going to get hypertension because it runs in your family, you may be fine until you hit 50. And then all of a sudden your blood pressure is climbing. So as these other things happen and you start to get that sort of metabolic syndrome phenotype, you can attack it early. There's medications that can be given that are low cost. There's also lots of lifestyle that you can apply to it. But quite often my patients have come to me after they have, we're in Colorado, they've stepped up their exercise. They know what to do. Women know how to food restrict. We do it all. We've done it all our adult lives to drop a few pounds before a holiday or to fit into something. So, those strategies have stopped working for them. And at that point, it's time to consider medication.

James Hill:

Are you more likely to gain weight if you go into menopause overweight?

Nanette Santoro:

I don't think that's necessarily so. Some people will and some won't. The ones I worry the most about are the ones who actually are normal, near normal, but start to really go up precipitously.

Annie Caldwell:

Another thing that might influence it, as Nanette introduced the higher propensity for depression and anxiety, that also is not equal across women going through menopause. But women who have experienced a stressful early life and had adverse childhood experiences are even more susceptible for those increases in depression and anxiety. And so that might be one thing that helps you clue in if you've experienced a very stressful childhood. That depression and that anxiety might be even worse. And emotional eating is a huge driver of weight gain and an inability to lose weight.

Holly Wyatt:

Yeah, definitely. I love that you say you're in Colorado and everybody can step up their activity and do all that. Well, with this concept of metabolic flexibility, I wonder if there really is even a bigger role for physical activity because we believe that increasing that physical activity improves metabolic flexibility. So if that's one of the mechanisms that's going on, it sounds like there's lots of reasons why people may be gaining weight. But if that's one of them, really stepping up that physical activity might mitigate that, you know, and any depression and all of that physical activity can help with those things, too.

Annie Caldwell:

Right. And it doesn't have to be high-intensity cardio. It's going for walks and lifting weights. And maybe you've never lifted weights before in your life and you think that that is something that only men do or the younger generation is really into. But really, weightlifting will also increase your lean mass. So that will help increase your body weight. And so if it takes finding a trainer to help introduce you to how to lift weights two to three times a week and be walking every day, those things will reduce anxiety, depression, as well as change your body composition in a way that's more favorable for maintaining weight even.

James Hill:

Yeah, I think this can be particularly important, Annie, for people that aren't exercisers, because what we believe is that people that are very sedentary, and on top of that, you add being overweight, that really is going to reduce your metabolic flexibility. So even a little bit of exercise is going to help. But you mentioned weightlifting, and this is important because as you age, you're going to lose muscle anyway. If you add on that, menopause being a time where that may happen a little bit more, the resistance exercise can be particularly important, maybe not even to add muscle, but to prevent the loss of muscle. And again, that has effects on metabolic rate. It has effects on flexibility. So I think one of the things that people need to think about as they're aging anyway it's adding some resistance training.

Nanette Santoro:

I think it's an important point because the strategies have to change. If you keep doing the same thing and it's not working, you've got to change it. So the way that exercise happens, my husband's been a lifelong runner and if he can't run, he does nothing. So anytime he gets injured, nothing happens. That would drive me crazy because I must cross train because if I can't exercise, I'm really not livable with other people. But having a backup plan and having another way to do it, because the other thing that happens is, again, poor sleep, not great mood, these things really work against you and they can destroy motivation that people used to be able to have. So, you know, the other strategies like getting a support group, having a pal who's going to help you when you're just not feeling like it that day. Those are really important things. And working through what's maybe minor disabilities that you may get or injuries is also pretty important.

James Hill:

Yeah, you mentioned, and I think it's so important, these things are connected. Sleep affects diet and exercise. Diet and exercise affects sleep. And we want to pull out these things and say, oh, it's nutrition or it's exercise. And in fact, it's all of those. Do you find that menopause may be a good time where people are a little bit more motivated to make behavior changes?

Nanette Santoro:

Absolutely. Yes. And by the time they come in to see me, they recognize that something's up. They don't quite know what it is. And it's an ideal time to intervene and head off a lot of these conditions.

