Summary
In this candid conversation, Menopocalypse author, nutritionist, and women’s health advocate Amanda Thebe joins The Health Insider to reveal how women can take charge of their menopause journey through knowledge and action. Amanda shares insights on hormone therapy, nutrition, strength training, and lifestyle strategies — showing why understanding your body is the most powerful tool for thriving through midlife.
The Health Insider had the pleasure of interviewing Amanda Thebe, a Fitness and Women’s Health Expert with nearly thirty years of experience in the fitness industry. Amanda is a passionate advocate for women’s health during the menopause transition. She is an in-demand speaker, recently headlining The National Menopause Show, and wrote the Amazon best-selling book, Menopocalypse: How I Learned to Thrive During Menopause and How You Can Too!
Transcript
Leslie Andrachuk (The Health Insider): Welcome to author and fitness coach Amanda Thebe. Amanda is the author of the Amazon bestseller Menopocalypse, how I learned to thrive during menopause and how you can too. Very important words. And with nearly 30 years of experience in the fitness industry, Amanda’s a highly regarded expert on women’s fitness and health and a passionate advocate for women in this midlife transition.
Welcome to the Health Insider.
Amanda Thebe: Thank you for having me today, Leslie, I’m glad to be talking about this.
LA: Today we’re going to focus a little bit on nutrition, diet, metabolism and body weight composition management during perimenopause and menopause. Many of my friends wonder why they are gaining weight in mid-life, especially around the midriff area.
Amanda Thebe: I’ve studied nutrition for about a decade now and I wrote a book about nutrition. We’re all learning all of the time. Nutrition scientists are looking at the data and we actually do have quite a lot of good data. I mean, there can always be more, but so far, the data is pretty robust that we have. What happens in menopause, as we know, is our sexual hormones start to decline. Specifically in this case, we’re talking about estrogen and when estrogen declines, what can happen – and it doesn’t always happen – is that our bodies’ fat distribution and storage changes more from say the traditional pear shape to an apple.
And what women who start to put on weight find that whereas they would have held it around their bum and legs before, they tend to find they hold it around their stomach. And what can happen is an increase in the visceral fat in our body. It’s important to know there’s a distinction between subcutaneous and visceral fat. Subcutaneous is our jiggly fat, it’s just the easiest way to talk about it. And the visceral fat we cannot see is all around our organs. You can be super small and thin and still have visceral fat. It’s just the way that our fat deposits are stored in our body.
What’s really important to say to women is if you have a high percentage of visceral fat, it can lead to increased health conditions. And that’s an important distinction. But it’s difficult to know if you’ve got it or not because you can’t see it. You can’t just assume you’ve got it, and you can’t assume you don’t have it. It usually is through things like DEXA scans that we know this, but even if we take the seriousness of that conversation away, what’s important to know is that, when you put weight on in menopause, it’s multifactorial. Our estrogen levels declining can change where fat deposits lie on our body, but it doesn’t happen to everyone. Not everyone puts on weight. Some people do, some people don’t, but more people do than less.
The numbers are up there – 60 to 70 per cent will put on at least 5 lbs. – and that just doesn’t happen in a vacuum. It doesn’t just happen because you’re going through menopause. And I think digging into that is really important.
What we know is as we get older and as we move less, we become at risk of a lot of things, things like losing our muscle mass, something called sarcopenia. We’re sort of touching on a few of the speaking points that we were going to touch on today. So, there’ll be a lot of crossover, but sarcopenia is when we start to lose lean body mass. And for the purposes of this conversation, let’s talk about that as being muscle.
If you don’t try actively to hold on to muscle as you get older, move more and do resistance training, you will start to lose muscle mass at a rate of about 3 to 8 per cent per decade from your 30’s, which is significant. Now, that doesn’t accelerate through menopause, but it accelerates when you don’t move, and you don’t do strength training.
LA: Why do women stop moving?
