Intermittent Fasting and Weight Management at Menopause

ABSTRACT

Menopause marks a significant transition in a woman’s life, characterized by hormonal changes that influence metabolism, cardiovascular health, and overall well-being. As women approach menopause, managing these changes becomes crucial for maintaining health and quality of life. Among various dietary interventions, intermittent fasting has emerged as a promising strategy, not only for weight management but also for addressing hormonal imbalances and mitigating age-related risks such as cardiovascular disease and cognitive decline.

INTRODUCTION

Menopause phase is associated with reduced estrogen levels and increased risk of metabolic syndrome consisting of obesity, diabetes mellitus, hypertension, hypertriglyceridemia, and cardiovascular morbidity. Menopausal weight gain, though modest in the majority of women, increased truncal adiposity and visceral fat predisposes to metabolic syndrome with its associated morbidity. Reduced physical activity during menopause exacerbates weight gain. Strategies aimed at reducing weight gain and improving physical activity have huge impact on physical and psychological health by reducing metabolic syndrome and cardiovascular morbidity.

Different types of diets aimed at reducing body weight and metabolic syndrome risk have been studied. Evidence is evolving in terms of the advantages of different types of diet and their health benefits. Intermittent fasting (IF) is a type of diet with alternating episodes of fasting and feeding for a specific period of time. Published clinical trials regarding the advantages of IF on body weight and metabolic syndrome are available. However, studies on the effect of IF among menopausal women are scarce. Unsupervised IF may result in nutritional deficiencies, also fasting episodes can have an effect on reproductive hormones – estrogen, progesterone, and testosterone which affect physical and psychological well-being in women. This article reviews current evidence of IF among menopausal women.

MENOPAUSE AND BODY WEIGHT

Changes in the body weight and body composition (in terms of fat distribution) are common after menopause. Whether it is due to aging or estrogen deficiency is controversial. Estrogen is a thermogenic hormone that increases basal metabolic rate. Estrogen deficiency and rising follicular-stimulating hormone are known to cause altered body composition with increasing brown adipose tissue along the waistline and viscera after menopause.[1,2]

Menopausal women tend to have more visceral fat than subcutaneous fat. Study of Women’s Health Across the Nation study showed that perimenopausal and postmenopausal women have higher cardiovascular fat deposition than premenopausal women after adjusting for age, obesity, and other variables.[3] Cardiovascular fat causes intense inflammation compared to subcutaneous fat as shown by elevated inflammatory markers such as C-reactive protein, fibrinogen, tumor necrosis factor, interleukins, and monocyte chemoattractant protein.[4] Visceral fat deposition causes local inflammation leading to coronary artery disease and insulin resistance. Abdominal fat acts as paracrine and endocrine organ and it secretes adiponectin and leptin which have anti-inflammatory and pro-inflammatory action, respectively. Indian data also suggested increased metabolic syndrome among postmenopausal women. About 64% of postmenopausal women had increased waist circumference versus 20% of younger women. Forty-two percent postmenopausal women had metabolic syndrome versus 16% in younger premenopausal women.[5]

Recent data have pointed toward altered gut microbiome as cause of insulin resistance and type 2 diabetes.[6] Estrogen and gut microbiome seem to be interrelated and menopause is associated with dysbiosis.[7] Altered gut microbiome is also associated with reduced high-density lipoprotein, high waist circumference, and increased blood pressure.[8] Menopause by itself has high chances of developing metabolic syndrome. Weight gain and aging have an additional impact on the development of metabolic syndrome. It is important to modify the diet and physical activity to bring down the risks associated with metabolic syndrome.

