I am at the time of writing this (2018) a 47 year old woman and most likely in peri-menopause. I say ‘most likely’ because so far the symptoms I do have are of the very light variety (mainly a mood swing here and there, some sleep issues and the occasional unexplained itching of the skin) and might as well be attributed to other factors and circumstances. But fact of the matter is (peri-)menopause happens to all women and can be a difficult period for several reasons: fat gain (the dreaded middle-age spread), loss of muscle tone, insomnia, mood swings and the dreaded hot flashes are all very common and can seriously inhibit your well-being.
I am convinced though my adherence to low carb plays, and will play, a large part in trying to make this period in my life more of a smooth sailing as opposed to what is perceived by many as mid-life agony. So let’s talk a little bit about (peri-)menopause itself and how a keto lifestyle can help alleviate the troubles that come with it.
What is peri-menopause?
A woman reaches menopause when she has gone 12 months without menstruating, but symptoms related to peri-menopause (the time where hormonal changes actually begin) usually start much earlier. They can also last for several years after this point AND new symptoms can even develop in the first few years after menopause.
The average age when peri-menopause starts is 46 and it usually lasts about 7 years. On the whole though, peri-menopause can start anytime between your mid-30’s and mid-50’s, and this whole period can last anywhere from 4 to 14 years. The period after a woman has gone 12 months without a menstrual period is called post-menopause.
During and after this menopause transition several symptoms may occur.The most common ones are:
- hot flashes and night sweats
- weight gain, especially around the middle
- insomnia (read here for ‘keto and your sleep’)
- vaginal dryness
- mood swings
- poor memory, aka ‘brain fog’
- loss of libido
- changes in menstrual cycle
- joint aches and pains
A word about low thyroid
Many of the symptoms that are attributed to (peri-)menopause can in fact also be symptoms of low thyroid or hypothyroidism. In my practice I regularly advise my clients to get tested to rule this out. Dr Ken Berry explains here what to look out for in terms of symptoms, both common and uncommon. He also explains here how to get properly tested: it is not sufficient to only get TSH, T4 and T3 tested so please make sure your doctor knows exactly what to test.
Hormones and insulin resistance
When a woman enters peri-menopause her ovaries contain fewer eggs and as a result begin to produce less of the hormones estrogen and progesterone. In response to that, the pituitary gland in your brain steps up production of follicle stimulating hormone (FSH) to try to increase estrogen output. During this period of time, estrogen levels may fluctuate widely, but during the last couple of years before menopause, they steadily decline.
Estrogen is normally responsible for depositing fat in the hip and thigh area (subcutaneous fat) after puberty. This is why many women gain weight in this area during their reproductive years (pear shape). But as the estrogen levels decrease during peri-menopause, fat storage moves to the midsection instead (and for many women the pear shape becomes an apple shape).
This excess visceral fat doesn’t just change your appearance and the way clothes fit (and can be cause for insecurities about your looks), it is also strongly linked to insulin resistance, heart disease and other health problems… which obviously goes way beyond looks.
Weight gain in menopause
In addition to the change in fat distribution as described above, most women also notice that their weight goes up several pounds during and after perimenopause, just like that it seems. But this is due to a combination of factors:
1 lower levels of estrogen promote insulin resistance and higher levels of insulin in the blood, or hyperinsulinemia, that promotes weight gain.
2 research shows that the ‘hunger hormone’ ghrelin actually increases in the early stages of perimenopause.
3 low estrogen levels during and after menopause may impair production of leptin and neuropeptide Y. These are hormones that help regulate appetite and weight balance. The result: an increase in appetite and lack of satiety can lead to overeating and weight gain.
4 loss of muscle mass that occurs during menopause and due to the aging process itself can slow down metabolism, making it easier to gain weight.
The importance of cholesterol
Estrogen, progesterone, cortisol, DHEA, and testosterone are made from cholesterol; if we don’t eat enough, our body takes cholesterol from our endocrine system to use for brain function and repair. When that happens, it becomes almost impossible for our bodies to maintain hormonal balance. It is important to remember cholesterol is very much needed for proper hormone balancing.
