I have a birthday coming up, and even though I won’t be turning the big “4-0,” to my dismay, it’s just around the corner. Around age 40, the nutrition and overall health challenges facing women can seem overwhelming. Good news though…whether it's unwanted weight gain, the loss of lean body mass, bone health concerns, or other issues that occur during the years leading to menopause and beyond, there’s much that can be done to remain healthy and stronger than ever.

The Weight Gain Culprit
One of the most infuriating challenges facing women in midlife is unwanted weight gain. The largest jump in the percentage of women who become overweight or obese occurs between the ages of 20 and 39 (51.7%) and 40 and 59 (68.1%) (1). Research indicates hormonal changes are responsible for the increase in body fat, especially in the midsection. The female hormone estrogen begins to decline during perimenopause, the time during which a woman’s body makes its natural transition to menopause, although very erratic. Perimenopause usually begins in a woman’s 40s but can begin as early as the mid-30s, according to the Mayo Clinic website.

The hormonal changes involved in menopause increase the rate which women store visceral fat, which surrounds the vital organs deep within the abdomen. This triggers changes in insulin sensitivity and glucose metabolism, putting them at increased risk of cardiovascular disease and diabetes (2). Emerging research has revealed changes at the cellular level cause menopausal women to store more fat with a diminished ability to burn fat (3). Unfortunately, fat is metabolized differently due to a loss of estrogen.

Luckily, there are strategies to decrease the rate of weight gain and chronic disease risk.

Research shows estrogen therapy helps prevent some of these age-related changes (4); however, it’s no longer recommended for all women because of potential adverse effects such as an increased breast cancer risk (5). It’s important for women to talk with their physician about hormone therapy, as it can be beneficial for some women, including those who experience premature menopause (before age 40) (5).

Physical Activity
The good news is exercise can help fight the inevitable weight gain. Physically active women who enter menopause are leaner than inactive women and have a decreased risk of developing metabolic disease (6). In one study, women whose activity decreased the most during and after menopause packed on the most pounds overall as well as in the midsection. Maintaining weight took an average of 60 minutes of activity per day, the same amount recommended for the average adult by the Institute of Medicine (IOM) (7).

Lean Body Mass 
Research has shown while changes in fat distribution can be attributed to hormonal shifts experienced by women in midlife, overall weight gain that occurs with age (about 1 lb per year) primarily is due to the effects of aging, such as decreased activity and a loss of lean body mass, which is more metabolically active than fat (6).

After age 40, women lose about 1% of their lean body mass per year if they’re inactive. All types of exercise are important to maintain and build muscle, such as cardio, strength training, and yoga. For example, cardiovascular exercise, such as brisk walking or jogging, strengthens the heart and lungs, helps improve the blood sugar and insulin response, and strengthens large muscle groups, while strength training helps build lean body mass in the arms, legs, and upper and lower back.

Protein Intake
In addition to including exercise to maintain and build muscle, women in midlife also need to eat protein during meals to promote muscle-protein synthesis, which is essential to the body’s ongoing growth, repair, and maintenance of skeletal muscle.

As much as 25 to 30 g of protein is needed at each meal to optimally stimulate muscle-protein synthesis (8). For example, in one study, people who received 90 g of protein evenly distributed among three meals (30/30/30) experienced a larger anabolic response to the meals after 24 hours compared with those who received a more uneven distribution (10/20/60) (9).

In addition to eating sufficient protein and balancing intake across the day, eating the proper amount and type of carbohydrate can help cut calories and control blood sugar. A good recommendation is for women to eat in reverse: the larger meal at breakfast and the lightest meal at dinner, and reduce calories from beverages such as alcohol, coffee drinks, and smoothies, which tend to be calorically dense.  

Bone Health
Another concern for women is the depletion of bone density, which often occurs after menopause when the ovaries stop producing estrogen. Women can lose as much as 20% of their bone density five to seven years after menopause (12). The best case scenario, experts say, is for women to enter menopause with sufficient bone density to minimize subsequent losses.

According to Dr. Diane Schneider, author of The Complete Book of Bone Health, there’s a critical window for bone loss, which occurs one to two years before a woman's last period and five years after that. Schneider says calcium, vitamin D, adequate protein, not smoking, and exercise are key components to decreasing the amount of bone loss. In one study, researchers estimated that women aged 80 who don't smoke, are physically active, and have a BMI of 25 will lose 25% to 38% less bone than women of the same age who smoke, are sedentary, and are thin (13).

After age 50, the Recommended Dietary Allowance (RDA) for calcium climbs to 1,200 mg/day, which makes meeting calcium needs challenging, especially since calcium supplements now are recommended less often because of potential heart disease risks.

