Menopause, fasting, and alcohol: Unraveling the latest research
April Midlife Roundup [2024]
Happy April!
I feel like lately there has been lots of news in the midlife space. Shall I say controversial news?
I’m talking about hot-button issues. By hot button I mean topics that not only get brought up frequently but bring about polarized views.
Then there are issues that no one seems to talk about (but me, ha ha) that are important. Today I want to share three hot-button issues and one that I wish got more attention.
Let’s start with the one that caused the biggest stir: The Lancet series on menopause.
Hot button issue #1: Is menopause as deficiency disease or natural?
In March, the Lancet came out with a series on menopause. The first paper in the series, “Time for a balanced conversation about menopause,” argues for a new approach. It’s not very long, but there was one part that caused quite a reaction:
over-medicalisation of menopause and promotion of MHT as a panacea is unhelpful and only serves to divide opinions further. It is time for a sensible conversation about menopause to enable informed, individualised decision making on optimal management of this transition.
Their response appears to be influenced by the promotion of menopausal hormone therapy (MHT) in regions like the UK and on social media. There is a trend to label menopausal women as having an "estrogen deficiency disease" and to advocate for menopause as a disability in the workplace.
It was the word “overmedicalization” that caused such a reaction. For those who believe menopause is an estrogen deficiency disease, this reaction makes sense.
Even though the noise is loud on hormone therapy, many midlife women, including here in the US, still don't have access to it. Some doctors dismiss women's complaints without considering perimenopause/menopause and claim hormone therapy is dangerous.
I believe healthcare providers should provide all midlife women with access to hormone therapy and explain the risks and benefits so they can make an informed decision. I also think vaginal estrogen should be over the counter as it's very safe and it will benefit vaginal and urinary health. But I don’t think evidence shows everyone has to be on hormone therapy or that menopause is an estrogen deficiency disease.
Menopause or midlife development?
The article goes on to explain more about its commitment to women’s health. And they said something that made my ears perk:
We need to send a realistic, balanced message to women and to society: menopause does not herald the start of a period of decay and decline but is a developmental life stage that can be negotiated successfully with access to evidence-based information as well as appropriate social and medical support. Women deserve nothing less.
Did they really write developmental life stage?
In my opinion, this is not entirely correct. Midlife is a developmental life stage in which menopause occurs during it. Remember, we don’t call puberty a life stage.
The problem I have with both the Lancet's view and the counterargument is we have neglected to recognize the life stage of midlife and conduct research to support women in meeting their distinct needs. We’ve done this for other life stages like adolescence, pregnancy, and old age under 65, so why not midlife?
Hormone therapy can't be the only answer because women are also aging. And those aging changes affect how well we do on hormone therapy. This is why I call it AGING PAUSE. And studies done to date do not show it helps prevent disease except for osteoporosis (when on it) and vaginal health.
As I see it, we can keep having the same hot-button argument or we can demand better research to discover what helps women thrive in the body they have.
I think by now you know MY hot-button issue.
Hot button issue #2: The intermittent fasting study
Intermittent fasting (IF) is a hot topic in the midlife world. Some women are told they should definitely fast and others (mostly health professionals) rail against it.
So when news of an abstract presented at the American Heart Association conference showing that an 8-hour window of intermittent fasting was linked to 91% increased risk of death of cardiovascular disease, it sent the internet spinning.
According to a press release by the American Heart Association, 20,000 people were followed. And those with established cardiovascular disease who ate less than 10 hours in a day showed a 66% higher risk of death from heart disease or stroke. And those with cancer did better when eating 16 hours or more in a day.
A few things are important to note. This study lacks publication in a journal and has not undergone peer review. We cannot get all the details about it, making it hard to discuss.
The study was criticized by IF supporters for conducting food recall only twice and other issues commonly found in observational research. This brought forth those already against IF and just another reason why women shouldn’t fast.
In case you missed it, I wrote an in-depth post on intermittent fasting and felt the research wasn’t compelling.
We can't really know for sure until the research study is published in a journal. However, I question whether skipping breakfast, a commonly chosen fasting method because of its convenience, may have any negative consequences. The problem is the morning is when our bodies are most metabolically efficient, and research has shown that skipping breakfast modesty increases risk of mortality.