Amanda Thebe: Good question. It’s not just women that stop moving less. What I’m trying to lean into here is that it isn’t just all menopause. There’s a lot that we can attribute to aging and being more sedentary. And I have a great example of this. A friend of mine went on holiday recently and she’d earned this holiday. She was like, I’m exhausted, I’ve been working hard. I’m going to lie on my sunbed and read a book and drink cocktails, and that’s going to be my holiday. She looked over at the other side of the pool and there was a mum with two kids who never stopped playing the whole time throwing the kids in the air and running around and literally being frantic. Any of us that have been mothers remember that.
I think as life stages has happened, we genuinely just don’t move as much as we needed to before, so we need to look for more purposeful ways of moving. And we just know this in general – something like 85 per cent of people in North America do not meet exercise guidelines.
It’s huge and it’s higher for strength training. So if you think that most people don’t get the required amount of cardiovascular exercise or don’t even think about how important strength training can be for going through menopause, for aging, for healthspan. We just don’t move as much unless we need to, unless we make time to.
Long story short, it’s complicated and it just happens, so a new emphasis needs to be put on the fact that as we get older, it’s really, really important to keep moving. Your body actually needs it.
LA: So, there’s a confluence of this change in our sex hormones and as you said, we’re going through menopause and then we’re also moving less.
Amanda Thebe: Yeah, and we’re getting older and there’s not a lot we can do about that, but there’s a lot we can do about the moving less, right? It helps support women going through menopause as well. Movement and exercise can be a great stress reliever and get those endorphins moving, build strength and help bone health, all of the positive things.
Exercise really doesn’t have very many downsides. Proactively trying to focus on our health through exercise, nutrition, and all of the lifestyle interventions will help women potentially reduce their symptoms. I’m not guaranteeing that for anyone because I know I went through the worst symptoms of my life, and I was exercising. It can be a stress reliever for a lot of women, but also just future proofing ourselves.
But if I can just quickly come back to weight gain as well. Weight gain can only happen when somebody is eating more calories than they actually use. And nobody wants to have a calories in, calories out conversation because it feels almost superficial and almost feels as though it’s disparaging to women. I’d like to clarify the science on this because I think when you understand this and you appreciate this, it puts a lot more emphasis on you having control over your situation.
And I’m all about giving women autonomy and making choices that support them. So, energy balance is the idea that the energy that you take in should match the expenditure that you have, and you find, this energy equilibrium.
And, and if you eat in excess of your body’s need, the body has no choice but to store that as fat. And if you eat less than your body needs, the body will reduce the amount of fat that you hold. So that’s how energy balance works. Energy is measured in calories. Calories are a unit of measurement and these are the laws of thermodynamics. This is nutrition science, and we can’t fight that. But there are so many influential parts that impact this equation.
Symptom management, not sleeping, high stress, not moving as much, aging parents that you’re looking after, and younger kids in that squeeze generation. We can stack that side of the argument for all the reasons why nothing’s working anymore. It’s a really challenging time for women. Those hurdles are real. And so it’s not a simple solution, but the science behind it is simple.
And then the last part I want to just add to that is that we have very, very good data from Herman Pontzer, who is a metabolic researcher, and he has shown that the metabolism doesn’t break up in menopause at all. In fact, throughout our lifespan it stays pretty stable until about the age of 60 when it drops by about.7 per cent.
So your metabolism is not broken either. So yay, Hooray. That’s another thing that’s actually positive. I just think it’s really important for women to have basic information because then they can go, OK, so if I know energy balance matters and I know my metabolism is not broken, but I also know I’ve got all of these challenges and that’s potentially contributing to extra work and feeling tired and, and all of the other things that they’re experiencing, then how can we make small impactful steps to improve that?
What, where would be my starting point? And that’s how I address these sort of situations.
LA: I have a number of friends who have gone on semaglutide and it’s been extremely helpful for them. So where do you stand on going the medication route?
