Staying Healthy at Midlife
Staying Healthy Through Midlife
Our culture largely emphasizes the negative experience of natural aging. While many aspects of aging are inevitable, the associated symptoms can be mitigated through healthy lifestyle habits. Whereas the body is quite resilient throughout our twenties and even thirties, it’s much less so come forty and especially fifty. This means it’s doubly important to lead a healthy lifestyle throughout midlife.
What Causes Symptoms of Aging for Women?
For women, many hormonal changes occur at midlife thanks to the ovaries. This reproductive organ slows the production of estrogen, testosterone and related metabolites like DHEAS. When a woman hasn’t had a period in 12 months, she is considered menopausal, which means her ovaries aren’t producing estrogen. However, fat cells continue to produce some estrogen.
Nonetheless, symptoms of low hormone levels include:
● Hot flashes
● Night sweats and sleep problems
● Weight gain (especially around the midsection)
● Increased risk of heart disease
● Increased risk of dementia/memory problems
● Decreased sex drive
Let’s take a deep dive into some of these symptoms and how to properly manage them through healthy lifestyle behaviors.
Hot Flashes and Night Sweats
Those pesky hot flashes and night sweats are referred to as vasomotor symptoms, forms of temperature dysregulation thanks to changes in reproductive hormones. Normally, core body temperature remains within a controlled range based off circadian rhythm. Disruption of this mechanism results in exaggerated heat loss responses. Not only can these symptoms be embarrassing, but night sweats can disrupt sleep and lead to negative health consequences.
Getting enough high quality sleep– generally 7-9 hours per night- is crucial for metabolic health. One night of poor sleep disrupts hunger and fullness hormones, increases cravings specifically for refined carbohydrates and high fat foods, enhances feelings of depression and anxiety, makes it difficult for your brain to assimilate new memories and increases the stress hormone, cortisol. Multiple nights and chronic poor sleep patterns greatly increase the risk of weight gain and obesity and many chronic diseases like cardiovascular disease and type II diabetes.
Luckily, there are excellent treatment options for vasomotor symptoms that are safe and effective. Another one of my blogs discusses the benefits (and risks) of hormone therapy https://evorawomen.com/blog/healthy-hormone-balance-for-a-healthy-life . In addition, you can improve the quality of your sleep by:
● Creating a wind-down/bed time routine
● Shutting off screens and blue light two hours before bed
● Eating your last meal three to four hours before shut eye
● Consuming a dinner high in lean protein, healthy fats and fiber (from veggies and whole grains)
● Drinking a calming tea like chamomile
● Reducing stress in the couple hours before bed
● Taking supplements like melatonin, chaga or lavender tea or using essential oils like lavender or peppermint
Weight Gain
Behind hot flashes and night sweats, weight gain is typically the next most undesirable consequence of hormonal changes. And although not fully understood, the most weight gain tends to occur in the midsection, an already vulnerable part of the body for many women. However, weight gain associated with aging in general is quite misunderstood.
Most people believe that substantial weight gain is inevitable in later adulthood. However, this isn’t necessarily true. The natural aging process decreases lean body mass, which is the most metabolically active tissue. As a result, metabolism down shifts, and adults require less calories to fuel metabolic reactions. Although some of this is unavoidable, you can prevent large losses of metabolic tissue through proper exercise (to be discussed in a little bit) and healthy eating.
In addition, cells stop working as well in mid to later life, especially when someone has led an unhealthy lifestyle in early life. It’s a wonderful privilege to be young and make unhealthy choices with few consequences, but it undoubtedly affects your health down the road.
Unfortunately the combination of poor food choices and decreasing estrogen make women more susceptible to insulin resistance. In fact, insulin resistance is a root cause of many health struggles, as it leads to more weight gain and a harder time losing weight. Insulin is considered an anabolic hormone that promotes the storage of fat, sometimes irregardless of caloric intake. This means someone could theoretically be eating in a caloric deficit, but if they’re choosing the wrong kinds of foods, a poor insulin response will still tell the body to convert their fuel into fat.
