What perimenopause gets blamed for

Philip Pape 0:00

If you've been gaining weight since your late 30s, into your 40s, and somebody told you, well, that's just perimenopause, maybe you don't question it anymore because, hey, it explains everything. It also takes the blame off you at the same time. Today I'm evaluating that claim against the longitudinal data. And that means a study that followed more than 1,200 women through the transition using DEXA scans. You'll learn what the scale actually does across those years, what genuinely changes that, hey, it's not your fault and not under your control, and why the metabolism piece of the story is actually the weakest link. Welcome to Wits and Weights, the show that puts a popular piece of fitness advice under the microscope, finds the hidden reason it doesn't work, and gives you the deceptively simple fix that does. I'm your host, certified nutrition coach, Philip Pape. And on the last episode, our big 500, I went through five beliefs that I used to hold about strength training over 40 and no longer do. Today it's sort of a sixth one, except this isn't something that I believe, but something that the entire industry has a collective delusion about, I'd say, and they keep repeating over and over, likely in the interest of selling you their quick fix program or the program that is the only one that can solve your problem. So menopause weight gain is probably the single most repeated explanation in midlife fitness right now. I see it on threads, Instagram, Facebook, everywhere. And I understand why, because it happens exactly when your weight does often tend to go up, or at least you have trouble losing weight around for many women in your early to mid-40s. Sometimes it's earlier, right? Like perimenopause, uh, that window can be quite long, can start in your mid-30s. But let's say 44, 45, 46, your genes get a little tighter, your cycle's getting a little more volatile because of the hormones. Of course, everybody's saying, oh, it's because of your hormones. And of course, that sounds reasonable, right? It sounds kind of intuitive. And you hear things like, hey, the math no longer applies because your body's changing. Whatever worked in the past doesn't work today. Your metabolism might be slowing down. Maybe you're losing muscle, maybe you're losing both. There's so many things. And I want to examine that today and kind of separate the wheat from the chaff, right? Get to the heart of the matter, like things that you can actually control that matter, and the things you can't, or maybe things that aren't even really happening. And then stick around to the end because I'm gonna share a study where lifting weights cuts hot flashes by 44% and what they did. And you're gonna like it because the recommendation is pretty much what I recommend anyway, but we're gonna reinforce exactly what that is. Okay, I know I'm such a tease. Okay, so here's the roadmap for today's episode. And I'm gonna come back to them, but I always encourage taking notes. First, what does the data, the human trials, longitudinal data show about weight versus body composition across the menopause transition? All right, I'm already giving you a little bit of a hint. Second, what about the metabolism claim specifically? Uh, and I want to spend a decent amount of chunk of time there because I think that is the one that is has the thinnest evidence that people misstate. Third, what about men over the same decades? What if we compare to what happens to men? That's gonna be interesting to see because if if we if men are doing something that is also happening to women, maybe we can take away some of the variables and simplify this. Um, and then finally, I'll tell you where I think the whole argument just falls apart. And I'm gonna have a little bit of tough love. Maybe you think I'm unkind, but it's gonna be the truth. It's gonna be tough love, and I think it might be the most important part of the episode.