Amanda Thebe: I always come from a non-judgmental place because it doesn’t serve anybody to judge people about their personal journeys and habits.
And one of the things that I do lean into is the science of everything. And unfortunately what’s happened is with the GLP drugs, all of these antagonists that are out there that really are helping people with their diabetes, being insulin resistant and obese people to lose weight. I think it’s amazing. I know so many people on it and I and I think that it’s been life changing for them.
What’s happened though, is that the GLP drugs have been abused: these were never created for everybody to go on. And I’m now seeing them advertise for women who’ve got 5 pounds to lose, 10 pounds to lose and, and then microdosing where there is zero data, and that doesn’t come from me, that comes from the experts. We also have many companies selling compounded versions, so not even FDA or Canada health regulated that you buy off label from a confounded compounding. I said confounding, but maybe it’s confounding A compounding pharmacy, often telemedicine online, there’s no checks or balances. You can lie. You can say you’re overweight, and have them delivered to your home. And so I, firmly sit on the side that this is, I think, a miracle drug for a lot of people, but it’s definitely being abused by people leaning into women’s insecurities about potentially having a few pounds to lose.
That’s the side that is difficult for me to support. But one of the things I would say is that if it does support rapid weight loss, then it does that by suppressing people’s appetite – they just don’t want to eat.
You will start to lose fat rapidly and unless you’re actively strength training, you’re going to lose muscle as well. And so and when it happens with any extreme diet, not just these you will lose both, right? And so it’s really important if you’re going to choose it for whatever reason, again, without judgement from me, consider doing a strength training program at least two times a week for 30 minutes just so that you can hang on to any lean muscle that you have. Because what’s happening is it’s making women frail.
We’re starting to see start, start examples of women that are very, very thin with low, low muscle mass. And so just like trying work with someone who is a medical professional, make sure you’re an appropriate candidate and realize that like there’s a little bit more to our bodies and, and our worth than what’s tied around about how much we weigh. That’s something I just would love women to just accept a little bit more as well.
It’s OK. You’re not less of a person because you’ve got a few extra pounds on you, right?
LA: What are the most important evidence based changes that women need to make to their diets during perimenopause and then on into post menopause? It’s really two separate things.
Amanda Thebe: But well, yeah, it’s it is, but it isn’t, it’s a really great way you’ve worded it because we can sort of talk about how it sort of our body goes through these changes, right? And it’s not a continuum. It doesn’t go like in chunks, does it? It’s a continuum of our lives. And actually, Leslie, this month is world menopause month in October when we’re recording this and the focus on world menopause month is lifestyle medicine.
One of the arms of lifestyle medicine is nutrition. I really like this because for the I’ve been talking about menopause now for 8 to 10 years, right. Regardless of whether you’re on hormone therapy or not or any other pharmaceuticals, it doesn’t matter. We need to dig into the lifestyle interventions because they work. We have real hard science to support them.
And then what’s happened in the space that we’re in is companies and influencers or whomever have seen that women are vulnerable, their bodies changing, they feel out of control.
And so, they will sell you a diet. There are so many diets out there and women just are going well, that’s the diet that I need to do for my menopause journey. And, and it’s really important to know there isn’t a specific menopause diet.
I’m not talking from just my opinion and my experience in education; I’m talking about what the menopause societies actually agree on globally. And globally, they lean heavily into diets like the Mediterranean diet, the DASH diet, the MIND diet, which are very plant focused diets. They’re not vegan or vegetarian, but they actively encourage women and men because this is just diet in general to support our body to eat many fruits and vegetables. We just don’t eat enough of those – fill half of your plate with vegetables and fruits. Look for lean proteins in your fish, chicken, meats. And there’s nothing wrong with eating plant based proteins. Sometimes they can be a great addition to your adventurous diet as well. We sometimes do that once a week.
