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Things to know about Late Life Weight Gain

May 23, 2023 By Deborah Leave a Comment

 

people sitting on gray concrete bench during daytime

When it comes to weight, it seems to be more of an issue in our later years…especially after our 60’s. Having a negative body image occurs for over half of women in their 60’s. Men are no exception. In a small Canadian study, half of men ages 60-83 said they felt unattractive because of their weight. Body dissatisfaction is associated with a higher risk of depression, poorer sleep and sub-optimal self care. Many people struggle with controlling those extra pounds that tend to deposit themselves around the middle while losing important muscle mass. Visceral fat is the fat that surrounds internal organs and is hidden in your abdominal cavity. What we have learned since the mid-1990’s, is that the fat cell is an endocrine organ, secreting hormones and other molecules that have far-reaching effects on other tissues. There are a host of chemicals that link visceral fat to a wide variety of diseases. This combination can lead to health problems such as high blood pressure and cholesterol, type 2 diabetes, sleep apnea and a decline in physical function. Your weight is one indicator of your health, but it matters where you carry those extra pounds. Here are some things to know about late life weight gain.

Visceral fat makes more of the proteins called cytokines, which triggers low lying inflammation and is a risk factor for heart disease and other chronic conditions.

Aging is an inflammatory process. The uncomfortable fact is that the fat you gained in your 50’s may continue in your 60’s. There is a natural increase in body fat until your 80’s!! While subcutaneous fat produces a higher proportion of beneficial chemicals, visceral fat produces chemicals that are far more harmful. Visceral fat makes more of the proteins called cytokines, which triggers low lying inflammation and is a risk factor for heart disease and other chronic conditions.

There is also a hormonal mechanism that perpetuates middle age weight gain (obesity) through eating high glycemic foods. Foods that have a high glycemic index pack alot of sugar into a small package. High glycemic foods cause a fast rise in blood sugar resulting in insulin release. Highly processed refined carbohydrates are absorbed quickly, increasing insulin levels that can result in rebound hypoglycemia and insulin resistance. These mechanisms increase insulin sensitivity in adipose tissue but create insulin resistance in muscle and brain. Your body continues to make more and more insulin which leads to metabolic dysfunction, inflammation, weight gain, fatty liver and plaque development. Weight gain has been said to be nothing more than your body’s chemical reaction to foods. It comes down to 2 things: hormones and inflammation.

A 2022 meta analysis described the metabolic consequences of partial sleep restriction. Out of 26 randomized clinical trials, 400 adults were studied under controlled laboratory conditions. It concluded that insufficient sleep results in a clinically significant decrease in whole body insulin sensitivity. This condition can lead to obesity and diabetes. This present study was the first to assess the impact of sleep restriction in post-menopausal women. The proportion of adults with chronic insufficient sleep (< 6 hours/night) is around 30%. And 41.5% of adults ages 60 and older are obese according to the Centers of Disease Control and Prevention. So getting enough sleep is important. At least 7 hours is ideal because sleeping less has been shown to elevate the hormone Ghrelin that signals us to eat. So less sleep= more hunger and calories.

We may want to eat as we did in our 20’s and 30’s but our metabolism slows down significantly as we age. Your body requires fewer calories to keep it working (calories needed for our lungs to breath and our heart to pump). Less muscle mass also contributes to this slower metabolism. We lose lean muscle as we age. So just walking those 10,000 steps is not enough. We need to fit in some weight resistance (weight lifting, push-ups, planks, etc) at least twice per week while consuming abut 25 percent of our calories from protein. Aerobic exercise like walking, biking, jogging or swimming are still important, but our muscles need protection and strength. You lose as much as 3% of overall muscle strength every year in your 60’s. Men hold on to more of their muscle power than women.

Menopause and it’s decline in estrogen also contributes to weight gain. By the time a woman is postmenopausal, 15-20% of her body fat is visceral fat, compared to 5-8% when she was premenopausal. Estrogen has direct actions in pancreatic islet beta-cells in regulating insulin secretion, nutrient homeostasis and in promoting fat burning. When estrogen falls during menopause, it is thought to reduce a women’s ability to use fat as an energy source leading to weight gain, high blood pressure and cholesterol, type 2 diabetes and inflammation. Estrogen replacement therapy may increase a woman’s resting metabolic rate.