What the medical bodies actually say

Philip Pape 3:44

Okay, let me start with a mainstream position. And I mean the real like medical bodies or organizations, not the interwebs or Reddit or whatever. Although Reddit could be pretty good, but also could be pretty terrible because it the real like medical and scientific advice does not say what you've necessarily been told it says. Okay, so if you go to Mayo Clinic's page on menopause weight gain, it says hormonal changes alone don't necessarily cause the weight gain, and that it's usually related to aging along with lifestyle and genetic factors. Then we have the menopause society. I love the menopause society personally, actually. I think if you can provide a find a provider, like an OB, that is associated with them, you'll probably have a higher quality person who really gets this stuff and tends to treat symptoms and understand things like HRT better. Anyway, the menopause society says aging is the primary driver of weight gain and that menopause plays its role in redistributing fat. The International Menopause Society published a position statement in 2012 saying that weight gain per se cannot be attributed to the menopause transition and that the steady gain of about a half a kilogram a year is due to age rather than menopause itself. So the official organizations already say roughly what I'm gonna spend 20 minutes saying. And that's important because medical consensus does have some weight. As much as the world we live in today with HHS and RFK Jr. and social media and broscience and everything else, right? And people pushing hormone treatment and the clinics and everything else, there's something to be said about scientific medical consensus based on real studies. There really is. There is a drift off of that consensus that has happened over the last roughly 15 years and it's been it's happened on social media. A lot of the loudest menopause causes weight gain messaging comes from people selling hormone therapy or a supplement or a menopause coaching program or menopause stack or whatever. I'm not saying that they are lying. I'm not saying that they don't have good intentions. Some of them are clinicians with lots of letters after their names that I might even take seriously on other topics. I'm not, I am saying that a claim which conveniently requires the thing that is being sold, it deserves a second look, a little bit of skepticism. Okay. And I like to disclose my conflicts, right? I sell an app, Fitness Lab, that tries to debunk all these mixed myths in the very essence of its messaging. So you should always apply the claim to me as well. Like, what am I trying to sell you? I have coaching, I have an app. What am I trying to sell you? Okay. The British Menopause Society is the interesting exception, by the way. Their patient fact sheet leans closer to the popular framing of this. They describe perimenopause as a kind of perfect storm for weight gain. So this is not a case where every expert body agrees in its own form of an echo chamber and that only influencers are dissenting here. I'm not going to tell you that either. All right. Even in the literature, there's always some disagreement. Okay.

What 1,246 DEXA scans found regarding scale weight

Philip Pape 6:54

So let's go to the best data that we have, which I think is the Swan study, the study of women's health across the nation. You probably heard me reference this many times at this point on the podcast because it's such a good data set. They followed women through the menopausal transition for up to 18 years with DEXA scans. Now, I've talked about DEXA versus other forms of body fat measurement. And I think it's a great tool when used in a research context, especially, where they're able to control how it's used. Okay. And they tend to use higher quality or better calibrated machines and things like that too. But it is a good tech, it is a good way to measure distribution of tissue. So we're not just using, for example, scale weight. Okay, we're gonna measure fat and lean tissue. Fat and lean tissue. Lean tissue includes muscle mass. The body composition paper from Gail Greendale and her colleagues in 2019 included 1,246 women, and they lined every woman up by her final menstrual period rather than by age. And what they found is that body weight climbed steadily through perimenopause or through pre-menopause. Okay. Body weight climbed steadily through pre-menopause, through the transition to menopause and out the other side, and that slope of increase didn't accelerate in any meaningful way at menopause. It just kept going the way it had been going. Now, underneath that increasing line of body weight, two things were changing at once. Fat mass gain roughly doubled, going from a quarter kilogram a year before the transition to 0.45 kilograms a year of increase after the transition. And then lean mass, which again includes muscle, flipped around from very slightly gaining to actively losing right around two years before the final period. Now it's interesting that these women were at least even just slightly gaining weight beforehand or gaining muscle. Now, that could be because we tend to gain a little muscle mass as we gain weight, regardless. So that probably explains it. But over the three and a half years of the menopause transition, that's about 1.6 kilograms of fat gained and two tenths of a kilogram of lean mass lost. And then both of those trajectories flattened out about two years after the final period. And I went to a workshop maybe a year ago with Dr. Bill Campbell showing that graph, a very fascinating graph. Okay. So, ladies, there's definitely something happening. But we need to understand what is happening and what you can do about it. So the scale isn't going to show you that. And the reason is fat gain went up by about 200 grams a year. Lean lean loss, lean mass loss went down by 120 grams a year. So when you add the two, they net out to roughly only 80 grams a year. And that's hardly anything. So the body composition changed dramatically, kind of under the scene or behind the scenes, whereas the weight barely showed any change, which, you know, going from an individual basis from woman to woman, you might have a slight drift up or slight drift down. My point is there's a lot more going on under the hood that you don't see. Okay. And that's what makes like trusting or relying on the scale weight so much very problematic. Now, the scale, you know, I've talked many times about how it's an important, helpful tool when used in the right way, especially when you're looking at your trend. But in this context, the scale can be very, very misleading. It could make you feel like nothing is happening in the exact years when a lot is happening under the hood, and you might be doing a lot of things about it too. And then it's easy for that, you know, passenger in your brain, you know who she is, who beats up on you on a regular basis mentally, to tell you, hey, that's your problem. Okay, now the body fat distribution piece is where menopause really does its

