Menopause for thought: The truth about hormones and midlife fitness
A few small tweaks to your behaviour can work wonders when you're middle-aged
Hot flashes. Raging moods. They’re symptoms typically associated with midlife hormonal bedlam. But hormones control so much more, from our energy and metabolism to how we build muscle.
Hormonal changes are an inevitable part of ageing but these can be influenced by the choices we make. Namely, how we move and what we eat.
“As we get older, exercise is key,” says Dr Richard Quinton, consultant and senior lecturer in endocrinology at Newcastle University. “Hormones are important to physical fitness but while they change with age, exercise can have similar benefits to what hormones do and help make up for some of those age-related changes.”
Get a grip on insulin resistance
One of those hormones is insulin, which regulates carbohydrate and fat metabolism. It’s released by the pancreas to promote the storage and absorption of glycogen – a fuel used by your muscles – and glucose for energy. But insulin can also cause fat to be stored instead of being used to fuel muscle activity.
“As people get older, they get more resistant to insulin,” says Quintan. This means your cells are less able to use this hormone effectively, leading to high blood sugar, weight gain around the middle and an increased risk of type 2 diabetes and heart disease, he explains.
“Exercise, however, can be transformative for insulin resistance.” The main way it helps is by keeping your weight down. A study published in the Journal of Obesity and Weight Loss concluded that not only did exercise help insulin resistance, it also influenced the way our muscles use glucose. “We’re not talking about endurance events for these benefits,” says Quintan. “It’s simply about getting out of breath for half an hour a few times a week.”
Can diet help?
“Research suggests that timing meals to our circadian rhythms, for example by eating more in the morning, followed by smaller meals as the day progresses, may be more favourable in terms of insulin sensitivity,” says Rick Miller, a clinical and sports dietitian and spokesman for the British Dietetic Association.
“This is especially important as we get older and insulin sensitivity goes down.”
Plan for the perimenopause
If you’re perimenopausal – that’s in the decade prior to the menopause, which hits the average woman at 52 – your oestrogen levels fluctuate dramatically, says Miller, which is going to affect your weight. “These fluctuations impact energy, cause hot flushes, cravings and abdominal fat.”
As oestrogen levels fall, muscle cells become less sensitive to blood glucose changes, leading to insulin resistance,” says Miller. “This leads to an increase in appetite, especially for sweet and carbohydrate-rich foods, making the cycle worse.”
So, what to do about it? “Choose foods that have less impact on blood glucose levels, smaller portions of starchy and wholegrain carbohydrates such as sweet potatoes, wholegrain rice and quinoa, and healthy fats such as avocados, olives, olive oil or nuts or seeds, and a source of protein such as meat, fish, eggs, lentils, beans, pulses or tofu at each meal.”
Master the menopause
Once menopause hits, oestrogen levels fall off a cliff edge. The two most important effects of this are weakening bone mineral density and the loss of the heart-protective effects of oestrogen, which can increase your risk of heart disease, explains Professor Greg Whyte, a sports scientist who has trained Davina McCall and David Walliams.
“Exercise can impact both, particularly load-bearing cardiovascular exercise such as walking or jogging, with a couple of sessions of circuit training that gets you sweaty with some weights, such as body pump classes.”
Indeed, resistance training twice a week has been shown to help strengthen bones, as a 2017 study on 101 women found. Katherine Brooke-Wavell, senior lecturer in human biology at Loughborough University and a scientific adviser to the UK’s National Osteoporosis Society, said the study provided evidence that brief circuit training exercises involving weights or jumping can improve spine and hip bone density in postmenopausal women, so may have a role in prevention of osteoporotic fracture.
“Team games that involve a twisting are also great during menopause,” Whyte explains. And it’s not as painful as it sounds. “By that I mean racket sports such as tennis, which are great for bones and for the heart, too.”
Handling the manopause
“We talk a lot about the menopause but men go through a similar process, something we term the somatopause,” says Whyte. “Falling testosterone is important, but another key hormone responsible is the reduction in human growth hormone middle-aged men are experiencing.”
Human growth hormone (HGH) is essential when we are young because it plays a role in bone mineralisation, helping us to achieve our final height. It’s also important for muscle growth and fat metabolism. Levels of HGH begin to decline in our mid-20s, but according to Whyte, declining levels in middle-aged men has a profound effect.
“This combination in men over 40 of reduced testosterone and falling HGH affects things like strength and mobility, along with central adiposity. In fact, that belly traditionally attributed to beer is in fact linked with this fall in HGH. There’s a social acceptance for menopause, but nobody ever talks about men’s changing hormones in middle age and recognising that it’s an issue for them,” Whyte asserts.
Men and muscle
“Their focus should be on exercise that builds muscle such as heavy weights with low repetitions. As men age they should lift more,” Whyte explains. “On top of that, men need to increase their aerobic activity to help deal with the increase in fat mass and also to protect their hearts.” Ideally, he suggests a couple of sessions of heavy lifting, a couple of sessions of high-intensity interval training (HIIT) and supplementing that with a couple of sessions of longer-duration aerobic activity at lower intensities for 45 minutes or more, like running, cycling or swimming.
As for food?
“As HGH goes down, muscle tissue starts to develop an ‘anabolic resistance’, which means it becomes more resistant to muscle building,” says Rick Miller. “This means that whatever amount of protein we used to eat when we were younger has less impact on maintaining muscle than before.” So eat more protein in midlife, aiming for 1g per 1kg of body weight. Both men and women have different circulating levels of testosterone, men higher and women much lower, and weight training increases it, says Miller, who says it helps with bone strength, muscle mass, brain function and, of course, sex drive.
The stress factor
According to a 2017 study of life satisfaction across 51 countries, people are most satisfied in their 20s before reaching a nadir in their early 50s (sorry) before bouncing back in old age. What that means is the emotional, endorphin-boosting effects of exercise are more important than ever in our 40s and 50s.
If you take nothing else from this story, go for a brisk walk or jog three to five times a week for half an hour. Middle age is also the time most of us face a peak in stress hormones, especially cortisol. “Having increased cortisol levels over a long period can contribute to weight gain,” says Quintan. But it’s not all bad. “In the short term, bursts of cortisol are motivating and help you cope,” he explains. Cortisol starts to get destructive when its levels are chronically raised, due to a grinding, underlying stressor that doesn’t seem to have an endpoint, he asserts. Think a bad marriage or thankless job.
Evidence also suggests exercise raises cortisol levels in the short term, bringing them back to normal after recovery. But that’s healthy, because it provides your body with a stressor to which it’s forced to adapt by becoming stronger and fitter, says Whyte. “Much of that occurs during sleep and rest. That’s why recovery is essential for over-40s exercisers. The older we get the more seriously we should ensure that we’re sleeping enough, rehydrating properly, eating enough protein, and taking 48 hours off between bouts of heavy strength training to help muscles recover. You can do active recovery during these times, with low-intensity walks or swims, but you have to let muscles rest and recharge.”
Food for thought
“Two to three larger meals a day with sufficient high-quality protein can be helpful,” says Miller. “By reducing the frequency of meals and avoiding snacking, circulating insulin remains lower, which will have an overall beneficial effect in middle age.”
If it’s safe and appropriate, he also suggests intermittent fasting. “This is where we eat within, say, an eight-hour time window and a 16-hour fast, which would mean having your first meal of the day at midday and your last at 8pm. Exercising in that fasted state could have some benefits.” But remember, “if you’re under continuous stress, fasting may not be for you because it increases cortisol,” Miller warns. “In which case, regular, balanced meals with few slow-digesting carbs will be helpful.”
– © The Daily Telegraph