Menopause, Weight Loss and Irritable Bowels – Dietitian Nigel Denby gives his top tips on what can help
Menopause can seem like purgatory. Not only do your moods swing but your waistline thickens and then – just to add insult to injury – your bowels turn on you too. What had once been a well functioning internal system suddenly seems hell bent on bloating and releasing gas at the most inopportune times.
But it doesn’t have to be this way. There are things that can help. Dietitian and author, Nigel Denby, explains.
Let’s start with the weight gain and thickening waistline first. You can see the video of out chat here.
“This does not happen because you’re greedy or you’re lazy,” Nigel says. “There are physiological reasons behind it. As your oestrogen levels reduce, your body becomes predisposed to lay down your fat under your internal organs, not just under your skin. It’s no longer subcutaneous fat, it’s now deeper in the body.
“But there’s another factor too,” he says. “The lack of oestrogen triggers your body to realise that you’re beginning to age and you are losing muscle tissue – maybe around 200 calories a day worth of [energy burning] muscle tissue over the period of your transition to menopause.
“That equates to 200 or so less calories that you need everyday. What we tend to see then is that many women will put on 1.5kg a year in perimenopause. On average she’ll gain around 10kg in the lead up to menopause – a good dress size, and it’s mainly in the mid-line area,” he says.
“I see many women coming into the clinic saying their legs and hips are fine – it’s the middle that’s the problem. It’s a really real thing – and more than three quarters of women will experience this.
“But there is something you can do about it – that’s the best news.”
Drop the Fad Diets, it’s a lifestyle plan
“The first thing I can say is if you see some magic wand, fad diet – that’s exactly what it will be, and it will take you back further.
“What we need to do is look at what you’re doing right now. Maybe your portion sizes are too big. Maybe your grazing unconsciously when you’re getting the family’s meals together. Maybe in the car or on the tube or the bus. Maybe you’re just having that extra large glass of wine in the evenings, or a second when it used to be just the one glass – or maybe you’re watching TV and start to get those sweat cravings.
“At the same time we need to look really closely at your physical activity levels. And I don’t mean if you’re going to the gym, I mean your baseline, what you do every day, how much you walk … because essentially, when I’m sitting down with anyone, I’m looking to save 500 calories a day,” he says.
“I’m looking to save 500 calories a day…”
“And I don’t want to give you a ‘one size fits all’ diet – I know those 500 calories will be in your day somewhere and if we find them we can put some strategies together to get rid of them. But if we just look at diet, you’re going to have to work really hard. So, what I want to try and do is see how we can reverse that aging process, get you more active and increase your day to day activities because that’s when your body will start to regenerate the muscle you’ve lost and get you back to the same sort of metabolic situation that you were in when you were in your early 40’s.
“It’s not rocket science, but it’s very personalised. There will be a reason why you are consuming more calories than you need – and we’ll find that reason, we’ll agree a solution and we put together a plan to make that your new lifestyle plan, not a diet.”
“We put together a plan to make that your new lifestyle plan, not a diet…”
Nigel says fad diets may have been great for shedding a few unwanted kilo’s prior to a holiday when you were younger, but they aren’t going to work for you now.
And if you’ve been a serial ‘yo-yo’ dieter for years, you know it won’t work because it’s not sustainable.
Instead, he says we need to find those extra calories and devise a way to get rid of them.
“If we reduce the glasses of wine from 2 to 1, or reduce the portion sizes of your meals we’ve done most of it.
“You do not need to be making pots of cabbage soup to control your weight – the really important thing to know is that whatever you do now to control your weight you are going to have to do for the rest of your life.
“You are going to be post menopausal for the rest of your life – and that can be 4-5 decades. So instead of looking for that elusive magic wand, accept it for what it is and think about finding the lifestyle that works for you.”
Plates, Portion Size and Mindfulness
Size does matter when it comes to eating.
“Dinner plates are so large now you could sail a family of four across The Channel on them,” Nigel says.
And along with the big plate comes equally large portion sizes.
To combat this, he has some tips:
- eat when you’re hungry, not ravenous
- eat regularly throughout the day.
“The amount of food you need for a meal is about the amount that will fit into your cupped hands is about enough. It may look small but we tend to serve up using our eyes and if it looks good we’ll serve up more than we need.
