How can we protect ourselves from getting colds and flu naturally?
The key is boosting your immune system. Consider adding a few key nutrients to your diet daily.
Vitamin C: This vitamin is an antioxidant which helps the body increase production of white blood cells. Found in red peppers, citrus (grapefruit, lemons, limes and clementine’s), kiwi, spinach and broccoli.
Beta Carotene: Is an antioxidant which increases the infection fighting abilities of the immune system. Found in carrots, sweet potatoes, spinach, kale, squash, red & yellow peppers, peas, broccoli, romaine, apricots, and cantaloupe.
Vitamin D3: Boosts the body’s natural defense against disease, lowering your risk of infection.
Zinc: Helps control inflammation and boosts immune response. Found in dairy, greens, whole grains, beans, meats and seafood.
Probiotics: Their function is to control inflammation blocking the harmful bacteria maintaining a healthy gut barrier. Found these foods: yogurt, kefir, sauerkraut, tempeh, kombucha, and pickles.
Anti-Inflammatories: Sources include omega-3 fish oil supplements, ginger, turmeric and cinnamon.
Also wash your hands often, hydrate, move or exercise daily, rest and ample sleep at night.
You put in the hours, pumping iron, logging miles, sweating buckets, overhauling your diet, and (most important) staying consistent.
And the results speak for themselves — every time you look in the mirror, a leaner, more athletic person stares back at you. You’ve even bought yourself a new wardrobe. So now what?
Some people will keep going, perhaps taking up triathlons, joining a hoops league, or training for the CrossFit Games.
But others will want to take their foot off the gas and appreciate what they’ve accomplished.
The key is not to leave it off for too long — two weeks of inactivity are all it takes to notice significant declines in strength and cardiovascular fitness, according to a study in the Journal of Rehabilitation Medicine.
Indeed, the body is incredibly efficient at adapting to whatever demands (or lack thereof) are placed on it.
So now that you’ve crossed the finish line, how can you keep from backpedaling and losing what you’ve built? Just follow these simple steps.
1. Cut Back Gradually
Smart training plans (like those available on Beachbody On Demand) can allow you to work out 5 or 6 days a week with no ill effects (read: overtraining).
But once you reach your strength and endurance goals, you can reduce your workout frequency without losing your hard-earned gains, according to a study at the University of Alabama.
The researchers found that adults aged 20 to 35 who worked out just one day a week not only saw no loss of muscle but actually continued to gain it (albeit at a greatly reduced rate).
Our recommendation: Start by reducing your workout frequency by a third, then a half, and so on until you find the minimal effective dose that’s right for you.
2. Keep It Intense
Even a single set of a strength-training exercise can produce hypertrophy (i.e., muscle growth), according to a study in the Journal of Strength and Conditioning Research.
So if your goal is to hold on to what you have, one or two sets per move per workout should do the trick.
The key is to keep them challenging; you should always feel like you stopped two reps short of failure.
Take a similar approach with cardio: In a study in the journal Physiological Reports, a team of British researchers found that a single, intense, 20-minute interval workout every five days allowed participants to maintain levels of cardiovascular fitness built through much higher frequency training programs.
3. Dial In Your Diet
Here’s the one category where you might have to be more diligent than you were before you reached your goal.
As you cut back on your workouts, you’re going to start burning fewer calories. To avoid the fate of the ex-athlete who balloons 50 pounds when he hangs up his cleats, tighten up your diet as you reduce your training time.
“On the days you don’t work out, cut 300 to 500 calories from your diet,” says Dr. Jade Teta, founder of The Metabolic Effect, a fitness and nutrition coaching service focused on maximizing results with minimal effort. “Ideally, those calories should come from starchy carbs and sources of empty calories [i.e., junk food] rather than from protein or veggies,” says Teta.
4. Stay Flexible
These general guidelines are just that: general guidelines. Though lower frequency, more intense workouts seem to work for most people looking to maintain their fitness gains, there’s no “one-size-fits-all” solution.
“It’s going to be different for everyone,” says Teta.
So be a detective: Monitor your strength, weight, definition, and overall sense of well-being as you tweak your exercise and eating habits, and be ready to adjust everything up or down accordingly.
