Weight Gain and Menopause

A recent review of the science published in the Mayo Clinic Proceedings shines a light on aging women’s health, in particular the influence of body weight on heart disease risk.

What is the Issue?

On average women gain 1 1/2 pounds per year in their 50s and 60s. This has resulted in high levels of overweight and obesity in midlife women in the U.S., where 2/3 are overweight.

Excess body weight is a leading risk factor for heart disease, the #1 killer of women in this age group.

Additionally, menopause changes where women carry their body fat, increasing abdominal fat to 15-20% vs only 5-8% in premenopausal women. This type of fat causes greater health risk, increasing cholesterol and blood sugar levels.

Potential Causes of Weight Gain

  1. Menopause: according to the authors, decreased estrogen brought on by menopause has a strong influence on where women store their fat, but does not appear to cause weight gain. However, symptoms associated with menopause- sleep disturbances and mood disorders- are factors that likely lead to increased weight.
  2. Aging or Physical Inactivity? Aging itself decreases muscle mass, resulting in lower calorie needs. Muscle loss increases around the age of 65 for most adults. However, lack of physical exercise may be more to blame than biologic changes of aging. Physical inactivity after the age of 30 results in 3-5% muscle loss per decade. For most people, physical activity declines with age, but it doesn’t have to- while you may slow down, staying active is essential to staying healthy.

    In studies of female twins, physical inactivity was the most important lifestyle factor associated with weight gain.

  3. Poor Sleep. I’ve written about the connection between sleep and weight gain, and studies of postmenopausal women make this connection clear: of 68,000 women, sleeping 5 hours or less lead to more weight gain than sleping 7 hours or more.

How to Keep it Off

  • Reduce calories: the authors don’t recommend a specific diet, noting that studies show any diet reducing calories will work – IF people stick to it. That’s a big if, possibly the key factor to successful weight loss. So find an approach that you like, that you can see yourself embracing for the rest of your life.

They suggest a daily caloric deficit of 500-750, equating to 1200-1500 calories per day.

  • Exercise: physical activity without caloric restriction is unlikely to result in weight loss. However, most successful dieters maintain their weight loss using a regular exercise regimen. Additionally, exercise improves blood pressure, blood sugar control and cholesterol- further reducing heart disease risk.
  • Or even better- do both! Combing exercise and diet will help to maintain muscle mass while maximizing fat loss. This will keep your metabolism burning at a higher level making it easier to both lose weight and keep it off.
  • Have a reasonable weight loss goal. Modest weight loss will provide health benefits. You don’t have to reach some arbitrary “ideal” body weight to be healthier and feel better.

Aim for 6-8% weight loss of your current body weight over about 6-12 months.


Happy eating,



Befriending your Appetites

hands-63743_1920Last week’s blog explored intermittent dieting as a solution to the psychological and physiological resistance to long term dietary change. Today we’ll look at another approach that addresses the common struggle to maintain efforts at improving nutrition: becoming a connoisseur.

Enjoy Your Food

This may sound like a paradox: enjoying food more will help you eat less of it and make healthier choices. However, this is a key concept in the mindful eating approach which has been shown in several small research studies to benefit long term weight loss.  Mindfulness- paying attention moment to moment without judgement- while eating helps slow down the eating process. This simple act allows the stomach and brain to register fullness so you can be satisfied with smaller amounts of food. Part of slowing down and paying more attention to your food is about taste. Called “tuning into taste” this is where you can begin to befriend your appetites and flavor preferences.

The Connoisseur-Health Connection

Focusing on flavor and the experience of eating bite by bite will:

  • guide you in choosing to eat only foods that you really enjoy
  • help you figure out what meals and foods bring you the most lasting pleasure
  • and which ones lead to unhealthy choices or overeating.

Try this experiment with a variety of meals and locations.

Tuning into taste exercise

  1. Bring your full awareness to the present moment. Take a breath and feel your chest rise and fall.
  2. Take a small amount of food, name it’s components as specifically as you can.
  3. On a scale of 1-10, how much do you like this food?
  4.  Place the food in your mouth, feel the texture, notice the flavors. Name them as specifically as you can.
  5. Swallow the food and notice the sensations.
  6. On a scale of 1-10, how much do you like this eating experience?
  7. Continue this exercise from #4 with at least two more bites. Notice how the experience changes. Notice how your rating of the experience changes.