INTERMITTENT FASTING AND ITS BENEFITS

Various dietary interventions mentioned below have been tried for health benefits.[9,10,11]

Intermittent fasting

This includes alternate fasting and feeding. This method is gaining popularity due to the benefits of weight loss and improvement in metabolic syndrome. There are many methods of IF.[11]

• Time-restricted feeding – 16:8 h method, where food is consumed over 8 h period followed by fasting of 16 h. During the 16 h period, consumption of calorie-less fluids is allowed such as water, green tea, and black coffee. Similarly, an 18:6 h pattern also can be done

• 5:2 method – This is the most popular method. Fasting for any 2 days in a week interspersed with regular feeding pattern on 5 days. Two days are nonconsecutive days, where regular feeding is allowed between the two fasting days. These 2 days, consumption of very low-calorie diet (~ 500 calories) is allowed

• Alternate day fasting – Fasting is done every other day as the name suggests

• Weekly 1 day fasting – Water-only diet for 1 day, once a week.

• Mediterranean diet: Consumption of whole grains, fruits, vegetables, fish rich in omega 3 fatty acids, with less amount of dairy. This includes the use of olive oil as a source of fats

• Nordic diet – Similar to the Mediterranean diet, it is plant-based high fiber diet with nuts, whole grains, nordic fruits, and fish and low in dairy, salt, and added sugars. This diet uses canola oil as a fat source

• Ketogenic diet: High-fat diet with low carbohydrate regime, planned to induce a stage of ketosis

• Vegan diet: Restricts all types of animal-derived foods

• Human chorionic gonadotropin (HCG) diet: Combining ultra-low calorie diet (~ 500 calories) with HCG supplements. This type of diet is not backed up by any scientific data and is not approved by the Food and Drug Administration

• Gluten-free diet: Exclusion of food products containing gluten, such as wheat and rye.

There are no studies comparing different types of diet on body weight and metabolic syndrome.

There are no studies comparing different types of diets on various parameters such as body weight and long-term advantages. Furthermore, there is no one type of diet which fits all. Each dietary pattern is associated with certain advantages and few drawbacks.[9,10,11] Furthermore, each type of IF has been compared only in few trials, as to know the benefits of IF on various parameters of metabolic syndrome.

Advantages of intermittent fasting

There are gaps in research as to the exact mechanism of IF on metabolic health. IF results in significant weight loss promoting healthy living.[12,13] During the fasting phase of IF, there is a shift in energy sources from glucose to fatty acids and ketone bodies derived from fat. This metabolic switch typically occurs after at least 12 h of fasting. There is reduction in visceral adiposity with reduction in body weight, about 7% below the baseline weight at 6 months.[11,12] During the fasting phase, there is reduced spikes of insulin which improves insulin sensitivity and glucose homeostasis.[14,15] IF improved insulin sensitivity and glucose control in prediabetics and diabetics in clinical trials.[16,17] Reduced adiposity and decreased insulin spikes cause reduced inflammation due to dyslipidemia and cardiovascular events.[18,19] Mechanism behind reduced blood pressure by IF is not clearly understood. It may be related to parasympathetic activation.[20]

Caution with intermittent fasting

Adherence to IF protocols is a challenge in the long term. Time-restricted feeding may interfere with working hours and intake of medications. Adherence is better with a 5:2 type of IF than with time-restricted feeding and alternate-day fasting. Initial side effects include features of hypoglycemia, weakness, reduced working, dizziness, and instability while walking leading to falls, particularly in the elderly.[9,11,21] IF is not recommended in pregnant women, breastfeeding mothers, children, advanced age, and immune deficiencies. Furthermore, adequate protein intake should be maintained during the feeding phase along with physical activity to avoid muscle wasting due to IF.

IF AND WEIGHT MANAGEMENT AT MENOPAUSE

Optimal weight loss strategies after menopause are under research. Continuous hypocaloric diet (<1500 calories per day) based on weight and physical activity is recommended. IF and Mediterranean diet have known to reduce visceral adiposity and promote metabolic health among menopausal women.[1,10,22,23] Although clinical trials on IF have included women irrespective of menopause status, data only among postmenopausal women are scarce.