And then on top of that, starch is a very important women are really scared of carbohydrates. We’ve been told to avoid them all of our lives, right? So we need them – they’re our main energy source. They change to glucose in our body and help our energy and they cross the blood brain barrier. And so I’m like, saying to women, you’re fatigued, you’re exhausted through menopause. Your body wants glucose, it really does. It will help you feel better. And you don’t need to reach for a blueberry muffin. You can have some rice, potatoes, you know, like you can still have a mostly whole food healthy diet with the occasional blueberry muffin. Nobody should ever cut those out.
But try and get the lion’s share of your meal from sources like this. And actually the Canada Health Guide, their food plate is great. And what’s really interesting, Leslie, is that people are like, yeah, those food guides are all out of date. No, they’re not. They get reviewed by health scientists. They’re great, but people don’t follow them. We don’t get taught them in school enough, but when they’re reviewed and they, you look at people’s socioeconomic status, you know, like, are they going to food banks?
Are they from indigenous cultures where they often don’t have a lot of access to fruit and fresh fruit and vegetables? It tries to cover all of those bases. And I think that it’s a really great leaping off point. But if I could just give generalized and advice to women, it would be to eat more fruit and vegetables. And by the way, nobody ever got fat eating too many bananas.
And then just minimize the fun stuff. Nothing changes through your lifespan but as you get older, you do need more protein.
LA: So yeah, talk to us about protein, how should get more into our diets as we get older?
Amanda Thebe: It’s a really great question. Now protein has got like a new wave of like appreciation and it is sort of like the queen of macro nutrients, I would say, because our body is made up of amino acids and that’s what protein breaks down into – an amino acid in its finite form.
And the RDA, the recommended daily allowance for protein is very, very low as it’s based on sedentary people. And if we’re trying to encourage people to be active, the protein needs increase. So if you’re an active person, if you’re somebody who is doing exercise and somebody who is, you know, trying to get fit and healthy, you need to support that with adequate protein stores.
There are so many different equations out there and, and if you boil them all down, the number tends to be the same roughly anyway.
And what I say to menopausal women is get a gram of protein for every pound of ideal body weight. So let’s say, for example, a woman whose ideal body weight is 140 lbs., that’s 140 grams of protein a day. That’s on the high side – about 80 to 100 per cent of that is great.
So then we’re talking between 100 and 140 grams a day. The 140 grams a day, is for someone who’s strength training a lot but for most women, if you can hit 100 grams a day, you’re on to a winner there. I struggle to get 100.
LA: Well, this is it. That’s a lot. And so do you incorporate things like protein powders in order to get up to that 100 or 120?
Amanda Thebe: Yeah, I do. And I and I am obviously at the stage in my life where I don’t need to like, count everything all the time. I’m instinctively quite good at knowing when to look for protein. So what I would say even if I don’t pare that back a little bit more to people is this, I don’t need you to count and measure and do anything. It’s just too stressful and it can cause a lot of anxiety.
But we do know that protein focus is important. And as you get older, you definitely need it as we start to lose muscle mass, etcetera. Try and look for it every meal, for example, for breakfast, you’ve just had a slice of toast with marmalade on. How about you have some Greek yogourt on the side?
And for lunch, you’ve got that lovely green salad because I’ve told you to eat loads and loads more plants. Chuck some chicken on top of that because you need protein. Look for some protein every time you eat and take that pressure away. If you feel like you haven’t had enough, stick it in a shake. Like you could have a little bit of chocolate protein powder with a little bit of whole milk, shake it up, and that’s like 40 grams of protein. So a lot of women will do that and I think that that’s perfectly fine.
Don’t stress it. I also would add that if you’re doing it to build muscle, the stimulus with building muscle is the resistance training. That’s the most important mechanism in resistance training. Protein supports that. So just have an increased awareness.
Protein, protein and fiber, they’re the two things I tell women to just have an extra focus on, and you can do that with a Mediterranean diet quite easily.
LA: I’ve been incorporating creatine into my diet for strength training in particular, can you talk to us about creatine? It’s getting a lot of attention too, especially for midlife women.