To better understand this concept– insulin resistance means the body over produces insulin. When cells become resistant to insulin, they can’t uptake glucose and it remains in the blood. This is undesirable because glucose then essentially attaches to the outside of cells and organs and greatly decreases their functionality. In addition, chronically elevated blood glucose levels signal the body to continue releasing insulin. High insulin levels tell the body to store more fat, but the more fat you have, the more insulin resistant you become. It’s a vicious cycle. Eventually, the pancreas tires and can’t produce enough insulin, which is technically considered diabetes at that point.
Breaking this cycle always involves nutritional intervention, typically includes a consistent exercise plan and may warrant medication.
Increased Risk of Diseases
The trifecta of genetics, natural again and poor lifestyle choices raises risk for chronic disease usually beginning around midlife, although it’s becoming earlier and earlier nowadays. For women, certain diseases are more common, also related to the decreased hormone production.
Did you know blood vessels (think arteries and veins) have estrogen receptors on them? When less estrogen is produced, it gives plaque the opportunity to build up and clog the blood vessels, leading to a higher likelihood of stroke and heart attack. In fact, heart disease is the number one killer of women. Luckily, estrogen replacement can help prevent the development of these atherosclerotic plaques depending on when started. If started within 10 years of the last menstrual period or before the age of 59, it is largely preventative, but if started after this time, estrogen hormone replacement can potentially destabilize the plaque and make it more likely to rupture (heart attack). Of course, diet and exercise are also vitally preventative. Focus on:
● Reducing refined carbohydrates to less than 10% of calories per day (cakes, donuts, pastries, crackers, chips, processed/packaged foods)
● Consume proportionally more omega-3 fatty acids (wild caught fatty fish, walnuts, chia and flax seeds) to omega-6 fatty acids (refined/hydrogenated vegetable oils like canola and safflower) in a ratio of at least 4:1
● Reduce LDL cholesterol levels by consuming 25- 35 grams of fiber from colorful fruits and vegetables and high quality whole grains (*Navy beans and oats reduce cholesterol most!)
● Increase HDL cholesterol by including moderate to vigorous cardiovascular activity 3-6 days/week
In addition, certain types of cancer risk increase as well. 1 in 8 women are diagnosed with breast cancer. Overweight and obesity are associated with an even higher rate of breast cancer. Regular screening is important, but screening catches cancer once its already developed. Thus, maintaining a healthy lifestyle and a healthy weight is vital for prevention.
The risk of uterine cancer also increases if you are overweight or obese. Because fat cells produce estrogen, an overabundance of them will produce too much estrogen (much more than estrogen hormone replacement therapy) and overstimulate the uterus. Again, maintaining a healthy weight is the single best preventative measure for risk reduction.
Women already have a higher risk of developing dementia and Alzheimer’s, but menopause heightens it further. Although mechanisms aren’t completely understood, researchers believe that estrogen exerts function in an area of the brain called the hippocampus, which is responsible for memory and certain types of learning affected by Alzheimer’s. Thus, decreasing estrogen levels reduce hippocampus activity. Furthermore, estrogen is protective against a build-up of amyloid-B proteins implicated in the disease as well. Hormone replacement therapy is way to reduce risk of dementia and associated Alzheimer’s, but eating a brain healthy diet full of omega-3 fatty acids, lean protein, colorful fruits and veggies and fiber from whole grains (aka a Mediterranean-like diet) and consistently exercising (aerobic and anaerobic) is equally protective.
Decreased Sex Drive
Midlife is already a difficult time of life for many women. Empty nest syndrome can contribute to a feeling of lost identity; societal standards of beauty begin to fade; family members might be sick; divorces; you name it. On top of this, libido decreases due to lower levels of hormones. Sex is not only healthy for the physical body because it releases “happy” hormones (dopamine and serotonin), it’s important for maintaining positive relationships. While hormone replacement therapy is usually the most effective treatment, there are other options as well. In addition, maintaining a healthy weight can help you feel empowered and more likely to want to have sex. Thus, taking care of your body through diet and exercise is vitally important, once again.
How to Stay Healthy Through Midlife
Now that you know how decreasing hormone levels associated with menopause increase risk of certain conditions and diseases, let’s discuss how to best prevent them or mitigate their side effects. Already sprinkled throughout this article, hopefully it’s evident diet and exercise are the answers!