EFFECTS OF INTERMITTENT FASTING ON MENOPAUSAL HEALTH

Weight management and metabolism

Postmenopausal women often experience weight gain due to a decline in estrogen, which influences fat distribution and metabolism. Studies have shown that IF, particularly time-restricted feeding, can aid in reducing visceral fat and improving metabolic markers, such as glucose and lipid profiles, by enhancing insulin sensitivity. This makes IF a viable option for counteracting menopause-associated weight gain and metabolic syndrome.[23,24,25]

Hormonal balance

IF impacts key hormones associated with menopause:

• Insulin and cortisol: IF improves insulin sensitivity often observed in postmenopausal women. By decreasing cortisol levels, it may also alleviate stress-related hormonal imbalances.

• Dehydroepiandrosterone (DHEA) and androgens: Research indicates that IF may increase levels of DHEA, a precursor to estrogen and testosterone, which declines during menopause.[23,24,25,26,27]

Cardiovascular health

Cardiovascular risks escalate postmenopause due to reduced estrogen levels, which provide protective effects against atherosclerosis. IF has demonstrated benefits in lowering LDL cholesterol, reducing blood pressure, and improving endothelial function. These changes collectively contribute to improved cardiovascular outcomes.

Cognitive function and brain health

The drop in estrogen levels during menopause can affect brain function, increasing the risk of neurodegenerative conditions. IF enhances the production of brain-derived neurotrophic factor, a protein that supports neuronal health and cognitive resilience. Preliminary evidence suggests that IF can reduce the risk of dementia and improve memory, though more longitudinal studies are needed.

Inflammation and oxidative stress

Menopause is associated with heightened inflammatory states, which contribute to conditions such as osteoporosis and arthritis. IF mitigates inflammation by modulating pathways such as nuclear factor kappa B and reducing oxidative stress markers. This anti-inflammatory effect is pivotal for improving overall health during menopause.

PRACTICAL CONSIDERATIONS FOR IMPLEMENTING IF IN MENOPAUSAL WOMEN

While IF offers several benefits, its application in menopausal women must consider overall individual health conditions, dietary preferences, and lifestyle.

• Nutritional adequacy: Ensuring a nutrient-dense diet during eating windows is crucial to meet the body’s needs for calcium, Vitamin D, and omega-3 fatty acids, which support bone and cardiovascular health. Adequate protein diet and physical activity to avoid sarcopenia (muscle loss)

• Hydration and electrolyte balance: Adequate hydration and electrolyte supplementation can prevent fatigue and headaches commonly associated with fasting

• Timing of eating windows: Studies suggest that consuming meals earlier in the day aligns better with circadian rhythms, enhancing metabolic outcomes and hormonal balance

• Exercise: Incorporating resistance and aerobic exercise alongside IF amplifies its benefits, particularly for maintaining muscle mass and bone density.

Challenges and potential risks in menopausal women

Despite its benefits, IF may not be suitable for all menopausal women.

• Hypoglycemia risk: Women with diabetes or prediabetes need medical supervision when adopting IF

• Hormonal sensitivity: In some cases, IF may temporarily disrupt menstrual patterns in perimenopausal women or exacerbate symptoms such as fatigue and mood swings

• Sustainability: Long-term adherence to IF requires careful planning and motivation, as abrupt calorie restrictions can be challenging for some individuals.

Future research directions

While current evidence highlights the potential of IF in improving menopausal health, further research is warranted to:

• Understand the long-term effects of IF on bone density and cardiovascular health

• Explore individualized fasting protocols based on genetic, hormonal, and lifestyle factors

• Investigate the combined effects of IF and hormone replacement therapy (HRT).

CONCLUSION

IF holds promise as a therapeutic strategy for managing menopausal symptoms and improving overall health. By addressing weight management, hormonal regulation, and age-related risks, IF can significantly enhance the quality of life for menopausal women. However, its implementation should be personalized, taking into account individual health needs and preferences, with guidance from healthcare professionals.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.