The rising rates of Type 2 diabetes also mean increased potential for developing serious health complications ranging from heart disease and stroke to vision loss and premature death. Exercise could be the antidote.
Several studies have found exercise can prevent or delay the onset of Type 2 diabetes; some research has shown a 58% risk reduction among high-risk populations. While much of the research has looked at the impact of moderate-to high-intensity cardiovascular exercise, a new study published in Mayo Clinic Proceedings examined the potential impact of strength training on Type 2 diabetes risk. The data showed building muscle strength was associated with a 32% lowered risk of developing Type 2 diabetes.
“Our study showed that very high levels of resistance training may not be necessary to obtain considerable health benefits on preventing Type 2 diabetes,” Wang says. “Small and simple resistance exercises like squats and planks can benefit your health even if you don’t lose any weight.”
Think twice before abandoning the treadmill or elliptical trainer for the weight room, advises Eric Shiroma, ScD, staff scientist at the National Institute on Aging.
As part of a 2018 study, Shiroma and his colleagues followed more than 35,000 healthy women for 14 years and found women who incorporated strength training into their workouts experienced a 30% lowered risk of Type 2 diabetes but women who also participated in cardiovascular activities experienced additional risk reduction.
“When comparing the same amount of time in all cardio, strength [training] or a combination, the combination had the most Type 2 diabetes risk reduction,” Shiroma explains.
THE BOTTOM LINE
Researchers are still unclear about which type of exercise could have the biggest impact on reducing your risk. Wang suggests erring on the side of caution and following a workout regimen that blends both pumping iron and heart-pumping cardio, explaining, “Both strength training and cardiovascular aerobic training are important for the prevention of Type 2 diabetes.”
The biggest takeaway, according to Shiroma, is any amount of exercise is beneficial for reducing Type 2 diabetes risk so do pushups or take a walk around the block as long as you get moving.
The chiropractor. A lot of people swear by chiropractic treatments as the only way they get relief from back pain, neck pain, headaches, and a host of joint problems. Others aren’t so sure about this holistic wellness discipline. Regardless of what camp you’re in, allow us to demystify this type of care for you.
Chiropractors Train as Long as MDs Do
That’s right, a Doctor of Chiropractic (DC) studies for four years of undergraduate and four years of chiropractic school, using similar books that MDs use for study, says Scott Bautch, DC, president of the council on occupational health for the American Chiropractic Association. Chiropractors must also pass a licensure test and take continuing education courses to stay abreast of the latest trends in their field and maintain their credentials.
Chiropractors Can Help with Overall Wellness
People mostly see chiropractors for pain relief, but it’s becoming more popular to see a chiropractor for general wellness. “Chiropractors are increasingly becoming overall wellness advisors — advising patients about their eating , exercise, and sleeping habits,” Bautch says. Since chiropractors focus on the health of the nervous system, particularly the spinal cord, they are treating the entire body. Therefore, they are addressing both acute injuries (such as low back pain), as well as general, chronic issues (such as fatigue).
The First Appointment Will be Really Thorough
Chiropractors use comprehensive intake screenings to learn not just about what ails you, but also to get a complete picture of your overall health (hence the “holistic” descriptor). This will include health history questionnaires as well as functional and neurological assessments to see how your body moves, how well you can balance, etc. The doctor may also take x-rays. Finally, there will be a discussion about cost and course of treatment.
This thorough first appointment was experienced by New York City resident Karl Burns. In a tennis game, Burns swung his racket too forcefully and injured his low back. He was referred to chiropractor Cory Gold, DC. “At first, I thought, ‘I’ve never been injured before, I don’t need a voodoo doctor,’” says Burns. “But Dr. Gold and I immediately gelled. After many tests and questions, he told me, ‘Your treatment plan will be three times a week for a couple weeks, then two times a week for a couple weeks, then once a week — this is not a lifetime injury.’”
You’ll Likely Be a Regular, Initially
In most cases, people see chiropractors for acute injuries (like throwing your back out) or chronic conditions (like headaches), so it may take a few of weeks of multiple visits to stabilize the problem. After a few weeks of multiple treatments per week, treatment tapers gradually to once per week, then once per month for maintenance, until the spine is able to stay in alignment without the chiropractor’s adjustments. The course of treatment and length of time until stabilization vary from person to person.
