Mainstream Menopause Advice is Misleading Active Women

Fasting, keto, low carb, all zone 2 all the time…those rules are not for us.

It’s been two years since my menopause training book, Next Level, came out and three years since we started working on it. Though it’s nearly impossible to believe at this point, just three or four years ago, menopause wasn’t a mainstream topic of conversation. But once Oprah and other high-profile women started talking about it–and businesses recognized that menopausal women were a massive demographic (read: potential profit center!), the conversation exploded, and menopause information is literally everywhere.

Sadly, so is misinformation, especially for active women who, because we are a minority (barely a quarter of adults over 18 meet the minimum physical activity guidelines for both aerobic and muscle-strengthening activity). That’s how I end up seeing so many midlife women with low energy availability because they’ve been told menopausal women need to cut carbs and fast. So, let’s talk about some of the mainstream advice that does not apply to active women (and really, often doesn’t apply to any women).

You Need to Fast

Fasting is sold to women as the Golden Ticket for health and wellness (and one should note, “health and wellness” are often social media code for “weight loss”) for menopausal women. Generally, it’s promoted as intermittent fasting (i.e., eating in a small window each day or severely restricting calories a few days each week). 

As I’ve said many times, from a health standpoint, intermittent fasting can be useful for the general population who are not very active and struggling with metabolic diseases. Exercise is also helpful here. What gets missed in the conversation is you do not garner any additional benefits from layering intermittent fasting on top of exercising. In fact, for women, it can backfire. 

That’s because women are more sensitive to energy restriction than men. A big reason why is kisspeptin, a neuropeptide that’s responsible for sex hormones and endocrine and reproductive function, which also plays a significant role in maintaining healthy glucose levels, appetite regulation, and body composition. It’s also more sensitive in women than men. When it gets perturbed, our sex hormones aren’t produced and released the way we need them to be. 

Intermittent fasting disrupts kisspeptin expression. When our brain perceives we have a deficiency in nutrients, especially carbohydrate, we have a marked reduction in kisspeptin expression, causing appetite dysregulation, and can induce changes in the circadian rhythm of our hormones

Now add exercise. When we layer exercise stress on top of the stress of denying our bodies fuel stress hormones like cortisol rise even higher. As you keep increasing that stress, it keeps your sympathetic drive high and reduces your ability to relax. Your thyroid activity is depressed, which messes with your hormones. Your body also starts storing more belly fat, and you may experience more menopausal symptoms. 

Finally, there’s a strange myth going around that fasting increases estrogen, which there’s absolutely no evidence to support. This misnomer came from a study using young female rats (3 months old, equivalent to a 9-year-old human). In this experiment, the rats underwent 24 hours of water fasting every other day for 12 weeks. By the end of the trial, serum estradiol increased, while luteinizing hormone (LH) levels decreased versus ad libitum fed controls. There was also significant evidence for menstrual cycle dysfunction (estrus dysfunction in rat speak). In female humans, fasting effects are a different story. 

In young, healthy women, significant changes in steroid hormones are observed, with a reduction of testosterone and dehydroepiandrosterone (aka DHEA), as well as a decrease in LH and leptin.  In menopausal women,  it downregulates our androgens, specifically DHEA, which isn’t ideal, because after menopause, all estrogens and almost all androgens are locally developed in the peripheral tissues from DHEA. We also see a downregulation of other hormones such as IGF-1 (important for bone density!). All in all, healthy active women should not look to fasting to improve hormone or metabolic outcomes.

You Should Stay in Zone 2

If you follow mainstream health and wellness content, you’ve seen that Zone 2 training is almost a religion these days. Women are also warned against doing hard training because it raises cortisol and will lead to weight gain. This message, like so many, is actually very counterproductive for women, especially active women.

For women, Zone 2 training is great for active recovery, a certain amount of base building for endurance athletes, and social exercise. But putting a precedence on zone 2 training in women may not be the ideal way to improve skeletal muscle mitochondria function (to include increasing mitochondria expression, improving fatty acid uptake, and improving lactate clearance…all the things zone 2 is promoted to do). 