Another common killer that becomes more common as we age is our risk for cancer. One reason according to the NIH is the decline in the immune system’s ability to detect and correct cell defects. Obesity is linked to at least 13 types of cancer. Some are hormone related. Obesity creates inflammation which disrupts the immune system and causes dysregulation of the endocrine system. Fat cells increase estrogen and other hormone levels that lead to an increase in cancer: breast, endometrial, thyroid and pancreas to name a few. Losing weight can reduce this risk.

Obesity is also a risk factor for autoimmune disease, a problem more common in women and as we age. This is when the immune system starts to attack the body’s own healthy tissues. People with rheumatoid arthritis in particular have premature aging. Researchers have found that their immune age is about 25 years older than their actual age.

Obesity, especially when there’s lots of visceral fat is a risk factor for faster brain aging and Alzheimer’s disease according to Howard Fillit, M.D. cofounder and chief science officer at the Alzheimer’s Drug Discovery Foundation. Belly fat can: reduce blood flow to the brain, shrink brain volume (up to 4%- 8%) and reduce cognitive function.

Think about monitoring your weight, BMI (body mass index- an estimate of your body fat based on your height and weight, aarp.org/bmi) and waist measurement as important as monitoring your cholesterol, blood pressure and blood sugar levels. A healthy BMI is 18.5-24.9 and 25-29.9 is considered overweight. A waist measurement (place a tape measure above your hip bones) above 35 inches for women or above 40 inches for men means you are at higher risk for heart disease or type 2 diabetes according to the National Institutes of health (NIH). Also if your waist size is more than half your height, you might be at greater risk.

Our immune systems can be re-set and inflammation significantly reduced with weight loss. Here are some tips:

  1. Increase your protein intake..especially in the morning. Eating 25-30 grams of protein with each meal helps maintain muscle mass and reduces fat gain.
  2. Choose fresh farm food over processed food. Consider following the MIND diet (a combination of the Mediterranean and DASH -low sodium diet).
  3. Move at least 30 minutes/day for cardiovascular fitness and add weight resistance at least twice per week for muscle strength. Exercise is the best thing you can do to prevent Alzheimer’s disease!
  4. Cut down on simple carbs, especially sugar. This includes alcohol too which is a toxin to the brain and destroys sleep. Simple carbs also retain fluid.
  5. Get some sleep…at least 7 hours. Avoid late night food and alcohol. Stop eating at 7 PM as it stores more body fat since you are not burning it off.
  6. Sunlight, especially in the morning even if it is overcast. It helps elevate Cortisol in the morning which you need for energy and resets your circadian rhythm for better sleep at night by increasing melatonin rise in the evening.
  7. Social connection is important. Remember that hormones are involved in weight gain and the more we can reduce high levels of cortisol throughout the day, the less insulin gets produced to allow fat to be stored. When you are connecting and having fun, it lowers cortisol and raises serotonin and oxytocin which help us relax, digest better and utilize glucose for energy more efficiently.  Meditate, deep breathing and prayer.
  8. Consider getting a food allergy test. Learn to avoid “trigger foods” (foods you are reacting to) so that inflammation and insulin subside and weight loss can begin. Reactive calories will put on weight.
  9. Get your thyroid level checked. It’s a major player when it comes to hormone health since it stimulates metabolism.
  10. Drink water. It is essential to drink approximately half your body weight in ounces. For every 16 ounces less than your body needs, it will hold onto half a pound! When you are dehydrated, your body has to extract water from your food and holds on to it in your tissues. When you drink enough, the body can let go of the extra water it’s been holding on to, and the numbers on the scale go down.

 

References: Mauvais-Jarvis, F, et al. The Role of Estrogens in Control of Energy Balance and Glucose Homeostasis. NIH: Nation Library of Medicine. Endocrine Review, 2013 June; 34 (3): 309-338.

Cauter, E. and Spiegel, K. Effect of sleep restriction on insulin sensitivity and energy metabolism in postmenopausal women. Obesity, Metabolic Syndrome and Prediabetes. May 9, 2023. Practiceupdate.com.