You may find that eating with certain people heightens your enjoyment of a meal or that eating in a crowded, loud restaurant decreases your enjoyment. And that along with the changing enjoyment of the experience you may be prone to eat more or less food. This awareness of our habits and tendencies is another key component of mindfulness. We can begin to make different choices to situations once we become aware of how we habitually react. The goal is to cultivate responses instead of reactions. This possibility is described beautifully by the psychiatrist Viktor Frankl:

Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.

So crank up your taste buds, explore the flavors and textures of your food. Have fun, experiment and make intimate friends with your relationship to food. You just might find a little more ease and freedom with cravings and enjoy your food more.

Happy eating!


Take a Break to Improve Weight Loss

diet-403588_1920Fact: 80% of people who lose at least 10% of their body weight will regain it. This is known as obesity rebound.

Why does this happen?

Theory #1 metabolic suppression:

  • There is growing evidence that extended periods of caloric restriction (dieting) result in a prolonged reduction in metabolic rate. What this means is that the body slows down it’s energy consumption in an attempt to prevent weight loss- as if it is in survival mode during starvation. A study of this reality for Biggest Loser participants got a lot of press a few years ago. Metabolic suppression may also explain why many people experience “plateaus” in efforts to lose weight as the body goes through phases of resisting further weight loss.

Theory #2 restriction leads to rebellion:

  • Another common issue is that when trying to lose weight, most people take an all or nothing approach- picking a very restrictive diet and sticking to it…until they don’t when many give up and abandon the effort. We’ve long known that this mentality is often not effective, as it tends to work against our very human difficulty in following specific diet plans for the long term.

How can you work around the weight regain trend?

A novel approach to sidestepping both metabolic suppression and the “make-it or break-it” approach is called intermittent dieting. In a recently published study out of Australia, 51 obese but otherwise healthy males followed a rotating diet plan of two weeks on and two weeks off for 30 weeks. Caloric intake as reduced to promote weight loss during the two week “diet phase” then increased to maintain current body weight for the “recovery phase.” The control group followed the caloric restriction diet for the full 30 weeks of the study. The results were positive for those on the intermittent dieting plan:

  • They lost more weight and kept more of it off (18 pounds) 6 months after the study was over.
  • Their resting energy expenditure (calories burned at rest – a stand in for the metabolic rate) was higher- meaning they had less metabolic suppression from weight loss.

This approach differs from intermittent fasting I wrote about a few weeks ago in that the resting phase is carefully structured to provide enough calories for no weight loss or weight gain. The working theory of the researchers is that this steady state allows the body to recover and prevents metabolic suppression.

Next week I will cover another solution: the connoisseur diet.

Happy eating,



The Skinny on Fats

Drizzled, creamy, rich, gooey…there’s no arguing, fats are delicious! And as with all things food, we have ever expanding options; some claiming to be healthy choices that won’t hurt your heart or inflame your cells and may even prevent disease. But can you trust the claims? Let’s look at the research behind a few of the latest trends:

Coconut oil

A relative newcomer to the western diet, coconut oil is often promoted as a health food that will benefit a myriad of conditions, from heart function to inflammation and cancer. Eaters flock to advice like this: you can enjoy all the taste and baking performance of a saturated fat without the guilt. Unfortunately the research has not supported these claims and yet is still in preliminary stages- so as we gather more evidence recommendations may change. It appears that the high level of saturation of this and other tropical oils (primarily palm) does not have a positive affect on cholesterol.

  • Studies indicate coconut oil raises LDL (unhealthy cholesterol). Not as much as butter, but lower LDL levels are associated with fewer heart attacks and strokes.
  • Populations who consume high levels of coconut oil tend to have better heart health outcomes, however they don’t consume high levels of saturated fat from other foods.

The bottom line: The American College of Cardiology recommends avoiding coconut oil due to its high level of saturated fat.  One way to think about this issue is identifying what coconut oil takes the place of in your diet. Given the last bullet point above, it may be healthier than animal derived fats like butter or cream.

Learn more: Ask the doctor: coconut oil.


High in saturated fat like all animal derived fats, butter has long provided the satisfying creamy texture and “buttery’ flavor to baked goods and sauces. Starting in the 1970s, health professionals warned Americans to eat less butter for their heart health. This early evidence has come under some scrutiny over the past decade, with some researchers suggesting we got it wrong and that butter is a healthy option. Recent studies have not born this out:

  • Researchers evaluating the very large, long term Nurses’ Health Study recently reported increase risk of death with higher saturated fat intakes. While this does not single out butter, it does support the predominance of both experimental and observational studies that the more butter we eat the higher our risk of disease and death.
  • Another large study evaluating the health of common dietary patterns in the U.S. found that the Southern Diet, high in saturated fats (along with processed meats and sugar sweetened beverages) increases risk of stroke by 30% and acute heart events 56% along with higher levels of diabetes and high blood pressure.