“A really nice thing I like people to try is to only take that [cupped hand] amount, eat slowly, look around the table and see whose finishes first – if it’s you, slow down. Satiety (the feeling of being full) is a bit like a delayed reaction. So check in with yourself and ask ‘am I still hungry?’ That’s a different thing from thinking ‘that was blooming tasty and I wan’t some more’ – that isn’t being hungry, that’s just fancying a bit more. And if you are genuinely still hungry then have a wee bit more and that should do it.
“You will be amazed how often that smaller portion will do it, particularly is you’ve had breakfast, a snack, lunch, a snack and then your dinner.”
He says this mindful approach is really important because at the moment because more of us are overweight than are a healthy weight these days.
“We’ve got all this confusion about whether women should take HRT because of breast cancer but it’s really important to know that if you are 10% overweight that gives you a much, much greater risk of [developing] breast cancer than HRT.”
He adds, if you aren’t active or if you drink too much – that will increase your risk too.
“I am not the food police. I used to be a chef before I was a dietitian, and I know how important it is to enjoy your food. So what this is about is making sure you know what the risks are and personalising a plan thats just about you, so its sustainable.”
Savvy Snacking: What’s Good To Snack On?
“Look at things that are around 100-150 calorie mark. The sorts of things I like, a people are often surprised at this are a couple of oat cakes with some peanut butter or hummus or cream cheese spread on them. I adore the old soreen malt loaf – its really low in fat, around 96 calories a slice, and if you’re someone who loves something a bit cakey, it’s brilliant. You don’t need the butter on it though.”
“You can have 40 grams of nuts or I like the little baby bell or laughing cow cheeses-they’re portion controlled and have a great supply of calcium for your bone health. That, with a few cherry tomatoes or some grapes is great.
“A snack is really a pit stop between meals just to bring those hunger levels under control until the next meal. Savvy snacking – planning your snacks, taking them with you is an essential part of weight management. And it’s about management.
Goals: Keeping It Real
“You don’t strive to be the weight you were when you were 20 – instead strive to reduce your weight by 10%. This will reduce your risk of heart disease, cancer drastically. For the vast majority of women it’s about the amount they want to lose and it is so, so doable.”
“The secret to healthy weight loss is simple maths. It’s calories in vs calories out. You get that wrong and you’ll gain weight, get it right and you’ll lose it.”
Generally speaking you should eat 1500-1800 calories a day and making sure you get in your 10,000 steps in.
Nigel isn’t a great fan of counting calories but says it’s more important to know where the calories are coming from so you can identify the areas that can be cut back on.
Myths and Tips
Does HRT help you lose weight?
Nigel says there is a huge myth that HRT makes you put on weight. There are some preparations, he says, that may initially make you gain a little but it usually settles down over time. He says the overriding evidence shows it helps you lose weight.
“If you were losing oestrogen and that was what was causing you to lay down extra fat, then it makes perfect sense that replacing it will help lose a little weight.”
It may not be everyone’s experience but many women find it helps. But “with or without HRT, you can do this,” he says.
There is some evidence to show they can be useful for morbidly obese people but for the vast majority of us it’s not useful as a weight loss tool, he says.
Apple cider vinegar?
“Make a nice salad dressing”, he says. In the past he says there used to be diets based lemon juice, – but, they don’t dissolve or melt fat or speed up metabolism.
“Don’t do it, you’ve got lungs and a liver – they’ll detox you.”
What about the irritable bowel?
This is bloating, a feeling of not being finished on the loo or a feeling of having to go urgently. There can be gas and it can be embarrassing and uncomfortable.
Once any underlying conditions have been ruled out it’s time to talk to a dietitian who can look at your history and guide you through the maze of triggers that – once identified – could give you some relief.
Nigel says this sin’t something you can do alone. You need to be guided through an elimination diet like the FODMAP diet to help identify the triggers that cause your bowel to react.
Keeping a food and symptoms diary is important.
A common pitfall Nigel says many people fall into is listening to friends or social media where they say cutting out gluten or dairy is the solution. He reminds us, what works for one person may not work for you. You really need to find out what the triggers are for you and how to manage them.
This doesn’t mean you can never eat certain foods you love again as there are strategies you can employ that may help reduce their impact on your gut.
Re-establishing a healthy gut microbiome with a good medical grade probiotic may help, he adds.
He reminds us though that – just like the diet – the solutions for IBS need to be personalised.
There is no ‘one-size-fits all’ advice – the key to success is finding out what works for you.