And second, is the potential loss of muscle mass, which in some studies show has been greater for fasting. This is why longevity doctor Peter Attia stopped fasting and wrote this in his latest book.
One not uncommon scenario that we see with [fasting] is that a person loses weight on the scale, but their body composition alters for worse: they lose lean mass (muscle) while their body fat stays the same or even increases.
-Peter Attia, author of Outlive
Hot button issue #3: Alcohol is poison (again)
Negative press around alcohol and health is at an all-time high. We used to hear messages that moderate drinking had some benefits but now its no amount of drinking is good for you.
So when study results presented American College of Cardiology Annual Scientific session showed over 8 drinks a week increased cardiovascular risk, the “you-should-stop-drinking-now" posts started rolling in.
The study included 432,265 members from Kaiser Permanente Northern California (KPNC) members average age 49 (18-65). The researchers interviewed the subjects categorizing them in low intake (1-2 drinks per week), moderate (<7 drinks per week for women) and high (8-15 per week) and binge drinking (>3 drinks a day women). They did not include non-drinkers in the study.
Young and middle-aged women in the high group were 33-51% more likely to develop heart disease than those who drank less. And binge-drinking women had a 68% increased risk. The researchers have also not published this study yet.
I have mixed feelings when I see posts about how we all need to stop drinking. First, it’s good that we are highlighting the negative effects of excessive drinking and I think we should normalize people who choose not to drink. Yet when you look at all the evidence, it’s still possible that light/moderate drinking can have heart-health benefits.
We can’t ignore that observational data, as flawed as it is, has overwhelmingly shown that light/moderate drinking benefits heart health. And as I show in an in-depth post I wrote last year, intervention studies hint at why this is (hello Nitric oxide). But also, it can help diversify the microbiome (too much alcohol does the opposite) and stabilize blood sugar.
Of course, there is an increased cancer risk from drinking, and that can be a deal breaker for some. And hormone therapy surprisingly heightens this risk, which no one talks about. And we know for sure that excess drinking negatively affects heart health.
In short, the right decision for one woman may not be right for another.
A review on Iodine
In the midst of these hot-button issues, I stumbled upon a review that I feel deserves greater attention. This was in the March edition of the Frontiers in Nutrition about the U shape relationship with iodine status and metabolic disorders.
That means that deficiency and excess are problematic. But surprisingly, the bottom of the U was somewhat high for certain conditions. If you pull out your biomarker guide you get when subscribing, you’ll see that urinary iodine of >100mcg/L is considered sufficient.
As I’ve talked about before, I believe iodine is a problem micronutrient for midlife women. And I wonder if midlife needs are a bit higher than the recommended 150mcg.
For instance, the bottom of the U for both metabolic syndrome and hypertension is a urinary iodine of 300-499 ug/L and for hyperglycemia its 100-199 ug/L. Higher cholesterol, triglycerides, and weight/waist circumference have also been associated with lower iodine status. Some potential mechanisms are shown in the figure.
Of course, there’s not that much research to begin with and there are some conflicting findings but the researchers conclude:
This review validates that iodine has effects on glucose metabolism, lipid metabolism, and obesity. The influence of iodine may be attributed to its antioxidant and immunomodulatory properties. Although the connections between iodine and metabolism are inconsistent, both iodine deficiency and prolonged iodine excess may pose a risk to thyroid disorders. It is important to maintain population iodine status within an optimal range.
When I’ve looked at studies, a urinary iodine less than 100 ug/L is quite common. For instance, in a 2015 study on iodine status and menopause symptoms, 99 out of 210 postmenopausal women had urinary iodine levels less than 100 ug/L. That’s almost half!
And those with lower iodine status had more hot flashes. I still can’t find a follow up to this study!
I know…I know. Another hot button issue for me.
The Menoclarity piece
Speaking of hot-button issues, MenoClarity has a great post discussing common claims made on social media about hormone therapy.
They help women understand what’s really behind claims made about HRT in “Let’s Focus on Known Facts About HRT.” Don’t miss this well done piece.
Well, that's a lot to mull over. Let me know what you think about all these issues (or any other one) in the comments.
Great summary!