The bottom line: it can be difficult to translate research into daily life. Will some butter increase your risk of disease? Probably not, but how much is too much? Using butter as your daily fat for cooking or adding to your bread is likely unhealthy. Using it on occasion, considering it a “treat” food would be a wise middle way.

Learn morewade into the butter wars.

Omega-3 Fatty Acids

Fatty fish, and some plants – flaxseeds, walnuts, and leafy greens- provide this type of fat that has been identified as health protective. You can also take these as supplements, and studies show that fish oil containing omega 3 fatty-acids EPA and DHA lower triglycerides (circulating fats similar to cholesterol) by as much as 50%. While plants don’t provide EPA and DHA, we can convert their omega-3s into these compounds. While this conversion creates only 10% of the marine omega-3s, these foods provide other health benefits in their fiber and phytonutrients.

The bottom line: Despite all the research and attention, the jury is still out in regards to health outcomes- omega-3s appear to reduce inflammation and cholesterol- does this translate to less disease and increased longevity? We don’t have studies that close that loop. The standard advice is to aim for two 3oz servings of fatty fish per week or supplement with 300mg DHA. The science is a bit complex for plant sources, read here for more: vegetarian omega-3 recommendations.

Learn more: where to get your omega-3s.

Happy eating,


Oil on a Hot Tin Roof

What fat is healthy to use when cooing?

The answer depends in part on how you are using the oil.

Cooking oils

Heating fats, just like any other food, begins to break down the chemical components- you are adding energy from heat to raise the temperature. All fats will eventually burn at high enough temperature- called the smoke point – which you have seen if you leave a pan of fat on the stove for too long. This is something you want to avoid, the smoke point will produce off flavors and carcinogenic (cancer causing) compounds. So, look for oils with high smoke points when you are cooking at high heat. Refining oils will increase the smoke point, making them safer to cook with at high temperatures.

Standard cooking temperatures

  • stove top (pan frying) 250-320F on medium/low heat
  • oven baking 350-375
  • oven roasting 400-450

Smoke point of standard fats

  • Butter 302F
  • Extra virgin olive oil 375
  • Olive oil refined 390-470
  • Coconut unrefined/ virgin 350
  • Coconut refined 400
  • Peanut, sunflower, sesame, peanut, corn refined 450
  • Grape seed 485

As you can see, lower temperature baking and pan frying are safe even with the lower smoke point oils like extra virgin olive oil. However, you should have a standard high heat oil option to cook with as well. Choose your oil based on the temperature you are cooking at.


This one’s up to you, experiment with unrefined oils which have more flavor than the processed oils. Walnut, coconut, sesame and olive oils will add a nice flavor to raw dressings and sauces. Cooking oils will degrade their flavor molecules, so save your expensive unrefined and virgin oils for raw uses or adding after foods are cooked.

Heart health

No fat is a health food per se. They all contribute significant calories (120 per tablespoon) to the diet, more than twice the calories per gram as protein or carbohydrates; but some are healthier than others. Fats have been studied for their impact on heart health, in particular how they affect cholesterol levels. If you have high cholesterol, replacing saturated fats (those solid at room temperature like animal fats) in your diet with unsaturated ones is a good idea. Vegetable oils tend to be rich in unsaturated fats, either poly-unstaturated or mono-unsaturated. Both will lower LDL (unhealthy cholesterol) when used in place of saturated fats or refined grain products. However, polys lower LDL the most, which is why the American Heart Association recommends them in heart healthy diets.

  • Poly-unsaturated oils: Corn, sunflower, peanut, walnut.
  • Mono-unsaturated oils: olive, canola, avocado, safflower

Tune in next week for the skinny on fat fads- from coconut oil to butter.

Happy eating,


Hormones and Appetites

anatomical-2261006_1920Who controls how much you eat? Are you in charge or are your hormones? Two new studies evaluate the impact of these chemical signals on hunger, body weight and fullness.