Holly Wyatt:

Yeah. So I'm going to switch gears and ask a little bit different question, totally selfishly, because this is what the questions I get all the time. What about supplements? What about hormone replacement therapy? Does that have a role specifically for the body weight issues? I know there's role for the hot flashes and other things, but what about for body weight? How do you address that question? Supplements or the hormone replacement therapy?

Nanette Santoro:

There's yet to be a supplement that's been proven that really has evidence to support it. So, supplements, no, miracle diets. Hormones seem to have some role in preserving what I would call more feminine contours, but the effect is very small. It's very overblown in the medical literature, and the weight effect is two-edged. Some studies show weight increase and some studies show that it's weight neutral, but it's not a magic weight loss drug. And it is widely perceived as being one. It is absolutely not.

Holly Wyatt:

Yeah, I think that's important because people say that all the time. So I'm glad that we can kind of set that straight, that that's not the solution in terms of your body weight. There may be a solution for other issues, but not for your body weight.

James Hill:

I'm curious, Nanette, are you seeing people now who are going through menopause on the GLP-1 medications? And if so, any insights there?

Nanette Santoro:

They work. They work great. One of the ways that I will approach this with a patient is if she's very symptomatic and weight is an issue, we'll always deal with the symptoms first because trying to get a person who's not sleeping at night to lose weight is just about impossible. And it's just going to frustrate them. So we'll try some other strategies. I am a big user of metformin when possible. There's a small evidence base that this is helpful. And it's also been something that's now being looked at in the geriatric literature as a senolytic, as an anti-aging type of drug that has had some efficacy in men. So I encourage patients getting that metabolic phenotype to consider it. It works very well for some. But then if that doesn't work and they meet criteria to take a GLP-1 RA, they work. They work even if they're symptomatic. You know, you don't have to wipe out all the symptoms. They work marvelously well and they seem to work at lower doses.

James Hill:

Very cool. Okay, Annie and Nanette, Holly and I love to talk about myths and look at things that people may believe that are true aren't true. When it comes to menopause, any myths that come to mind that may help our users separate the ones that are true from those that are really myths?

Annie Caldwell:

I think the main one is, and I'm having trouble thinking outside of it, but just that the weight gain is inevitable and there's nothing you can do. And when I put my anthropologist hat on, we also in our population think that increases in blood pressure are an inevitability with age. And that's why so many people are on blood pressure medications and things like that. But I did fieldwork with an indigenous population in Bolivia during my graduate training. And in that population, so they have no electricity or running water and very little interaction with the market economy. That's changing, obviously, with globalization. They have no increases in blood pressure across ages. And so that shows that that's not an inevitability. They also, observationally, though very few women speak Spanish, and that's our primary way of communicating with them and talking to them about symptoms, but it doesn't seem like the menopausal transition is as difficult in that population. And so there is some level of our environment that is making these things seem inevitable, but they really aren't. It's not a part of our human trajectory.

Nanette Santoro:

Interesting. And I would say the biggest myth I see is that estrogen is the answer to everything.

James Hill:

Ah, that is a good one.

Nanette Santoro:

So it's an oval focus on menopause means the change in estrogen. If I give back estrogen, all of this stuff will go away, make it go away with this magic pill.

Holly Wyatt:

Yeah. And I know that so many times people, patients come to me and say, my doctor said, you know what, gaining weight during this time is inevitable. There's nothing you can do. Just accept it, accept the weight gain. What would you tell someone who has been told that by, you know, a lot of times by their primary care doctor, just accept that you're going to gain weight during this time, nothing you can do about it?

Nanette Santoro:

Yeah, that's a very pernicious comment because it strikes on a number of levels. The end of your reproductive life really changes how you are perceived by society, by many women. They're perceived as less attractive, They're cougars, et cetera. You know, they're not hot, young, sexy things anymore. I think, trying to remember the author who said this, you stop becoming a babe. She described that. So this feeds right into that sort of negative narrative and is really kind of a harmful comment. Now, when we had few things that worked, that may have been a less irrational thing to say to someone, even though it's still hurtful. And I don't think that anyone should ever say that. But now with the GLP-1 RAs, I mean, they will really work as an adjunct to everything else.