Where the fat goes during the transition

Philip Pape 10:43

thing. The Swan Regional Fat Paper, okay, so this is a kind of a substudy or subset in 2021, it found that visceral fat, good old belly fat, the fat around your organs, the dangerous fat. We don't, it's not great to have too much visceral fat. It's very inflammatory fat as well. And I mean that in the very scientific way of it creates inflammatory compounds like cytokines, et cetera, in your body, which causes a whole host of other issues. Anyway, the visceral fat started rising at the transition at over 6% a year. And android fat, which is that trunk pattern, went from 1.2% a year to 5.5% a year. This is the so you know the bigger uh belly fat and the more hip fat and things like that. There was also a study uh earlier by Pennington or out of Pennington by Jennifer Lovejoy, and it was a four-year study that used CT imaging. I like this study because of how it isolates the variable. Every woman in it gained subcutaneous abdominal fat with age. Okay, that's that's the safer, okay, fat. Only women who actually became postmenopausal gained significant visceral or belly fat. So there is a very real effect from menopause that we've seen with imaging, and that's distinct from aging. Very interesting, right? Nobody should be trying to disabuse you of that notion. That's the truth based on the evidence. And it's also not talked about in the right way, I think, in this industry.

Men over the same decades

Philip Pape 12:10

Now, let me do the comparison to men, which a lot of people don't do, because this is gonna be fascinating. So if you're a man listening or a woman listening, this is gonna be fascinating. The Fells longitudinal study followed 102 men and 108 women between ages 40 and 66. Men gained weight at about 0.3 kilograms a year and women at 0.55. The fat gain was almost identical, about 0.37 kilograms a year in men and 0.41 in women. Men, of course, don't go through menopause. They don't have a big cliff with their hormones like estrogen. You know, they might have a gradual transition to testosterone, but they don't have this transition that's distinct like women do. And they gained fat across those decades anyway, anyway. So we need to start to say what's causing what here. Now that was a small cohort, right? I said 102 men, 108 women, which isn't nothing. It's not like studies I have 10 people, but it's not as good as maybe somebody with someone with 500 or 1,000. The day is a little bit older. It's hard to compare the sexes across studies because of other variables, potentially. Women did gain somewhat more total weight and women lost fat-free mass faster. So I'm not claiming the sexes are identical. I'm just saying that there is some overlap happening with age that we have to account for before saying, okay, what is left? I hope that makes sense. Now I

How to use your data for fat loss instead of guessing

Philip Pape 13:35

just want to take a quick moment to talk about if you are wondering how to control the lifestyle factors that we're gonna talk about, especially your nutrition and your training, and you've been hearing the message over and over my metabolism is broken. I'm not sure what to do. I can't stay consistent. I can't see the results. That is the problem my app was built around called Fitness Lab. I'm very proud of this app. Everyone who's using it now are finding it very helpful because of not just the features, but how it keeps you going to the gym, watching what you eat, being flexible, being sustainable, actually starting to move the needle in a very confident way that integrates your whole lifestyle. It's kind of like a lifestyle app almost. Okay, it doesn't just give you numbers like here's your expenditure, here's a calorie target. It is far, far, far more than that. It's a little bit unusual, in fact. So I want to explain it today. Yes, this is part of a pitch, I'll say, but it's also why we need to think of these a different way. All right. Total energy expenditure estimates typically have enough error that when you anchor to it with your calorie deficit, for example, you tend to just start distrusting the idea of calories in, calories out, or the idea of calorie deficits, fat loss, all of that, especially when you do it in conjunction with your scale. I also have seen that having targets, just having numeric targets, can create these all or nothing past fail comparisons in your brain. And then you start to judge yourself. And then you start to feel like even in even in neutral apps, you know, like some apps that I like that don't really judge you intentionally, you still tend to judge yourself and you create this loop that is connected with dieting history and dieting culture, probably from your past, that led to these multiple cycles of cutting and gaining and cutting and gaining. So we take something like my app Fitness Lab, it uses AI. It's technology. I'm gonna admit that because AI is amazing when you can use it for good. So, what it does is it reads the rate of change in your weight, it reads the trends, it looks at your lifting, it looks at your biofeedback. If you use an iPhone and connect it to Apple Health, it can pull up to 85 metrics from sleep to nutrition to workouts, everything, to then infer, hey, what is going on with your body right now? Let's put those patterns together. And I know you want to lose fat, but here's some tough love on the reality of what's going on and how you can do that successfully. So, anyway, I wanted to just kind of take that detour because we are running a Labor Day sale right now through September 15th. And the only way to get the 30% off permanently is if you're on my email list. If you're not on the list, go to witsandweights.com slash email. That's witsandweights.com slash email. As soon as you join the list, the welcome email will give you the discount. Again, it expires at the end of September 13th. It's our Labor Day sale, 30% off permanently, but you have to be on our list. Witsandweights.com slash email. Okay, so that's what happens to fat and lean tissue during the menopause transition. Now let's