That said, visits are often quite short — an average of 15 to 20 minutes — of hands-on manipulation. “Chiropractors aren’t trying to fight an internal battle against infection the way medical doctors are,” says Burns. “The treatment consists of much smaller movements and adjustments to your body and alignment of the spine.” Burns points out that he experienced pretty significant pain relief from the get-go. “Every time I walked out of there, I felt amazing,” he says. “The benefits are instant and can be perceived better [than with conventional doctors].”
You Won’t Be a Patient Forever
There’s a general belief that chiropractors want to make you reliant on them, but Bautch and Burns believe otherwise. “There are three phase of care,” Bautch says. “Acute — let’s get you functional; corrective — let’s adjust you so that it doesn’t happen again or as frequently; and then maintenance — maybe down to once a month.” Indeed, this is what Burns experienced — but he also learned the hard way the importance of self-maintenance. “Chiropractors take the approach of ‘let me teach you how to fish,’ not ‘let me just give you the fish,’” says Burns. He, like most patients, was given exercises to compliment and maintain his recovery — and he only ran into trouble again once he stopped doing them. “If I skip my exercises, sure enough, my lower back gets tight,” Burns says.
If you’ve ever hurt your lower back, you know how much it can affect your life. Whether you’re getting up from a chair, carrying groceries or hoisting a barbell overhead, your lower back is involved in nearly every movement.
While lower back injuries should be treated with the help of a doctor or physical therapist, many cases of lower back pain can be avoided with simple exercises that strengthen the core muscles and teach proper movement of the spine. Stuart McGill, PhD, professor emeritus at the University of Waterloo and the world’s premier authority on spinal health, designed exercises to build a healthy spine.
McGill’s research has been pivotal in helping people understand core training for a healthy spine should focus on stability exercises like planks. Movements that bend the spine like crunches and situps, could even contribute to lower back injuries if performed incorrectly or too often. McGill’s “big three” exercises can be combined into a daily routine that requires no equipment and can be done at home or in the gym.
If you’ve been injured and your doctor has cleared you to work out again, or if you’re perfectly healthy and want to give yourself the best chance to keep your spine pain-free, try these three simple exercises to start building a more resilient spine for all of life’s activities.
Back pain can often be traced to two simple culprits:
1. The lower back itself moves too much.
2. The joints around the lower back (e.g., hips and upper back) don’t move enough.
The McGill curlup teaches you to stabilize your lumbar spine (lower back) using your abs, while moving through the thoracic spine (upper back). The act of pushing the lower back into the floor is how you properly “brace” your abs, so remember how that feels because you should be using it for just about every other exercise you do.
The move: Lie on the floor, face up to the ceiling. Bend one knee until your heel is flat to the floor, a few inches away from your butt. Keep the other leg straight and dig the heel of that foot into the floor, pointing your toes to the ceiling. Place your hands under your lower back and actively push your lower back into your hands to engage your abdominal muscles. Bring your chin toward your chest but keep your head on the ground. Continue to push your lower back into the floor to gently lift your shoulders off the ground. Make sure not to curl your chin toward your chest or let your lower back leave the floor. Perform all your reps on one side, then repeat on the other side.
Sets and Reps: 2 sets of 5–10 reps per side, holding each rep for 3–10 seconds (hold each rep longer to make these more challenging)
The McGill curlup teaches you how to brace your abs, now it’s time to put that stability to the test with bird dogs. This teaches you how to move your arms and legs around a solid core position without moving from your lower back.
The move: Start on your hands and knees with your hands directly under your shoulders and knees directly under your hips. Flatten your back by bracing your abs much like you did with the curlup, but instead of pushing your lower back into the floor, tighten your abs as if someone is about to punch you in the stomach. Reach out with your opposite arm and leg until both limbs are parallel to the floor. Be careful not to arch your lower back — imagine keeping your leg long and low. Repeat with the other arm and leg, making sure to brace your abs on every rep.