Stuart, A. Menopause, Weight Gain, and Exercise Tips. WebMD. March 17, 2023.

Migala, J. The Weight Issue. AARP, the magazine. April/May 2023. pp 52-57.

Genet-Recitas, L. “The Plan”. Grand Central Publishing, 2013.

Healthline.com/nutrition/mind-diet. The MIND diet: A detailed guide for beginners.

 

 

 

Filed Under: Featured, Wellness

Weight Gain at Mid-life: It’s Not Calories in, Calories Out

October 31, 2021 By Deborah

grayscale photo of woman holding her breast

Weight gain in middle age is challenging and very common.

I see many women over the age of 40 that are frustrated with their weight. They are eating healthy and exercising, but the extra weight just won’t come off! Some women even decide to “clean up” their diet and hit the gym even harder but still…no change. Weight gain has been said to be nothing more than your body’s chemical reaction to foods. It’s not that you’re eating too many calories or not exercising enough. It comes down to 2 things: hormones and inflammation.

As women go through their middle years, their body composition changes in proportion to fat.

The proportion of fat to body weight tends to increase (more than men), and fat storage begins favoring the upper body over the hips and thighs. In other words, your waistline starts to grow in inches as visceral fat (the fat that wraps around your abdominal organs) pushing out against the abdominal wall.

What we have learned since the mid-1990’s, is that the fat cell is an endocrine organ, secreting hormones and other molecules that have far-reaching effects on other tissues. There are a host of chemicals that link visceral fat to a wide variety of diseases.

While subcutaneous fat produces a higher proportion of beneficial chemicals, visceral fat produces chemicals that are far more harmful. Visceral fat makes more of the proteins called cytokines, which triggers low lying inflammation and is a risk factor for heart disease and other chronic conditions. It also produces a precursor to angiotensin, a protein that causes high blood pressure.

We know that there is a hormonal mechanism that perpetuates middle age weight gain (obesity) through eating high glycemic foods. Foods that have a high glycemic index pack alot of sugar into a small package. High glycemic foods cause a fast rise in blood sugar resulting in insulin release. Highly processed refined carbohydrates are absorbed quickly, increasing insulin levels that can result in rebound hypoglycemia and insulin resistance. These mechanisms increase insulin sensitivity in adipose tissue but create insulin resistance in muscle and brain. Over time, fat accumulates viscerally while less is taken up in the muscle. Your body continues to make more and more insulin which leads to metabolic dysfunction, inflammation, weight gain, fatty liver and plaque development.

Other research by Mengeste and colleagues describes the characteristics of muscle between obese and lean people.

The obese muscle changes its composition to a muscle fiber (type 2) that is less able to utilize sugar for energy. This is because the number and function of mitochondria decline. These muscle fibers fatigue more easily than the dominant type 1 found in lean people. This is where exercise is so important but initially will not result in quick weight loss because the muscles are less able to absorb and burn energy.

What Does This Mean and What Can We Do?

All calories are not the same. Carbohydrates that are refined and have less fiber get absorbed very quickly and trigger hormones that allow the accumulation of fat. This changes muscle fibers and its function, making weight loss and exercise more challenging. So eating less and exercising more just doesn’t work…especially in middle age. High quality food is key.

So what can we do after age 40 (or even after age 35!)

  1. Eat more multicolored fiber-rich whole foods
  2. Eat more fiber and protein with a carbohydrate to slow absorption
  3. Drink a glass of water with 1 tsp of psyllium husks (or any soluble fiber) before meals to help reduce the glycemic index of a meal. Here is a patient handout on glycemic index/load.
  4. Do not use artificial sweeteners. They can actually exacerbate obesity
  5. Try to sustain good nutritional and exercise habits over time to increase type 1 muscle fibers. These muscle fibers have more mitochondria to help burn sugar and fat while increasing muscle endurance.