The metabolism claim and its thinnest evidence

Philip Pape 16:36

talk about metabolism. Okay, metabolism, this is probably the weakest link of the whole discussion around menopause right now. The popular version says, hey, menopause slows your metabolism. And some people say, oh, it's two or three hundred calories a day. Okay. I don't believe it. I don't believe it because of the evidence, and I don't believe it because of anecdote and personal experience. All of it put together. Herman Poncer published a paper in science in 2021. And if you've read his book, Burn, like I have, I have it on my shelf. It's a great book. You know his work. And he has changed how a lot of us think about energy expenditure. He and his group pooled doubly labeled water data, very high quality way to measure metabolism. And he did it on over 6,400 people. Now, doubly labeled water is the gold standard because you drink water with tagged hydrogen and oxygen. And then they can measure how fast you clear those from your body, which tells them exactly what you burned for your metabolism. Pretty cool, right? And what they found is once you adjust for fat-free mass and fat mass, total energy expenditure is essentially flat from about age 20 to age 60. It is flat across pop the populations, across cultures, Western, tribalism, tribal cultures doesn't matter. Active, inactive, it doesn't start declining until roughly 60 years old. And then it's like 0.7% a year. So this entire window where women are told their metabolism is crashing is the same window where the best measurement we have says, no, it's not really happening. All right. It's not really happening. Now, Ponser's own group will say, you know, we had some limited resting data through midlife specifically, but still they have it all the way from 20 to 60. Then we have a 2023 paper from Carpin and colleagues that went at this directly in 120 women. Some of them were mother-daughter pairs. The adjusted resting energy expenditure did decline with age, which we expect, but the menopausal status didn't contribute anything to that decline. Not estradiol, not FSH. None of them predicted resting energy expenditure once you accounted for body composition. Now, if we look at the other side of the research, Eric Pullman published a six-year longitudinal study in 1995 showing that women who went through menopause had resting metabolic rate drop by about 103 calories a day, compared to eight calories in women who didn't, okay, who didn't go to menopause. And a lot of people cite that study, but when you look at what else happened in the same group, they lost three kilograms of fat-free mass versus only half a kilogram in the non-menopause group, and their leisure physical activity dropped by 127 calories a day, but the comparison groups went up by 64. So the metabolic rate went down because why? Because the muscle decreased and the movement decreased. That's a totally different claim than menopause is just independently lowering your metabolism. Now, Lovejoy's group also measured sleeping energy expenditure in a metabolic chamber. And the decrease was about one and a half times larger in women who became postmenopausal. And fat oxidation fell by about 32%. Now it was a small sample. It hasn't been, I don't think it's been replicated. I'd love to see it done again. But there still does seem to be something genuinely menopause specific happening with how you use fuel. And if you've heard me talk about menopause belly fat and you know substrate oxidation before, that's what I was talking about. And then I think that stands. I think that still is a thing. What doesn't hold up is taking this leap of logic from okay, my body's changing in how it uses the fuel and distributes fat to, oh, you're just gonna burn 200 fewer calories fewer per day. And hey, come come to my program. We're gonna do the reverse diet, metabolic, hormonal reset, optimized program for you. Okay.