If you feel like a fish out of water when doing bird dogs because you’re not quite coordinated enough yet, try them with just your legs first. Once you’re able to lift your leg parallel to the floor without arching your lower back, add in your arms, too.
Sets and Reps: 2 sets of 5–10 reps per side, holding each rep for 1–5 seconds (hold each rep longer to make these more challenging)
SHORT SIDE PLANK
Curlups and bird dogs mostly work your ab muscles on the front of your body: the rectus abdominis and transverse abdominis. But we can’t forget the important oblique muscles, your “side abs.” The short side plank builds strength in your obliques to prevent unwanted twisting and side bending of the spine.
The short side plank resembles a traditional side plank but leaves your bottom knee on the floor for added stability. Think of it as a more user-friendly side plank so you can learn how to properly use your obliques to support your spine.
The move: Lay on your side with your bottom elbow and leg on the floor. Bend your knees until your upper and lower leg form a 90-degree angle. Tuck your bottom elbow tight to your side, squeezing your bottom fist. Lift your bottom hip off the ground while leaving your bottom knee and elbow on the floor. Pull your shoulders back and squeeze your glutes to keep a straight line from your head to your knees. Inhale through your nose and exhale through your mouth for the duration of the exercise. Repeat on the opposite side.
Sets and Reps: 2 sets of 5–10 seconds per side. Even though 10 seconds may seem quick, exhaling forcefully (like you’re blowing up a balloon) can make even just 10 seconds seem challenging.
If you feel overwhelmed trying to build a healthier life for yourself, stop stressing. You can perform the simplest tasks and still create a more active, flourishing life. Plus, executing such small activities can put you on a path toward accomplishing your larger health and fitness goals.
If you struggle with any of these issues, try incorporating these easy actions into your daily life and you should begin noticing encouraging changes:
If you’re ever feeling unproductive, a power nap could help. In a study published by Sleep, researchers found a nap lasting as little as 10 minutes mitigated short-term performance impairment. “What’s surprising is how little sleep is necessary for better focus,” says Martin Rawls-Meehan, CEO of Reverie, an organization that creates sleep systems. Plus, he says a nap can reduce your body’s levels of cortisol — a stress hormone responsible “for a lot of the negative physiological effects.”
If you’re ever lacked the motivation to work out, spend a moment thinking of friends and family. In a study published by the Proceedings of the National Academy of Sciences, researchers asked 220 sedentary adults to complete one of two self-transcendence tasks: reflect on what matters most to them (such as friends and family) or make repeated positive wishes for both strangers and people they know. A control group reflected on what mattered least to them. Then, everyone viewed health messages encouraging physical activity. Results showed those who thought of others decreased their overall sedentary behavior versus those who did not think of others.
Researchers looked at data from almost 92,000 middle-aged people and found that those with disturbed sleep patterns were more likely to experience depression or bipolar disorder. Worse yet, one of the culprits of bad sleep was something completely within people’s control: scrolling the internet in the middle of the night on their cellphones, according to a study published in The Lancet Psychiatry. To negate the negative effects of disrupted sleep, Rawls-Meehan suggests using an old-fashioned alarm clock and charging your phone overnight in the kitchen — completely out of reach.
Feeling sluggish and bloated? Dr. Brian Levine, the founding partner and practice director of CCRM New York, says to avoid foods like white rice and white sugar that cause inflammation. Although you might crave these foods, swapping them for a healthier alternative just one meal per week can help you begin a healthy diet transformation — you don’t need to make sweeping food changes right away.
For example, instead of chicken and rice, try chicken with cauliflower. You can pulse the vegetable in a food processor until it resembles the consistency of rice, say Jessica Jones, RD, and Wendy Lopez, RD, of Food Heaven Made Easy. Or, swap one cup of white sugar for a half a cup of honey. According to a review published in Pharmacognosy Research, “honey can act as a natural therapeutic agent for various medicinal purposes” such as diabetes and cardiovascular and respiratory diseases.
You don’t need meditation experience to begin a compassionate meditation practice. In fact, all participants in a study published in Frontiers of Human Neuroscience had no background in meditation. But in 20 minutes a day for two months, researchers found people who practiced compassionate meditation increased their social support, felt more purpose in life, decreased illness symptoms and enhanced their life satisfaction. To start such a practice, simply sit with your eyes closed, concentrate on your breathing and think of someone you love. As you get more comfortable, expand your thoughts to more people you know, then on to strangers and on to the world. Although you will still hear bad world news, you should start to achieve a healthier ability to digest negative information.