First- the brain

A study published in The Journal of Neuroscience evaluated the impact of a large meal (1040-1100 calories – about 50% of the recommended intake for an entire day) on opiod receptors in the brain. The opiod system is known to be involved in perceptions of enjoyment – often referred to as the hedonic response. These chemicals are released when we experience pleasurable sensations, like eating. The researchers found that the opiod system was triggered after a meal regardless of the perceived enjoyment of the meal; the subject ate either pizza or an unflavored drink containing the same amount of calories and macronutrients..

What does this mean? Our brain’s pleasure signals are triggered automatically when we eat large amounts of food. It doesn’t matter how much you like the meal. By triggering opiod release in the brain, eating will impact mood, and the authors suggest that repeated overeating may lead to a chemically induced cycle where we are chasing the feel good hormones with every bite. The authors also point out that prior studies indicate the opiod system is less responsive in obese individuals and normalizes with weight loss.

And now-  the gut.

Researchers have long known that cells lining our intestines release chemical signals influencing perceptions of hunger and fullness (among other things). In a study published in Nature’s Scientific Reports, researches evaluated the number of fullness signaling cells in obese people before and after bariatric surgery (reducing stomach size to promote weight loss). They found a reduced number of these fullness cells in tissue samples prior to weight loss, which indicates a blunting of the metabolic response to eating. That is, the subjects were receiving weaker fullness signals after eating when they were obese. The authors theorize that this impaired signaling system could be a reason why it is so difficult for overweight people to lose weight.

The bottom line

Pleasure, satisfaction and eating are intertwined in many ways, including automatic release of pleasure and fullness signalers in the brain and gut. Repeated overeating and excessive body weight may lead to a decreased sensitivity to eating and make it harder to control your appetite- experiencing less fullness and pleasure from the same amount of food. By maintaining a healthy weight and sticking to reasonable portions when you eat, you can turn these automatic processes to your advantage.

Happy eating,



Intermittent Fasting

solar-clock-2691569_1920Occasionally a patient or student comes into my office already on a very specific diet. The approach is often reflected in media stories on popular diet trends, rarely unhealthy, just the diet of the moment. In the past few months I’ve been hearing more people experimenting with fasting, and specifically intermittent fasting.

What is it?

As the name suggestions, short periods of little or no calories. These are usually done by restricting food intake to an eight hour period, so fasting for sixteen hours a day. Other methods involved fasting for longer periods one or two days a week while eating normally otherwise- called feast days. Some plans follow a healthy approach during both fasting and feasting times, others just set a calorie max for the fast then it’s free game.

What does the science say?

Intermittent fasting is a way to alter the body’s metabolic response to food, to stress the metabolism in a healthy way- at least in theory. Researchers have found similar physiologic responses to fasting and caloric restriction, reducing metabolic risk factors for heart disease, diabetes, and strokes- namely blood sugar, cholesterol, and blood pressure. The calorie restriction approach requires consistent reduction of calories by 20-40% and is associated with increased longevity; many embrace this as a way of slowing down the aging process.

A recent study published in Science Translational Medicine by a researcher out of The University of Southern California found similar results from a 5 day a month intermittent fasting, the “fasting-mimicking diet” to those of regular caloric restriction. Participants “fasted” for five days in a row, eating 1,1100 calories on day one then 700 calories for the next four days. They ate regularly the rest of the month. And they didn’t just count the calories, the fasts were a carefully designed nutrient dense and nutritionally complete diet high in unsaturated fat, low in sugar and protein. The types of foods researchers believe stimulate healthy metabolic response. The physiologic benefits came after three months on the protocol with no loss of muscle mass.

An important factor in any diet is can people stick to it? This study had a high drop out rate: 25% were not able to complete the fast. So this diet is, not surprisingly, hard for many people to follow. However, the lead researcher, Valter Longo thinks that healthy people may be able to reap the benefits of the fasting-mimicking diet with just two fast periods per month. He cautions that this type of diet should only be followed under medical supervision.

Should you try it?

Think of intermittent fasting as another option in the menu of healthy lifestyles. If followed correctly, this can be an effective way to reduce your risk of the primary causes of early death and disease. Keep in mind that there are other dietary approaches that don’t require this level of restriction and careful attention to what and when you eat. In the end, finding the plan that works for you is more important than the specific one you choose.

Caution- if you take insulin or have a history of, or risk for, eating disorders, this type of restrictive diet should not be done without professional assistance.

Learn more:

The Hunger Gains Scientific American.

BBC documentary following one man’s experiment with intermittent fasting.

Happy eating – and fasting!