Amanda Thebe: Oh my goodness, This is what happens. First of all, I would just say as a natural born skeptic and a little bit cynical, I’m always like, oh God, here’s the next thing. But the creatine thing – it’s a very well-studied supplement, which is great, right?
And there’s some great researchers in Canada. Doctor Dr. Darren Candow is a Canadian researcher. This is his area of expertise and even he’s cautious in the way he talks about this. You should try and get the majority of the stimulus for strength training from your protein sources during the day, and the creatine’s like the cherry on the top of that big sundae. It’s not going to replace anything else, it’s literally like the additional cherry. Think of it that way.
There is emerging data, but it’s not definitive about brain health, that a lot of the data was done on people with brain deficiencies, things like Parkinson’s, Alzheimer’s, older, older individuals.
There’s no research on menopausal women and brain health, so we can just say that definitively, right?
But it doesn’t mean it may not help. It’s certainly not going to hurt, right? But what we do know is if you’re actively strength training, then creatine can really help with muscular performance and endurance. And that can be really great when you’re tired and you want to work out. Some women, they don’t notice any difference at all, and some do. Some women find it really bloats them and others don’t, but all of the claims that have been made really boiled down to the fact that if you’re doing strength training, it can really help you.
With all the other all the other claims, we’re not there and we’re not able to support those yet. When it comes to the supplementation stuff make sure you’re doing the stuff that requires you to support it, right? And a lot of a lot of people aren’t doing that yet. But to me, it’s because it’s not cheap. It’s 50 bucks for a container and that might last depending on how much you use, about a month or two.
I mean, do you want to spend that if it’s not going to actually do anything? But for strength training, I actually take it because I think it helps me, but I’m under no illusions that it’s going to help with other stuff at the moment, and if it changes, I’ll change too.
LA: Are there any other macro nutrients that that are important that we should be aware of?
Amanda Thebe: Well, the three macro nutrients as we know are carbohydrates, protein and fats. Carbohydrates are broken down into complex carbohydrates as they’re the ones with lots of fiber and micronutrients in them.And they are there’s also starches there.And then there’s simple carbohydrates which is sugar.So on that spectrum, we need to be leaning more into the complex carbohydrates like the fruit, the vegetables, the grains and some starches and then a little bit less of the, like I said, the fun carbs, right?And then fats tend to work themselves out.
I know we had this whole movement for keto that’s been and gone, but when you’re equating for protein and looking at your fibre sources, the carbohydrates and the fats sort of can, you can do what you want with them. If you’re somebody who is actively exercising, your body doesn’t need carbohydrates, it needs glucose, right? So don’t be afraid to eat them. To me, this is just like eat a mixed bag of all foods that you enjoy trying. And for whole foods, because we know that they contain vitamins and minerals, that’s really important to us. And when you’re doing that, you don’t need to take extra multivitamin supplements, right? The whole point of a supplement is that a supplement is meant to replace things that you can’t adequately get from food sources, and some things are harder to get from food sources than others.
If you eat an abundance of fruit and vegetables and even proteins and fats, you’re going to cover your bases.
LA: And do the timing of certain macro nutrients matter, should you bulk up on the carbohydrates late in the day or earlier in the day?
Amanda Thebe: Well, there’s different schools of thought on this. I’m going to remove fats in the equation because I think that we eat enough fat because we cook with it and it’s in foods and is very easy to find our fat in foods. And when it comes to protein, spreading protein out throughout the day is perfectly fine, the body doesn’t tend to store it. If you look for protein throughout the day, it’s a really great way to know that you keep your protein stores available.
If you wanted to do carbohydrate timing, you could consider doing having like the simple foods such as a blueberry muffin in and around your workouts because it breaks down in the body quickly. You get sugar into your body quicker. I run with gummy bears because I want that sugar hit when I’m running, but if you’re doing a 30-40 minute workout in the gym, it really doesn’t make that much of a difference. If you keep your protein up during the day, you don’t even need to quickly eat protein after workouts as well, You’ve got a period of time that you can just keep eating protein.