Planks are one of the hardest exercises to get right. Yet, most of us incorporate planks into our workouts, whether it’s running, lifting or doing bootcamp. What many of us don’t realize is we’re planking all wrong.
“Planking is the gold standard exercise for core strength and stability,” explains Shana Verstegen, fitness director at Supreme Health and Fitness in Wisconsin. Doing them properly has real benefits. “They will make you a better athlete, help prevent/reduce back pain and allow you to move better in life.”
Here, learn how to maximize the perks of this exercise staple.
Most exercises can benefit from a bit of glute engagement, and planks are no exception. “Squeezing your glutes causes a bit of a stretch in your hip flexors, which transfers more of the workload to the abdominal muscles,” explains Greg Pignataro, certified strength and conditioning coach at Grindset Fitness. And your abdominal muscles are what you’re trying to work, right? “Additionally, contracting the glutes will reduce strain on your lumbar spine by preventing your lower back from sagging,” Pignataro adds.
Seriously. “Dr. Stuart McGill, a professor from the university of Waterloo who has spent 30+ years researching the spine and back pain, touts groundbreaking research about core ‘stiffness,’” Verstegen notes. “Holding planks for 10 seconds at high tension followed by a brief rest period before the next rep creates a much stronger core with fewer injuries.
“Pavel Tsatsouline, most famous for popularizing kettlebell training, agrees. He designed the ‘RKC’ plank around this philosophy of full-body stiffness and also promotes shorter, stronger plank holds.” Try doing a set of 3–10-second holds with maximum contraction for the best core strength gains.
Just as every body is different, every perfect plank setup is different, too. “Due to individual differences in body size and limb length, the ideal position is probably slightly different for every single person,” notes Pignataro. “This is important, because planks should challenge your core musculature, not hurt your elbows or shoulders. Experiment by moving your elbows and feet a few inches inward, outward, backward or forward until you find your sweet spot!”
Some people struggle to feel their abs firing during planks. If that sounds familiar, try this: “Once in plank position, pretend you are looking over a fence by pulling your elbows down so you can get your head and neck to feel taller,” recommends Brian Nguyen, CEO of Elementally Strong. “This will pull your hips and shoulders into alignment and you should feel more where you want it … abs, baby!”
“To make your planks count, every muscle needed to stabilize your spine is firing at a maximal effort,” says Kari Woodall, owner of BLAZE.
Doing so can even even help with your preferred method of exercise. “If I want to crush my deadlifts, I need the requisite core strength to pick up something heavy. If my body doesn’t understand what a maximal contraction feels like, then I am not only limiting how much I can lift, but I’m increasing my risk of injury if I do pick up something heavy,” she explains.
Not feeling the burn? “Squeeze your armpits like you have million-dollar bills tucked underneath each one, and you get to keep the money if no one can rip them away from you,” Woodall adds.
Falling on ice can leave you red-faced with embarrassment, or far more seriously, hurt badly from taking a knee to the ice or falling awkwardly on icy snow. Slippery sidewalks, driveways and icy parking lots can be risk factors for falls in winter. Avoid a bad fall with these top tips!
Walk like a penguin
The penguin waddle helps you keep a center of gravity over the front leg as you step, instead of split between the legs. Short strides also help keep your center of gravity, which help avoid falls. When walking, extend your arms out from your sides to increase your centre of gravity. Don’t keep your hands in your pockets! Walk slowly, with short strides and try to land your steps with a flat foot.
Keep walkways clear
Shovel snow and scrape ice as soon as possible. Liberally sprinkle ice melt product or sand onto walkways to provide foot traction and to make sure surfaces don’t turn to ice. This not only protects you and your family, but also postal carriers and others when they’re walking around your property. Where possible install or use handrails for extra support.