Consume a Healthy Diet
Consuming a healthy diet not only reduces the risk of many chronic diseases like the ones already mentioned along with diabetes, but it helps to maintain a healthy weight. This is vital because being overweight or obese increases health risks that aren’t always so obvious.
Overweight and obesity keep the body in a chronically inflamed state. This is often referred to as metabolic syndrome, a group of conditions characterized by increased weight and waist circumference, high blood pressure and/or cholesterol and insulin resistance. In essence, inflammation decreases metabolism and generally weakens every bodily function. This is what further leads to chronic fatigue, the inability to lose weight, hormone imbalances, autoimmune conditions, joint, muscle and bone pain, mood problems, a decreased motivation to exercise and ultimately a lower quality of life.
However, consuming a healthy diet greatly reduces the risk of these complications, can reverse conditions (like type II diabetes) and/or treats these issues. Healthy foods aren’t healthy because they’re low in calories, although they are typically lower calorie than less nutrient dense foods, but because they contribute nutrition in the form of antioxidants, polyphenols, fiber and other beneficial compounds. These nutrients fuel cells and maintain healthy metabolism.
So, what does a truly healthy diet look like?
5-9 servings of colorful fruits and veggies/day
Non-starchy for fiber and antioxidants
Cruciferous veggies for hormone and thyroid health
All different colors for a variety of vitamins and minerals
1-3 servings of high quality whole grains (sprouted whole wheat breads, whole wheat pasta, brown rice, quinoa, oats)
A few servings of healthy fats/day
Omega-3 fatty acids (EPA and DHA)
Avocados, nuts/seeds, unrefined oils like olive, avocado and sesame, high quality, grass fed meat and hormone/antibiotic free poultry, organic, free range eggs
Plenty of lean protein to preserve muscle mass
High quality, grass fed meat and hormone/antibiotic free poultry, organic, free range eggs
Legumes, beans, nuts/seeds
Plant-based products like tofu, tempeh, seitan (avoid modern meat alternatives as they’re filled with additives [i.e. the beyond the burger trend])
Practice moderation with “fun foods”
Generally follow the 80/20 guideline
Save desserts for special occasions
Portion foods rather than eating straight from the container
Read nutrition labels and eat appropriate servings
Work with a professional (like a therapist) to determine root causes of overeating/binge eating
Consistently Exercise Enough
Behind a healthy diet, exercise is undoubtedly valuable. Aerobic exercise like walking and jogging helps prevent heart disease, diabetes and stroke and keeps brain blood vessels flexible, which improves blood flow. In turn, this improves memory capacity and reduces risk of dementia and Alzheimer's. Aerobic exercise also improves depressive and anxious feelings because it releases “happy” neurotransmitters, responsible for the commonly known “runner’s high.” I can certainly attest to this effect!
However, strength training is equally important in midlife. The natural aging process innately decreases some muscle mass, but strength training greatly mitigates this. As mentioned earlier, muscle mass or lean body tissue is very metabolically active. This allows one to maintain a higher caloric intake while also maintaining a healthy weight. In addition, strength training protects bones and reduces risk of osteoporosis. Again, the decline in estrogen is partly responsible for the thinning of bones, which can then lead to loss of height, fractures and the dreaded dowager’s hump. Vitamin D and calcium also help maintain healthy bones, but many women are deficient in one or both, so it’s important to optimize them through diet and sometimes supplementation.
The Takeaway
A lot of hormonal changes occur at midlife for a woman and the decline in estrogen production is largely responsible for increasing the risk of many of the discussed symptoms. However, leading a healthy lifestyle highly reduces the risk of the associated diseases and drastically reduces common symptoms of menopause. It’s very possible to lead a high quality life through midlife by eating a nutrient dense diet, exercising regularly, managing stress and optimizing sleep. Make the most of menopause!
Dr. Becky Kaufman Lynn is a gynecologist and the founder of the Evora Women’s Health. She is a North American Menopause Society Certified Physician who has been treating menopausal women for over 20 years. Her practice is located in Chesterfield just outside of St. Louis, Missouri. Dr. Lynn offers a comprehensive midlife wellness program helping women lead healthy lives. Go to evorawomen.com for more information about her practice or to schedule an appointment or send us an email at info@evorawomen.com