But again, women are not small men. Females have better mitochondria respiration and mitochondria density than men, so they don’t need endless hours of zone 2. What they do need is to add high-intensity work to improve mitochondria capacity and anaerobic capacity by the nature of the high-intensity work.

From a performance perspective, high-intensity training, specifically short sprint-style intervals lasting less than 30 seconds, are critical, not only to improve lactate production and clearance, but to also stimulate an increase in the fast twitch, Type II fiber cross-sectional area (size and function); of which female have significantly less as compared to the slow twitch Type I fibers. 

For menopausal women, high-intensity sprint interval training sessions can provide the metabolic stimulus to trigger the performance-boosting body composition changes that our hormones helped us achieve in our premenopausal years.

Carbohydrates Are Bad for Menopausal Women

Like fasting, keto, which is very low carb (<10% of calories), is also promoted as metabolic magic for menopausal women. In reality, this can be as bad, if not worse, than fasting, because it leads to low energy availability (LEA) in active women, which can reduce thyroid hormone levels, cause bone mineral density loss, and mimic or exacerbate symptoms of menopause. 

In my own work, I've found about 55 percent of individuals who are training every day are in low energy availability. And females are especially at risk. As we discussed in our International Society of Sports Nutrition Female Athlete Position Stand, eating sufficient carbohydrates can help you avoid LEA. For endurance training that means 4.5 to 7 grams of carbohydrates per kilogram of body weight a day. Women doing moderate training and/or short intense days (like CrossFit training) still demand about 3.5 to 5 grams of carbs per kilogram of body weight per day.  

Menopausal women already have more anabolic resistance and trouble making and maintaining muscle. Keto will not help! Low carb availability impairs the feedback we need for those adaptations (primarily by increasing BCAA oxidation)! Eating enough carbohydrate also helps us maintain a healthy immune and stress response to exercise and helps moderate cortisol (which menopausal women want), improving adaptations and recovery.

Supplements are a Scam

The mainstream media is currently very pro menopause hormone therapy (more on that in a bit), which is a natural backlash to the unwarranted doom and gloom headlines that scared everyone away from this very effective therapy for decades. But now, there are some influencers who are writing off anything that isn’t estrogen, especially supplements, as useless for helping with menopause. 

Not true. While there’s certainly a lot of gimmickry in the supplement industry and you have to make informed choices, there are plenty of supplements with well established track records that can bring women significant relief! 

As many of you know, I’m a fan of adaptogens, which are a class of medicinal or therapeutic plants that increase your body’s resistance to stress–something menopausal women benefit from especially. They do so by targeting your hypothalamic-pituitary-adrenal (HPA) axis, a neuroendocrine system that controls your reaction to stress and regulates various body functions, such as digestion, mood, temperature control, and immunity. 

Menopausal women also benefit from creatine, which can help increase strength, power, and athletic performance in females, and it’s also good for your brain health (I hear from many menopausal women who say it helps with brain fog) and maybe even your mood. It might be the most important and most exhaustively researched supplement many women still aren't taking. 

Every Woman Needs to Replace Her Hormones 

Some people misrepresent me as “anti hormone therapy.” I am not in any way anti menopause hormone therapy. It is a valuable tool for relieving menopausal symptoms, especially vasomotor symptoms like hot flashes and night sweats. And it can provide invaluable support for women who are struggling with the menopause transition, as it delivers low levels of estrogen and progesterone to prevent the disruptive symptoms women can experience as they fluctuate during perimenopause. Testosterone can also take a dive from the stress of perimenopause, thus supplementation can help here too. Menopause hormone therapy is also good for women who are at risk for osteoporosis. 

What I am “anti” is the misguided, and all too pervasive, notion that menopause hormone therapy “replaces” your natural hormones and therefore essentially keeps you in a premenopausal hormonal state. That’s simply not true. 

It’s also not true that every single woman needs it. I work with hundreds of women who feel great, perform well, have good cardiovascular health, and strong bones without hormone therapy. If you need and/or want it, that’s great. But just as we shouldn’t have been scared away from it 20 years ago, we shouldn’t be scared into it today.