 

References

    1. Ludwig DS, Aronne LJ, Astrup A, et al. The carbohydrate-insulin model: a physiological perspective on the obesity pandemic. Am J Clin Nutr. 2021 Sep 13. doi: 10.1093/ajcn/nqab270. Online ahead of print. https://academic.oup.com/ajcn/advance-article/doi/10.1093/ajcn/nqab270/6369073
    2. Mengeste AM, Rustan AC, Lund J. Skeletal muscle energy metabolism in obesity. Obesity. 2021;29(10):1582-1595 https://onlinelibrary.wiley.com/doi/10.1002/oby.23227
    3.  Jovanovski E, Khayyat R, Zurbau A, et al. Should Viscous Fiber Supplements Be Considered in Diabetes Control? Results From a Systematic Review and Meta-analysis of Randomized Controlled Trials. Diabetes Care. 2019;42(5):755-766. https://care.diabetesjournals.org/content/42/5/755.long

Filed Under: Featured, Wellness

Weight Changes and Hormone therapy

January 22, 2017 By Deborah

 

 

I often have women complain about added weight gain during the peri-menopause and menopausal years. After going through a thorough search of any lifestyle changes such as  intake of sugar or carbs, lack of exercise, recent surgery, etc. I try to let women know that  women walking photoeven if you continue to have healthy eating habits and exercise. When women are struggling with night sweats, hot flushes, lack of sleep, fatigue and mood swings, it tends to exacerbate the problem. Offering bio-identical hormones not only helps symptoms but can assist in weight management. Again, hormone replacement therapy does NOT cause weight gain! That is, if hormones are started less than 10 years after starting menopause.

Studies indicate that estrogen therapy improved insulin-stimulated glucose uptake among women in early menopause. What does that mean?

Many women have something called insulin resistance which occurs sometimes as early as age 35 and increases as we age. The insulin receptors on our cells stop functioning adequately and this dysfunction causes us to make more insulin which then has a very easy time converting excess glucose into fat.

Investigators in one study assessed the effects of short-term high dose transdermal (topical patch) estradiol on these insulin receptors in 22 women. These women were on average 56 years old and less than 6 years into menopause. They compared this group with 24 women that were on average age 63 and over 10 years after menopause. Mean BMI (basal metabolic index-weight) and GDR (A measure of insulin-stimulated glucose uptake) were the same in both groups.

After 1 week of transdermal estrogen where women used a patch delivering 0.05 mg daily, investigators found that the women using the estrogen patch raised the GDR in the women who were less than 6 years after menopause, but lowered the GDR in those women more than 10 years after menopause.

This demonstrates a difference in the change in glucose uptake due to years since menopause. There was a beneficial metabolic effect only in recently menopausal women. Another popular study, known as the Women’s Health initiative, also found a similar reduction in risk for diabetes with estrogen therapy across all age groups. This supports the “timing hypothesis” which proposes that hormone therapy slows atherosclerosis progression in recently menopausal women but has neutral or adverse effects in women who are at least 10 years past menopause onset.

Talk to your health practitioner on whether hormones may give you additional benefit of preventing diabetes in additional to helping other symptoms.

Reference: Pereira RI et al. Timing of estradiol treatment after menopause may determine benefit or harm to insulin action. J Clin Endocrinol Metab 2015 Dec; 100: 4456.

Filed Under: Featured, WomensHealth

Is the Healthy Food You’re Eating Causing Weight Gain?

January 11, 2015 By Deborah

Healthy Food

Here we are at the start of a New Year where many of us have resolutions for better health and weight management…in particular weight loss. More people seem to be in the gym lately and eating healthy.

This is a great time to consider an elimination food plan. It really cleanses the palate and helps us detox some of our indulgences of the season. It can reduce inflammation and help us lose those unwanted pounds we may have put on with all those holiday parties.

The elimination diet has been around for a while and is especially helpful for those feeling sluggish, fatigued or for those who have chronic health problems. It allows people to identify foods that cause symptoms or reactions. The sensitivities to common foods such as wheat, dairy, eggs and corn has gained much attention, especially when it comes to its association with weight gain. British doctor John Mansfield in his book Six Secrets of Successful Weight Loss asserts that food sensitivities are “by far the commonest single cause of weight gain…” and besides the above food list, Mansfield also adds yeast, coffee, tea, potatoes, chocolate, oranges, onions, beef and pork to the list of intolerant foods by some people.