James Hill:

Wow.

Annie Caldwell:

And if long-term adherence to the medications, you know, that are so expensive and difficult to access, there are studies now looking at if you do stop taking them, what happens to weight gain? A really great study recently showed that if you are doing weight training, resistance exercise, you can actually go off the GLP-1s and gain much less weight back. So, again, that resistance training is key. And potentially, there's a lot we don't know yet, but you might not have to take them for the rest of your life, as we once thought if you're modifying your exercise and putting on that lean mass or keeping what you have by doing that resistance training.

Nanette Santoro:

And that may be especially true for perimenopausal women, because we know that they're going through this period of turbulence. One of my colleagues, Jerilynn Prior, calls it estrogen storm season. But then the turbulence goes away, and you resettle. You reset your thermostat at a lower level. And once you're reset you have hormone stability again. A lot of the physiologic changes we see that acutely worsen and Annie graphed this out beautifully on a slide that I call Annie slide that I send around that looks at a number of measures we looked at in SWAN, you can see the trajectory of these things worsen in that year or two right around the final menstrual period and then they level off again. So I really wonder if this weight issue to the degree it's related to only menopause, would resolve and at least get people on much lower doses or have them be able to go off these drugs.

James Hill:

So one of the big take-homes I'm taking away from this conversation so far is if you're going through menopause, you need to see someone like you, Nanette, to help with that. So the question is, at what point do you go and find someone like you? And then how do you find someone like you to talk to?

Nanette Santoro:

Well, there's actually a pretty big gap in training. And we are trying to train OB-GYNs to take menopause back because with the turning away from hormone therapy, OB-GYNs kind of dropped it. Family medicine docs, you know the ones we have in Colorado, they're very dedicated to giving primary care. There's a group that does for women, so they will treat patients with hormones. My best advice to a patient is to make a specific appointment about this and nothing else. Don't try to bundle this with an annual visit. This really requires a taking apart of a number of different things and more of a holistic look. Many primary care doctors could do this, but it's probably worth asking the question that it's specifically about menopause. And there is a society called the Menopause Society in the United States that trains, provides a certificate to make you a certified menopause practitioner. In order to be a certified menopause practitioner, you have to go through this guide to learning and pass a test. And it's a pretty tough guide to learning as somebody who's contributed to it repeatedly. It's pretty rigorous. And it does take all of these things into account. So a doctor who's been through that or an APP nurse practitioner, nurse midwife, PA, who's had this training, should be able to really evaluate and treat all of these aspects of menopause.

James Hill:

Cool. All right, Holly, is it time for listener questions?

Holly Wyatt:

I think so because we have several and maybe we can talk about a couple other things with these questions too. I'll start, Jim. Is that okay?

James Hill:

No.

Holly Wyatt:

Okay. So here's a good one. Should women approach weight loss goals differently during menopause compared to earlier in their life. I get this one a lot. So I, you know, what I was doing earlier, should I take a different tactic now that I've gone through menopause?

Annie Caldwell:

Definitely. Particularly with regards to just your mindset and the way that you handle not getting exactly what the results that you got previously. And so try different things and it will take more potentially or different things, different dietary approaches or different lifestyle approaches. And then a key is not to interpret a lack of success immediately or as immediately as you did before. And don't take that on as a burden that you're somehow a failure or this isn't going to work for you or any of those things can really, really impact how you are able to continue trying healthy behaviors, doing, you know, more exercise, more resistance training, those kinds of things.

Because you get so hard on yourself, all you want to do is just have that comfort food come from somewhere. But that comfort can come from you. And you can use self-compassion. There are self-compassion meditations by Kristin Neff that are freely available online. And it can be really helpful to just change the way that you are talking to yourself about these difficulties that you're facing all at the same time and not in the way that you say, okay, I'm so nice to myself that I can fail at this and just tell myself it's okay, but more as a way to keep that motivation because consistency is key with all diet and physical activity behaviors.