I think that if we can take that pressure off people about when and what to eat and, just look at this more big picture and just say you’re just not eating enough carbohydrates, that’s why you’re tired, right? You’re, having a 2:00 PM slump and you’re reaching for the blueberry muffin because your protein stores are low and protein helps stabilize blood sugars and helps keep us fuller longer.
So if we keep our protein levels up, then we tend not to have those slumps in the day when we get extra hungry and need quick satisfaction. Understanding how your body responds to food is to me a little bit better than saying, oh, it’s 10:00, I have to eat, because then we become stuck to this regimented way of eating that may not suit you, it’s just arbitrary.
LA: Now I want to shift gears a little bit and talk about cholesterol. I’ve heard that cholesterol increases during menopause, so what can we do about that from a nutrition standpoint, and is it possible to alter your diet such that you don’t have to go on statins?
Amanda Thebe: First of all, speak to your healthcare professional if you’ve got high cholesterol because it’s the doctor that you need to be speaking to. But sure, question for me a minute.
LA: Should we all get tested for cholesterol around menopause, perimenopause?
Amanda Thebe: The American Heart Association and the Canadian Heart and Stroke Foundation, recommend this, especially as we get older because guess what, being sedentary, aging and and going through menopause somewhat all impact cholesterol, right?
Men get high cholesterol too, is the point, but menopause does have an impact on it, we do know that. And after menopause, we know that women are a higher risk of cardiovascular disease in general, right? It’s the biggest killer of women. And all of the associations tell us that by shifting the needle on our diet, even just a little bit can move the needle by up to 25%.
That can be things like reducing the amount of saturated fats you’re eating. You know, the good stuff like butter and steak and things like that. Saturated fat is easy to recognize because it goes hard when it’s cold. Don’t freak out about it. There are many things that you can do to move the needle on this. First of all, speak to your healthcare professional, ask for the blood test, ask to get tested.
It usually is in a full blood panel in Canada. So maybe your primary caregiver can do you an annual blood test. It can be impacted by exercise and by nutrition. Changing your diet to the diet that we just spoke about, like the Mediterranean best diet can be very, very impactful.
Exercising and moving more can be very, very impactful as well, but if you’re somebody who has a genetic leaning towards high cholesterol – my husband does, he’s the fittest person I know – like crazy fit, has high cholesterol and is on a statin because of it. It doesn’t matter how well he eats, it doesn’t really move the needle.
And that’s what the science is telling us. If it’s a genetic reason that you’re on it, usually there’s not a lot you can do to move the number down with good diet and exercise, but you still need to do the good diet and exercise anyway in addition to the statin.
So it’s a very individualized conversation that you need to have, but all of the scientists are actively telling people get out and just walk more. Walking can just have a real good impact on all of your metabolic systems in your body. We know that that we’re as we get older and go through menopause, we’re at higher risk of some of these diseases and health conditions. By exercising and improving our stress and getting decent sleep, we can mitigate cardiovascular disease with exercise nutrition.
There’s so much that you have within your control, and if you need support in with medication, nobody should be ashamed about that.
LA: On that note, I want to thank you so much, Amanda. You’ve been amazing, such great information. A lot of this puts women in the driver’s seat of their own health.
Amanda Thebe: That’s exactly how I do my work because I just want women to know that if you know the information, then you get to make valid choices that give you autonomy to make choices that support your body. You can have a valid conversation with your healthcare professional, and you can become your own bodies’ detective. We’re all very different, right?
And I think that we can take general guidelines and then apply it to ourselves. I’m very pragmatic about everything I do. I ask myself what’s the most practical way we can do this, how can we translate the complicated issue into practical solutions? So hopefully this has been helpful for some women.
LA: Extremely helpful, thank you again.
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