What 28 hormone therapy trials found

Philip Pape 20:36

So one claim is physiology, which is true, the other one is an excuse to sell you something. Now, we have a natural widespread experiment that has occurred for a long time in the world that we should look at, and that's called hormone therapy. If estrogen loss causes weight gain, then guess what? Replacing estrogen should prevent weight gain, shouldn't it? Right? Well, the Cochrane Review looked at 28 randomized trials, over 28,000 women, and they found no evidence that hormone therapy prevents menopausal weight gain. That's crazy. Wow. I've heard a lot of podcasters make the claim that, oh, just go on HRT and it's gonna solve your weight gain issues, issues. What it did find in the Women's Health Initiative body composition substudy, which I know women's health initiative has a huge asterisk because of how it's been interpreted and used for some nefarious purposes, like saying that there's a link, there's a cancer link that that's not there. But if we actually look at the data of 835 women, they found that hormone therapy the hormone therapy group lost quite a bit less lean mass over three years and carried less trunk fat. So guess what? I will agree that estrogen appears to affect where the fat goes and how much muscle you hold on to versus what the scale weight says. And that's exactly everything else we've been talking about. So going back to all the people claiming you you need HRT to lose weight, that's not accurate. But it could probably help with your body fat distribution, which then can help you. With other things, including potentially gaining or losing weight. But again, weight doesn't really matter. What matters is are you healthy? Do you have the energy? Do you have the fuel? Are you functional? Do you look good? Like feel good? All those things that matter, whatever matters to you. Okay. Now, I am not saying menopause is in your head either. Hopefully you couldn't get that from this episode. You know, I'm not saying nothing changed. I'm not saying you're eating more than you think and you won't admit it or you're not tracking properly and all that, you know, things that 25-year-old influences will yell at you about. I'm not saying this is a discipline pro discipline pro discipline problem, because I've seen so many of you be working so hard at this for that to be true. What I'm saying is that four things have changed and they're very specific, just to recap. Your fat moved toward your midsection, toward your organs. That is hormonal and it is measurable. Not your fault. Your muscles started to decrease faster around that final period as you get into post-menopause, not your fault. Your sleep probably got worse. And when we look at the Swan data, it shows hot flashes precede the weight gain with sleep problems affecting part of that, right? Kind of a bi-directional thing. So activity and then adherence are negatively affected by that. And your physical activity most likely dropped, which is behavioral, but it's often downstream of the other ones. Again, rather than quote unquote, your fault. What didn't change in all this is whether energy balance works, calories in calories out, that still does work. That's kind of good news buried in here. Okay. As well as lifting weights and all the other things we talk about. That is the good news because if your body's still gonna respond perfectly normally to those inputs, well, then it's in your control. You are the captain of the ship. It might take you a little long to steer the ship, a little long to turn it around, but you can do it. Okay. So