James Hill:

Cool.

Nanette Santoro:

Yeah, and I just want to echo that. I think resetting the expectations a bit, and I try to focus my patients more on health markers for cosmetic issues, because there are some cosmetic accumulations of fat that people get that they don't like. I think Wanda Sykes named her belly fat Esther when she was going through menopause. She gave it a name and a personality. It was a very good routine. Esther may not go away. You know, Esther's there to stay. So you can use my sister's philosophy, which is to buy it gone, which is to just have the fat sucked away for cosmetic purposes if you want your waistline back, because it may not otherwise come back. Some fat is just, it's resistant to just regular weight loss strategies. So it's really important to focus on what you want. And I do encourage my patients to be a little less cognitively rigid about, you know, what they must look like and their expectations for themselves.

James Hill:

Okay, I'll ask one. You've talked a couple of times here about sleep problems and menopause. And people who can't sleep well, it messes up every aspect of their life. If someone comes in, Nanette, who has that problem, what do you do to address their sleep?

Nanette Santoro:

Well, we'll usually start, if they have not had a lifetime history of sleep issues, we'll start with some cognitive behavioral therapy. There's a great app. There's the VA app, CBTI Coach, that I recommend for everyone because that's got a bunch of strategies that they can try that are not pharmacologic. Because usually most people are turned off to trying to use medications right away. And I agree with that. I think there's a lot of things you can try first, especially if you get on an exercise program. That's a good way to sleep well at night if you're starting to train again. There's a couple of studies of non-pharmacologic things or not prescription things that can be used. There's an old study that valerian root's helpful, one of the few supplements that seems to have some help. Melatonin can be helpful but important for my patients and for everyone to know that the doses that you are sold in a health food store are ginormous doses that are meant for jet lag and that's not good for everyday use so much much lower doses less than a milligram, a day are more appropriate especially if you're 50 60 years old those lower doses are usually fine because some people will take those jet lag doses and say you know I woke up with a hangover I was wiped out and they're taking way too much. Benadryl 25 like hydroxyzine 25 milligrams or even less. If you're somebody who really goes to sleep all night from a dose of NyQuil, that stuff might work for you to help you sleep. And those are pretty harmless things to take over longer periods of time before you get into the heavier duty sort of sleep medications.

Holly Wyatt:

Yeah.

James Hill:

Holly, I want to ask one more. Nanette and Annie, what does the future hold for treatment of menopause? Look ahead a little bit. And is it going to get better? Are we going to get better strategies? What do you see in the future?

Annie Caldwell:

I see a much bigger increase in the study of menopause than previously, and so I'm hopeful for the future. However, if we are reducing the federal investment in research, and particularly research that's focused on women, that could be really harmful to a momentum that is definitely growing.

Nanette Santoro:

Well, there's a number of exciting things. I share Annie's apprehension, although I do think that this will go on somewhere else in the world. If we seed our premier position as the best place in the world to do research, another country is going to take it up because it's too important to ignore. I think there's less tolerance for menopausal symptoms than there was before. I see that in the population that women just are like, "Why is this happening to me? I don't want to feel like this." And I think that's a good thing. It's going to drive some changes that I actually think are going to be very beneficial for women in the workplace. Because the things we don't see with the current set of menopause treatments we have and our paradigm or narrative about menopause is what doesn't happen. What women don't apply for the big job, the big promotion, the career advancement that they would otherwise get because they don't feel okay. I think that syndrome is called NFM, not feeling myself. So I think that looking at that and drilling down on that a little more is going to happen. And that's important. We've seen some initial studies that have looked at that because that helps us identify the gap. We have some new drugs that are very effective treatments for hot flashes that target the neurokinin receptor in the brain. And neurokinins are interesting molecules because they influence reproductive pathways, but they also influence pain perception and some inflammatory pathways.