Many women however start to eat a calory restricting low-fat diet in an effort to combat the menopausal weight gain. Not only does this automatically decrease the intake of necessary cholesterol for hormonal balance, it almost always entails eating a lot of carbohydrates.
These carbohydrates are metabolized into sugars which cause weight gain and insulin resistance which in turn disturbs normal ovulation: healthy estrogen gets converted into androgens. The abundance of starches and sugar in a low fat diet, but also caffeine, increase androgen production and this is also why women on such a diet experience an sudden inability to lose weight once peri-menopause sets in.
How can a ketogenic lifestyle help?
It stands to reason that eating in a way that lowers insulin levels and helps control hunger, as a keto lifestyle does, would be very beneficial for menopausal women. The appetite suppressing aspect of ketosis in particular can be very useful. However, although middle-aged and older women have been included in some studies on carb restriction, there is surprisingly little research looking at the effects of this way of eating in menopausal women alone.
There is also a lack of formal research into the effects of keto or low-carb diets on hot flashes.The women I have spoken to though who start a keto diet reported having fewer and/or less severe hot flashes.
mood swings, brain fog and emotional issues
While anecdotal, a lot of women have spoken to me about a pleasant reduction of negative emotional changes, including brain fog and mood swings. As of yet there are no studies though supporting carb restriction for these issues.
How many carbs?
Generally speaking, restricting intake to less than 50 grams of net carbs daily will help suppress appetite, reduce insulin levels and increase insulin sensitivity, which can make weight loss or maintenance easier.
If your goal is to be in nutritional ketosis in order to help with hot flashes, improve your mood or boost your memory and concentration, you may need to stick to about 20-30 grams of net carbs per day.
Flaxseed can help relieve certain menopausal symptoms, especially hot flashes.
Green tea is rich in catechins, which are very potent antioxidants. It is also the best source of a specific catechin known as epigallocatechin gallate (EGCG), which may be beneficial for cardiovascular and metabolic health. In addition, green tea may help in lowering insulin levels.
Research shows fatty fish can reduce inflammation, lower your triglycerides, improve artery function and protect brain health. These effects are due to the high content of EPA and DHA, the long-chain omega-3 fatty acids found in salmon, sardines, mackerel and herring.
Apple cider vinegar
Although anecdotal many women report using apple cider vinegar daily helps with several menopausal symptoms including hot flashes, sweating, gut health and digestion.
Staying active is very important during and after menopause. Regular exercise can help relieve stress, boost your metabolism and fat burning and prevent loss of muscle mass. It is also reported that physical activity may potentially help with hot flashes.
Strength training, as opposed to cardio, is the most effective for dealing with symptoms of menopause as well as slowing down the aging process and improving body composition. Obviously, if strength training is not an option for you any other exercise is perfectly fine too, even walking.
I have never practised yoga myself (I prefer meditation) but yoga is well known for relieving stress. Similarly, tai chi and other mind-body therapies may also improve certain menopausal symptoms, such as sleep issues and hot flashes.
Acupuncture has been reported to be effective for hot flashes and improving sleep. I have yet to try this myself though as a fear of needles is not very helpful in that respect.
(Peri)-menopause can be an extremely difficult period in a woman’s life but a ketogenic lifestyle based on whole healthy foods can definitely help lower insulin levels, improve insulin sensitivity, keep your appetite under control and potentially even reduce hot flashes and other symptoms. As the decrease in estrogen means losing out on the cardio protective aspect of the hormone it is also important to reduce the risk of additional heart disease factors.
Weightloss during menopause can be difficult to achieve, many women say it can be very slow going and a lot of patience is in fact required, even with a keto lifestyle and while doing everything right. If it will lead to weight loss depends on a number of other factors, some of which you can control and others you just can not, such as genetics and bio-individuality.
Regular exercise, stress management and generally creating healthy habits can improve your chances for maintaining a healthy weight and great quality of life during and after menopause.