4 things to target instead of the scale

Philip Pape 23:45

what is the fix? Well, there's four things. So this is where we get to okay, here's the simple fix. Simple, not always easy. Two different things. Simple, but you got to make it happen. First, the scale should no longer be your primary measurement instrument. Okay, it's it can be one of them, and it probably should be if you're trying to calculate your metabolism, right? Like we do in our app and fitness lab or in macrofact or whatever. But waist circumference and strength are probably better indicators. Those two track the things that actually change. If your weight is flat, but your waist is decreasing, that's a huge win, right? You're getting leaner. Second, progressive resistance training is the biggest lever. Okay, but it has to be progressive. As in the loads, weight on the bar, weight on the dumbbells, weight on the machine, and/or the reps are going up over time. You are getting stronger. You're not just doing the same three sets of 12 forever with the pink dumbbells. That's my uh flippant way of characterizing a lack of increasing weight. I apologize. Muscle loss is around three to eight percent per decade after 30, and the menopause transition accelerates it for a few years. Training, therefore, is the only input that can reverse all of that. And we see this in trials in postmenopausal women that are, you know, which are consistent when it comes to strength and lean mass. Okay, this is not just something I believe, this is something that works. Third, protein, protein, protein, protein. We can't talk enough about protein. I'm sorry. And if you're at the point where you're sick of it, then great, then you know what to do. Okay. I work with a minimum of 0.7 grams per pound of body weight. That is what I always say all the time, and I will continue doing that. All right. A an increase above that has small additional benefits. So we always say that anything higher than that is more about preference, lifestyle, balancing your macros, things like that. Maybe even a little bit of optimization if it if it gives you a little bit more muscle potential. That's the third one, protein. Fourth is sleep. Now, I want you to think of sleep and hot flashes as a body composition intervention. Because remember, in the Swan study we talked about, that's the pathway that tends to connect menopause to weight. If you can fix the vasomotor symptoms, right, to use the technical term, and the sleep, it then helps you be more active and be more adherent. And also, by the way, tend to eat fewer calories just naturally. And all of those things then help you affect your fat loss, right? So again, a lot of this does come back to sleep, not just for recovery, but for how it downstream affects these other things. And speaking of eating, which I know where there's a lot of fear about eating for a lot of you, both fear of like what to eat, that you're gonna gain weight, that you're eating the wrong things, and all these things are just toxic for you. There was a the Monet study looked at energy intake across the menopause transition, and they found that it didn't go up. In women who became postmenopausal, it actually went down. So, this story, this narrative where menopause makes you ravenous and you eat your way through it, it's not what the data shows. Now, maybe as an individual you're eating more, and there could be other reasons for that. And if anything, guess what? Most of the women I see and coach and eat more lift heavy or those who use my app are probably under-eating relative to what their training demands. The key being that they are training. If you're a sedentary, it's probably a lot easier to overeat and have it, the body fat distribution thing work against you. All right. So it's not that you have to be in a surplus, by the way. We're gonna have an episode coming up soon about how you can build muscle without even being in a surplus. So definitely follow the show if you're not already. So before we wrap up, I wanted to share the hot flash trial and how you might be able to reduce hot flashes naturally. Okay. Quick reminder that the Fitness Lab sale runs through September 13th. Join my list at witsandweights.com slash email. And the permanent 30% off for life of Fitness Lab will be in the welcome email. If you're already on my list, you'll be inundated with several emails about this anyway. Hopefully you don't under unsubscribe so you can get that. You can then unsubscribe after you if you want. But that's through September 13th, wits and weights.com slash email.

Bonus: how to reduce hot flashes

Philip Pape 27:57

All right, so let's talk about hot flashes for a second. Researchers in Sweden took 58 postmenopausal women who had seven moderate to severe hot flashes a day, and they were not exercising. Half of them started lifting three times a week for 15 weeks, and they did chest press, leg press, rows, leg curls, and pull downs, and their loads went up over time. So progressive overload. Their hot flashes dropped 44%. In the control group that didn't change anything, they didn't start exercising, their hot flashes dropped 2%. Now, they dropped, but that's hardly anything. And I'm guessing that's like a placebo effect potentially. So what do you do with that data? Well, are you lifting weights? Okay. If not, big lever right there for a million reasons. And if you are lifting weights, are you actually progressing? Are you actually progressing? If you're not training frequently enough or with enough volume or intensity, any of those things can prevent you from progressing. And if hot flashes or anything else are your concern, just lifting the right weight and getting stronger, you'd be surprised at how much that can help. And again, if you want to use my app Fitness Lab, it does that for you. It will give you a program based on your needs. It'll tell you exactly what to lift, what you lifted last time. It is bang on an amazing experience for all those who want it. You got to go to witsandweights.com/slash email to get the 30% off. Okay, until next time, keep using your wits, lifting those weights. And remember that menopause changes where the fat is distributed and how fast you lose muscle. It doesn't change whether the overall math works. So don't let anybody sell you that when you have all the control. I'm Philip Pape, and I'll talk to you next time here on the Wits and Weights podcast.