So these things may be feeding into menopausal symptoms as well. And the neurokinin receptor is kind of where estrogen acts to prevent hot flashes. So if we interrupt that receptor with a non-hormone treatment, we may also change some of those downstream negative feelings and affect that accompanies some of the menopausal symptoms and bundles them together. So we may see novel non-hormone ways to treat this, which would be great because many women cannot take hormones because they have a contraindication. We're also seeing some technologies that are looking at extending the lifespan of the human ovary. So if it poops out at age 50, is there a benefit to having it last longer? And that may be so. But we know that there are some downstream consequences to delaying menopause. When women have late menopause, they tend to have more risks of cancers of the breast and the uterus. We know early menopause also has risks. So are we in the sweet spot for a world where the average female life expectancy is in her 80s? I don't know. And if we are to extend the lifespan of the ovary, how many women are really going to want to continue to have menstrual periods and need contraception until they're 60, 65 years old? I don't know about that either. But those are some of the frontiers that are being looked at that I think are going to change the landscape.

Holly Wyatt:

Yeah. So I'm going to jump back because I still have a couple listener questions that I want to make sure we get to. I get this one all the time too. Is there a specific diet that if you're going through menopause, you should use either for weight loss or for weight loss maintenance, a menopause diet, so to speak?

Annie Caldwell:

Yeah. So I always like to go back to something that I learned actually from you both very early on when we started working together. The best diet is the one that you can stick with over the long term. And we already said physical activity recommendations is to increase that resistance training and the best benefits in terms of health outcomes that you get from exercise is from going from nothing to something. And so if you are doing anything and going for walks a couple of times a day or those kinds of things, that's great. And in many, there's just been secondary analyses done in a few big weight loss trials where we were expecting to show what women experience in that, the women that are in that trial that are postmenopause are going to lose less weight in the trial. Because we know all these things make it harder. But actually, it's very hard to see in a clinical trial. We haven't actually seen that. We've seen actually menopausal women doing better in the trials.

And one way that we've tried to interpret that is that women earlier in life have kids are really trying to hit their careers hard through their 40s and all those kinds of things. Whereas later in life, you get some time freed up to actually do these things and make these changes. And like Nanette mentioned, women are really motivated to make changes at this age because all those health things become more salient. All the health risks of not doing exercise or not managing weight become so much more salient. So there is a higher motivation there and you have more time. So why not try to incorporate that with other things you're doing, even if movement, all movement counts.

And so gardening, things that you're starting to get into it as you become this new non-babe person, everything's changing and you can add the activity in with this new person that you're becoming. That post-reproductive age and as you're creating a new identity for yourself. And that will make it easier to keep doing those things that you enjoy, but that also include movement. And then one final thing I'll say is that in Dr. Catanacci's recent trial showing intermittent fasting versus daily caloric restriction, intermittent fasting has gotten kind of a bad name. Some people have said it's not good in women. But in that trial, there was actually a slightly better weight loss in women. And so don't rule out intermittent fasting because you've heard that it might not be good for women, women's weight loss and giving intermittent fasting a try as another tool in your toolbox. But stick with something that works for you and you really feel like you could do it for the long term.

Holly Wyatt:

Yeah, we had Dr. Catanacci on. And so we have a whole episode on 4:3 fasting, intermittent fasting. So I definitely think that's something our listeners are very, very interested in. So it's good to know that it's a good option for women, but doesn't sound like there is a special diet, one diet, the diet. That's what people want, the diet for menopause. I'm hearing no.

Nanette Santoro:

No, save your money.

James Hill:

Good advice.

Nanette Santoro:

I use the same philosophy as Annie. I just tell my patients, do what you hate the least.

James Hill:

I like it.

Nanette Santoro:

These are the options, you know, do what you hate the least. It's all about how you can just get less food into your face without being miserable.

Holly Wyatt:

I would say not miserable, but I would agree. It's what you can do, what fits you best, and what I think actually feels good for you, right? The fit that feels good for you. And I love that Annie brought up identity. I think that's so important. What is your identity? And kind of thinking about that as you go through this process. All the time, Annie, we bring up this identity stuff. So, Jim, is it time for a quick vulnerability question for each one?