Take all precautions
Be extra cautious walking after a storm. Tap your foot on potentially icy areas to see if it is slippery. Hold a railing while walking on icy steps. Stay steady by wearing proper winter footwear. Lightweight boots with a thick, non-slip tread sole will provide good traction on ice. If a sidewalk is icy down the middle, walk on the snow beside it to avoid slips.
Lighten your load
Carry fewer bags on snow days, since excess baggage can throw off your balance and make it tougher to regain your balance once you lose it. Keep your hands free by putting away your phone while walking – you may need to catch yourself!
Boost balance with exercise
You can’t control the weather, but you can improve your balance through regular exercise. Exercise is an ideal way to help you stay safely on your feet because it helps improve balance, flexibility and strength. Talk to a chiropractor about ways to improve your balance and strength in order to prevent falls.
Visit your chiropractor
Don’t let a fall get you down. If you do take a tumble, visit your chiropractor. They’ll get you back to doing the things you love to do and will work with the rest of your care team to help prevent future falls.
You try to eat well to feel good and stay healthy. While it’s optimal to get your nutritional needs from the foods you eat, it’s not always possible. There is conflicting information out there on the benefits of supplements, but the Dietary Guidelines for Americans 2015-20201 say that supplements may be useful for providing the nutrients you may be lacking from diet alone.
Still on the fence? Consider these top five reasons to add a multivitamin to your daily regimen.
Healthy aging. As we get older, our bodies have a harder time absorbing nutrients from food. The National Institute on Aging notes that starting around age 50, people begin to require increased amounts of certain vitamins and minerals.1 In fact, according to a study published in the June 2009 issue of the American Journal of Clinical Nutrition, researchers found that taking a daily multivitamin & mineral supplement may help improve micronutrient deficiencies associated with aging.3
Making up for eliminated food groups. While some people have to cut certain foods like nuts or gluten out of their diets due to allergies, many eliminate particular foods or food groups from their diet voluntarily. This can cause vitamin deficiencies that would be helped with a multivitamin.
Trying a paleo diet? You might risk a shortage of calcium or vitamin D by eliminating dairy or grains. Cutting back on red meat? A multivitamin will replace the iron and B12 you would normally get from diet.†
Getting the RDAs you’re not getting from food.You’ve probably heard that the typical Western diet doesn’t include nearly enough daily fruits and vegetables. As part of that, you don’t always get the vitamins those natural foods supply. Supplementing with a multivitamin containing phytonutrients from fruit- and vegetable-derived ingredients may help. In addition, it’s important to keep in mind that RDA levels are set to prevent nutrient deficiencies. But there’s a wide range between taking enough vitamin C to avoid scurvy and the optimal amount you can benefit from.†
Getting that extra energy to get through the day. In today’s “go-go-go” society, one of the top complaints is a general lack of energy. Instead of reaching for that third cup of coffee, remember that your cells require certain vitamins and minerals to power your busy life; especially if you’re not getting a full eight hours of sleep or eating a balanced diet, a multivitamin can help provide the nutrients you need to feel energetic throughout the day.4
Managing stress. Daily life stressing you out? You’re not alone. But vitamins and micronutrients play a significant biochemical role in improving your brain’s cognitive processes, and studies have shown that a daily multivitamin—particularly one with high doses of B vitamins—can help to reduce stress and support a healthy mood.5†
Ready to add a daily multivitamin to your diet? Be sure to check with your healthcare practitioner to see if he or she has a recommendation and to ensure that any medications you’re currently on won’t interfere with their effectiveness.
Many women notice after age 45 that fat seems to accumulate readily at the waist. There are even terms for it, like menopause belly, muffin top, or “meno-pot.” What does the science tell us about menopausal belly fat and how to get rid of it? What are the hormonal drivers and are they amenable to change with personalized lifestyle medicine? Certainly belly fat, specifically subcutaneous and visceral abdominal fat, increases during menopause,1-3 when the changing hormonal environment can bring with it a remodeling of fat storage patterns. Abdominal fat, especially visceral fat, is biochemically different and more metabolically active than fat stored in other areas, secreting more pro-inflammatory cytokines and adipokines.4 That means preventing or reversing belly fat is not just a vanity project, it’s a meaningful step in managing a woman’s overall health, as abdominal fat has been consistently linked with insulin resistance, impaired glucose control, and overall higher cardiometabolic and breast cancer risk. Practitioners are often asked ‘How can I get rid of menopausal belly fat?’, and it is important to remember that effective management is multifaceted – encompassing an understanding how changes in sex steroids interact with other endocrine systems and also with lifestyle choices, and recognizing the best time to implement a lifestyle medicine approach is in the years before a woman’s final menstrual period.