Gastrointestinal Changes
Other issues women in midlife may face include changes in digestion. Fluctuations in ovarian hormones may contribute to belly bloating and sluggish intestines, says Kate Scarlata, RDN, CDN, author of The Complete Idiot's Guide to Eating Well with IBS. Common gastrointestinal (GI) symptoms that occur during perimenopause and menopause include bowel discomfort, abdominal pain, bloating, and altered bowel patterns. Researchers believe fluctuations in ovarian hormones contribute to this GI distress (14).

Scarlata says gut microbiota changes with age (15) with a decline in the number and variety of protective microbes, but she says researchers aren't sure how that specifically impacts GI issues in midlife.  

Some women develop lactose intolerance as they age, so incorporating lactose-free milk, cottage cheese, and yogurt into the diet will enable them to continue to eat dairy products and help them meet their calcium needs.

If gas and bloating are related to milk consumption, it may help to follow a low-lactose diet. Drink six to eight 8-oz glasses of water daily and eat adequate amounts of fiber (approximately 25 g/day). Choose less gassy forms of fiber, such as chia seeds, pumpkin seeds, and strawberries vs. choosing inulin or whole wheat fibers, which can cause more GI distress. 

Changing Nutrient Needs
When it comes to nutrient needs, women who have reached menopause don't need as much iron as they used to because they no longer menstruate; the RDA drops from 18 to 8 mg/day.

Folic acid, which helps protect unborn children against neural tube defects in the womb, no longer is a concern since postmenopausal women can’t get pregnant. Some research suggests that too much folic acid from fortified foods and supplements may increase the risk of certain cancers (16) so discussing folic acid supplements and fortified foods with postmenopausal women is important.

Because the risk of cardiovascular disease, diabetes, and weight gain rises after menopause, helping women choose a diet rich in nutrients but lower in caloric density is key, as is choosing healthful fats, lean sources of protein, low-fat dairy or dairy alternatives, and plenty of fruits and vegetables.

While women in midlife face many challenges, there’s much they can do to begin a healthful transition into the postmenopausal years. It’s possible for women to live their healthiest lives before, during, and after menopause. 

In Health and Happiness,

Kelly Harrington, MS, RDN

Registered Dietitian Nutritionist for Healthy Goods

Article courtesy of Today's Dietitian

 

References:
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2. Keller C, Larkey L, Distefano JK, et al. Perimenopausal obesity. J Women Health (Larchmt). 2010;19(5):987-996.

3. Santosa S, Jensen MD. Adipocyte fatty acid storage factors enhance subcutaneous fat storage in postmenopausal women. Diabetes. 2013;62(3):775-782.

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5. Hormone therapy: is it right for you? Mayo Clinic website.

6. Sternfeld B, Dugan S. Physical activity and health during the menopausal transition. Obset Gynecol Clin North Am. 2011;38(3):537-566.

7. Sternfeld B, Wang H, Quesenberry CP Jr, et al. Physical activity and changes in weight and waist circumference in midlife women: findings from the Study of Women’s Health Across the Nation. Am J Epidemiol. 2004;160(9):912-922.

8. Paddon-Jones D. Lean body mass loss with age. Abbott Nutrition website. Accessed December 27, 2013.

9. Paddon-Jones D, Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia. Curr Opin Clin Nutr Metab Care. 2009;12(1):86-90.

10. Symons TB, Sheffield-Moore M, Wolfe RR, Paddon-Jones D. A moderate serving of high-quality protein maximally stimulates skeletal muscle protein synthesis in young and elderly subjects. J Am Diet Assoc. 2009;109(9):1582-1586.

11. Layman DK. Dietary guidelines should reflect new understandings about adult protein needs. Nutr Metab (Lond). 2009;6:12 .

12. National Osteoporosis Foundation. Hormones and Healthy Bones. Washington, D.C.: National Osteoporosis Foundation; 2009.

13. Wilsgaard T, Emaus N, Ahmed LA, et al. Lifestyle impact on lifetime bone loss in women and men: the Tromso study. Am J Epidemiol. 2009;169(7):877-886.

14. Heitkemper MM, Chang L. Do fluctuations in ovarian hormones affect gastrointestinal symptoms in women with irritable bowel syndrome? Gend Med. 2009;6 Suppl 2:152-167.

15. Mariat D, Firmesse O, Levenez F, et al. The firmicutes/bacteroidetes ratio of the human microbiota changes with age. BMC Microbiol. 2009;9:123.

16. Shelke N, Keith L. Folic acid supplementation for women of childbearing age versus supplementation for the general population: a review of the known advantages and risks. Int J Family Med. 2011;2011:173705. doi: 10.0055/2011/173705.

 

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