Certified nutritionist, J. J. Virgin has written a book entitled The Virgin Diet. She believes food intolerances are the real cause of weight gain. Her program has 7 foods to avoid that causes weight gain which include gluten, soy, dairy, eggs, corn, peanuts and most sweeteners.

Food intolerances contributing to weight gain may be theoretical for some since there just hasn’t been enough research studies, but I see it consistently being a big contributor with most of my patients.

According to nutritionist Lyn-Genet Recitas in her book, The Plan, some of the most common foods revered as “healthy” are the biggest factors in causing toxic reactions and weight gain. Other symptoms and health problems such as premature aging, inflammation, constipation, migraines, joint pain and depression also become more obvious. She says, “…that same 100-calorie food acts like 700 calories if it’s reactive to you. ” Recitas has a way of walking you through a step-by-step elimination diet explaining how a food (even healthy food) can be reactive for 80% of people but not necessarily for you. It’s about individualizing which foods are inflammatory to you so with avoidance, you can feel better and lose that excess weight.  

If you suffer from frustrating weight gain and other inflammatory symptoms, consider looking into one of these elimination food plans.

Filed Under: Featured, Health

How Gut Bacteria Determines Weight Gain

July 6, 2014 By Deborah

#455808989 / gettyimages.com

Here we go again…more information about how our “poop” effects our health.

Well…it does.  About 35% of Americans battle with obesity. So if you’re one of them, listen up. New evidence indicates that gut bacteria can change the way we store fat.  Certain microbes helps us balance levels of glucose in the blood. These microbes also effect how we respond to hormones that make us feel hungry or full.  

The human body is home to multiple species of bacteria. Did I say multiple….I meant billions of microbes that outnumber our own cells 10 to 1. Most of these reside in the large intestine and the mouth. By studying the genes of these unique microbes, researchers have been able to identify the most common residents, although these can vary from person to person. Now we are starting to look at the types of jobs these tiny organisms fill in the human body and the effect they have on our overall health.

Of course, diet plays an important role in determining the gut bacteria. For instance, those who eat processed foods have a less diverse gut community. A diet high in fat and low in fruits, vegetables and fiber in mice has been shown to prevent the beneficial bacteria from moving in and flourishing. These mice continued to grow fatter even though they were in cages with lean mice.

The wrong mix of bacteria may set the stage for obesity and diabetes the moment you’re born. Formula fed babies and infants delivered by cesarean section have a higher risk for obesity and diabetes than infants who are breastfed or delivered vaginally. Infants that are born through the vaginal canal swallow bacteria that will later help them digest milk. Substances found in breast milk nurture beneficial bacteria and limit the colonization of harmful ones.

According to a Canadian study, the gut bacteria in formula fed babies vs breast fed babies are very different. The presence of gut bacteria from formula fed babies before the gut and immune system have matured may explain why these babies may be more susceptible to allergies, asthma, eczema, and celiac disease as well as obesity.

Antibiotics in children are also a problem. These commonly over-used drugs wipe out important bacteria that help us maintain healthy body weight. “Antibiotics are like a fire in the forest,” Maria Gloria Dominguez-Bello of N.Y.U. says. “The baby is forming a forest. If you have a fire in a forest that is new, you get extinction.”  Don’t get me wrong…antibiotics are necessary in treating bacterial infections when warranted but we treat viruses and minor infections with these strong antibiotics when other options are available.

There is a tremendous amount of variation that makes it difficult to isolate the role of microbes in a complex disease like obesity. There are many research ideas such as swabbing babies mouths born by Cesarean section with the mothers vaginal fluids, fecal transplants, and possibly enriching foods with beneficial bacteria and other nutrients needed to establish healthy flora in the gut. For now, more studies are being done, but exercising and eating right are still the basis for enlisting a healthy microbial army. 

Reference: Wallis, C. “Gut Reactions, Intestinal Bacteria May help Determine Whether We Are Lean or Obese”.  The Science of Health. p. 30-33.

Filed Under: Featured, Health

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A Little About Me

Debbie is a board certified family nurse practitioner with an emphasis on women's health. During the past 22 years she has worked in women's health and family practice with a focus on the integration of conventional and alternative therapies.

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