The changing hormonal environment
A robust understanding of the hormonal changes associated with perimenopause and menopause can guide women toward effective intervention. Here are the top five hormonal changes associated with the menopausal transition.
Changes in estrogen and estrogen dominance: Menopause is often framed simply as the loss of estrogen, but the road from pre- to post-menopausal estrogen levels is not necessarily smooth. Although loss of estrogen itself is linked with increasing abdominal fat,2,3 paradoxically the estrogen dominance that occurs in perimenopause and that may continue into menopause is seen clinically as a culprit in expanding abdominal fat mass.5 Between age 35 and 45, most women are beginning to run low on ripe eggs and experience hormonal changes linked with advancing reproductive age.6 During this time reduced progesterone coupled with high and erratic estrogen occurs.6,7 Estrogen declines but is in relative excess to progesterone. This is the definition of estrogen dominance: having a progesterone level that’s less than 100X the level of estrogen, creating an imbalance in the estrogen-progesterone partnership and essentially an inadequate level of progesterone to keep estrogen in check. Local estrogen production in adipose tissue can also contribute to estrogen dominance during this time. For example, aromatase enzymes, responsible for converting androgens to estrogens, are more active in visceral adipose tissue of post-menopausal women in response to cortisol.8
Cortisol: Dysregulation of the HPA axis and cortisol excess can manifest as increased central and visceral fat mass and metabolic disturbances such as insulin resistance.9,10 Increased production of cortisol,11 and conversion of cortisone (inactive) to cortisol (active) has been described in post-menopausal women,12 indicating that increased cortisol synthesis and conversion could contribute to metabolic dysfunction in these women. Cortisol is regulated in part by sex steroids, and estrogen down-regulates the expression and activity 11β-HSD1, the enzyme involved in converting inactive cortisone to active cortisol13 – so higher estrogen, lower 11β-HSD1 and less active cortisol formed. Declining estrogen levels during menopause can have a knock-on effect on cortisol formation, and 11β-HSD1 has been shown to be upregulated particularly in visceral fat in post-menopausal compared with pre-menopausal women. 1,11,12 As well as contributing directly metabolic dysfunction, higher cortisol can feed back to hormonal environment and contribute to estrogen dominance occurring at this time through cortisol-induced aromatase activity.8,14
Insulin: Fat cells accumulating in the abdomen is linked with insulin resistance. The pro-inflammatory cytokines produced by abdominal fat interferes with insulin signaling.15 This results in insulin resistance where cell response to insulin is lost, which creates a cycle where greater production of insulin is required to manage blood glucose levels. Insulin is a gatekeeper of metabolism, and rising insulin levels can set off a chain reaction that ultimately leads to a cycle of weight and abdominal fat gain. Insulin can lower production of sex hormone binding globulin (SHBG) in the liver.16,17 Lower SHBG results in greater free androgens and estrogens in circulation, and is linked with visceral fat and insulin resistance in menopausal women.18,19 In addition, insulin resistance can have a knock-on effect on leptin, insulin’s cousin.
Leptin: Leptin is the put-down-your-fork hormone, the one that tells you when you are full.20 Elevated insulin levels eventually lead to elevated leptin, which despite what you may think, does not mean you are more likely to put down your fork and stop eating. Instead, consistently elevated leptin levels lead to a dysfunction of leptin receptors and they stop sending signals to the brain to tell you to stop eating – this is called leptin resistance.21 The mechanisms driving leptin-resistance are complex, but high intakes of refined carbohydrates have linked with its development.22
Thyroid hormones: Thyroid hormones, which regulate how quickly we burn calories and maintains our metabolism, can becomes unbalanced with age, a trend that has been labeled ‘thyropause’. If the thyroid becomes underactive, this can lead to symptoms including weakness, fatigue, and weight gain.23
What can be done?