James Hill:

We got to have one vulnerability question for each. I'll go first. All right, Nanette, what's one thing about menopause that you used to believe, but you now, through research or whatever, you know you think differently?

Nanette Santoro:

You know, I used to think that it was something that really set you up for the rest of your life. It's one of the things we're looking at in the SWAN study now, that how you go through menopause was going to be a real clue. And for the most part, it's a temporary disruption. That's significant. And it can set some women on a different health course, but a lot of that's genetic. And getting through the temporary disruption is probably the most important thing to do.

Holly Wyatt:

Yeah, I like that. All right, Annie, are you ready?

Annie Caldwell:

Yes.

Holly Wyatt:

Ready for the vulnerability?

Annie Caldwell:

I hope so.

Holly Wyatt:

Yeah, these are tough. Not really. Can you think of a moment when you felt like you got something wrong in the field? A lot of times people think, oh, it's all what I got right. But sometimes what we get wrong actually leads us in a path that teaches us something. So can you think about something maybe you got wrong? What did you learn from it? Or maybe something that really surprised you and you ended up learning something from that.

Annie Caldwell:

I have two. One was just that a lot of things were known in this space about hormones and weight management. I wanted to ask a question that is probably years in the making because there's so little known, and so we're working on it. But something that I got wrong, another thing that was more crucial was, you know, I'm approaching this as a trained anthropologist and evolutionary psychologist. And, you know, all the research that was done on physical activity was showing how historically we were very, very active and strong and healthy. And there was just something missing. Why aren't we doing that now? And if we could just find that missing piece, then we could just plug it in and we'd go back to our ancestral selves, and all of a sudden want to be super active.

And the first time I went to do fieldwork, I lived in a community for six months. I was expecting a bunch of activity to just be happening all the time. But actually, they were very strategic about when they expended energy. So if they were going to go hunting, but it had rained the night before, they would just sit around and talk. Because when you're putting muddy footprints everywhere, it's really hard to sneak up on anything. And so they wouldn't do it. They would sit around and drink and it's not like they're just every day go, go, going. There's actually a similar amount of sedentary activity in that population and the difficulty to get yourself motivated to get moving is not some inherent human thing, especially when there's no payoff in terms of evolutionary gains that you're going to get. So if you're not working for your food or to survive, there's a lot less internal motivation as humans, even though historically we had that. And actually, wanting to conserve energy is really more the natural thing to do. And that's what all organisms do.

Holly Wyatt:

Got it.

James Hill:

Okay, Holly, I think it's time to sum up here.

Holly Wyatt:

All right, go for it.

James Hill:

The data suggests that on average, there's a little bit of weight gain with menopause, but that's the average. There are some people, it's a time where they gain a lot of weight. Other people, they don't. But if you are going through menopause, there are things you can do. It's a good time to make behavior changes. It's a good time to talk to an expert that can help you manage symptoms, that can help you think about strategies to manage your weight. One of those strategies may be more exercise, particularly more resistance training, which is going to minimize your loss of muscle mass. So it's not inevitable, and there are things you can do to help. And then one of the things that Nanette pointed out is because research is really moving forward in this area, there are good things to come. It's going to get better for people going through menopause to manage their symptoms and manage their weight. Another reason why it's so critical that we continue doing this kind of research.

So Nanette and Annie, thank you. This has been a fantastic conversation. You have given our listeners a lot of practical advice. So thank you for joining us on Weight Loss And.

Annie Caldwell:

Yeah, thanks so much for inviting us.

Holly Wyatt:

Thank you. Bye, everybody.

James Hill:

Bye, everybody. See you next time. And that's a wrap for today's episode of Weight Loss And. We hope you enjoy diving into the world of weight loss with us.

Holly Wyatt:

If you want to stay connected and continue exploring the “Ands” of weight loss, be sure to follow our podcast on your favorite platform.

James Hill:

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Holly Wyatt:

And remember, the journey doesn't end here. Keep applying the knowledge and strategies you've learned and embrace the power of the “And” in your own weight loss journey.