One of the biggest myths in women’s health is that once hormones change with menopause, abdominal adiposity is immovable – however addressing modifiable hormones such as cortisol and insulin in the following ways can have an impact.
Make foundational changes to dietary intake. When evaluating diet, consider factors that influence insulin levels, such as high carbohydrate intakes or intake of refined carbohydrates which require greater insulin response to manage spikes in plasma glucose. Remove inflammatory or trigger foods, as inflammation can contribute to insulin resistance.31 Add in foods rich in antioxidants which promote detoxification. Eliminate alcohol which robs you of deep sleep and lowers metabolism by more than 70% for 24 hours. Choosing when to eat during the day can also make a positive impact to insulin levels and insulin sensitivity. Time-restricted feeding (TRF) protocols, a type of intermittent fasting, where food is consumed during a limited number of hours per day (often 6 or 8) has been shown to reduce body weight and abdominal fat32 and improve insulin sensitivity even without weight loss.33
Add more movement to the day. Sitting is like the new smoking. Approximately 35 chronic diseases and conditions are associated with sedentariness, and sedentary behavior makes people more prone to gain body fat.24High intensity interval training (HIIT) is effective at reducing abdominal and visceral adiposity, as well as improving insulin sensitivity and building muscle.25,26 Studies in post-menopausal women show that HIIT training results in greater abdominal and visceral fat mass loss compared to continuous exercise programs (where heart rate was maintained at a constant level)27,28 showing that HIIT is a time-efficient strategy for improving central obesity in this population. In addition to HIIT programs, practicing yoga can be recommended for menopausal women, showing significant reductions in menopausal symptoms.29 In broader populations, interventions that included yoga asanas were associated with reduced evening and waking cortisol levels, as well as improved metabolic symptoms.30
Support reparative sleep. A primary step to losing belly fat is to get enough sleep and to make it quality sleep. Epidemiological studies have repeatedly shown links between sleep duration and the risk of obesity and central adiposity.34 People sleeping 7-8 hours/night night have been shown to accumulate less visceral fat mass than those sleeping for ≤6 hours/night.35 Sleep debt leads to changes in leptin and other hormones related to satiety, greater feelings of hunger, dietary indiscretion and poor food choices, as well as reduced physical activity and insulin resistance.34 In other words, getting that solid sleep needs to be a priority. As well as sleep quantity, sleep quality has to be considered, as poorer sleep quality is associated with higher visceral fat mass.36 Subjective poor sleep quality is linked with altered cortisol response37 and insulin resistance in postmenopausal women.38
by Sara Gottfried, MD and Annalouise O’Connor, PhD
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Sara Gottfried, MD
Sara Gottfried, MD is a board-certified gynecologist and physician scientist. She graduated from Harvard Medical School and the Massachusetts Institute of Technology and completed residency at the University of California at San Francisco. Over the past two decades, Dr. Gottfried has seen more than 25,000 patients and specializes in identifying the underlying cause of her patients’ conditions to achieve true and lasting health transformations, not just symptom management.
Dr. Gottfried is the President of Metagenics Institute, which is dedicated to transforming healthcare by educating, inspiring, and mobilizing practitioners and patients to learn about and adopt personalized lifestyle medicine. Dr. Gottfried is a global keynote speaker who practices evidence-based integrative, precision, and Functional Medicine. She has written three New York Times bestselling books: The Hormone Cure, The Hormone Reset Diet, and her latest, Younger: A Breakthrough Program to Reset Your Genes, Reverse Aging, and Turn Back the Clock 10 Years.
Annalouise O’Connor, PhD, RD
Dr. Annalouise O’Connor is the R&D Manager for Therapeutic Platforms and Lead for Cardiometabolic and Obesity platforms at Metagenics. Her role involves research coordination, as well as developing formulas for targeted nutrition solutions and programs to assist practitioners in the optimal management of their patients’ health. Annalouise trained as an RD and worked in clinical and public health settings. Dr. O’Connor completed her PhD in the Nutrigenomics Research Group at University College Dublin (Ireland) and postdoctoral work at the UNC Chapel Hill Nutrition Research Institute.