The Intersection of Menopause and Nutrition: A Weight-Inclusive Approach with Val Schonberg

Hola amigos! Welcome back!

Menopause may feel like something to fix and yet, “menopause is a process, not a disease.” Val Schonberg sits down with David to discuss everything menopause.

Highlights of this episode:

  • The stages of menopause
  • Menopause and nutrition
  • Menopause and digestion
  • Body image and menopause
  • Physical and emotional well being

Guest Bio: 

Val Schonberg MS, RD, CSSD, LD, NCMP, FAND, was born and raised in Nebraska, Val’s a Cornhusker at heart!  After graduating from the University of Nebraska-Lincoln, she went on to complete both her Master of Science degree in nutrition and dietetic internship at the University of Minnesota.  She is Board Certified as a Specialist in Sports Dietetics, a certified menopause practitioner by the North American Menopause Society, and a Fellow of the Academy of Nutrition and Dietetics.

Val has over fourteen years of experience treating all types of eating disorders while also specializing in sports nutrition, menopause, and women’s health. Prior to establishing her private practice, she worked as a clinical dietitian in the treatment of eating disorders.  In addition to her role as a lead clinical dietitian, she implemented and coordinated The University of Minnesota-The Emily Program Dietetic Internship program, the first ACEND accredited eating disorder dietetic internship in the country.

Although her practice has expanded to provide comprehensive nutrition services to individuals beyond those struggling with eating disorders, Val is passionate about eating disorder prevention and providing nutrition care to populations vulnerable to pathological eating problems, most notably with athletes and midlife women. She has worked as the consulting dietitian for the University of Minnesota Women’s Gymnastics team; and, has provided nutrition consulting and presentations for numerous dance, figure skating, gymnastics, and other sport organizations including the Minnesota Dance Medicine Foundation, the Wisconsin Association of Cheer/Pom Coaches and Just for Kix, a company providing dance programs in fourteen states. Currently, Val serves as the consulting dietitian for Emory Sports Medicine and Orthopedics and The Atlanta Ballet.

Episode Show Notes: 

 [06:04] What is Menopause Exactly?

Menopause is the end of a woman’s reproductive years, usually around age 51, confirmed after one year without mensural cycle. The reproductive eggs run out so the ovaries do not produce estrogen and progesterone. There are three stages of menopause, perimenopause, menopause, and post-menopause. Over time, women experience hormone changes, resulting in symptoms like hot flashes, night sweats, irritability, and fat is stored in the central area – we don’t know why actually. Menopause can be short or up to 10 years. Post-menopausal years without estrogen can mean a decline in bone health, osteopenia, and cholesterol can rise. 

Just like puberty, there is a process. If women’s life cycles were an airplane ride, puberty is a turbulent ride up and menopause is the landing. Fun fact, the orca whale is the only other mammal with menopause. Menopause is not something to fix. We can address the symptoms without throwing supplements at it. What if mindset was a consideration? Instead of fixing, learn how to work with it. Val thinks her generation is struggling more with menopause than previous generations. What is different? Life is different for people of 40-60 years old in this time. We have the stress of caring for another parent and or struggling to take care of our children longer into their adulthood.

Also, medicine has changed for menopause as well. Val’s mother generation experienced a blanket treatment with hormone replacement therapy. Then, a 2004 study by the Women’s Health Initiative show that hormone therapy was contributing to cardiovascular events and breast cancer. Women like Suzanne Somers, took economic opportunity in this vacuum for menopause treatment by producing supplement alternatives. In capitalism, someone always steps up to fill the gap from medicine and science. Then with further research about hormone therapy, it was determined that the age and stage of menopause were factors in to whether or not to undergo hormone therapy. 

[16:48] Menopause Treatments 

Is there a time to interfere with the natural process of menopause with hormone therapy? Val explains that if menopause is extremely disruptive to life, it may be a good option. She also cautions that many supplements do not outperform placebos. There are many questions about supplements. Black cohosh is controversial due to associated liver problems. Val suggests working with an experienced dietitian to consider the safety of supplements and doing a risk assessment to determine if any supplement is right for you. She also encourages to tell your physician what you are taking, even if its natural. Supplements can be overwhelming and expensive. Sometimes the supplements provide an unnecessary mega dose. We don’t know what impact supplements have on the body. Just because its natural, doesn’t mean its safe. 

[21:50] Menopause Symptoms

Hot flashes are commonly known because it is estimated that over 75% of women get them in this life change. What causes a hot flash? We don’t know! (So frustrating.) Symptoms can be head to toe because estrogen receptors are all over our body. Some women even have hair loss, like male balding, which looks different from balding from an eating disorder. Other symptoms are loss of libido, sensitive to some topics, joint pain, skin itching or hives, skin dryness and weight gain or weight redistribution to the abdomen. Any previous digestive symptoms can amply since estrogen helps us digest food.

We understood that estrogen may cause weight gain. If that’s true, why recommend any supplement or diet? No one had good explanations for why a certain diet would be effective.  Val criticizes that if a shortage of estrogen was the reason, then why would we not see weight redistribution or gain in patients with female athlete triad or anorexia nervosa? It’s possible that other hormones are in play. For example, the follicle-stimulating hormone (FSH) and luteinizing hormone are increasing. Research is attempting to find more nuances about the weight gain, like hormones, sarcopenia, and then yo-yo dieting – this may be a perfect storm for weight gain. While some women may gain 5 pounds, others gain 20-30 pounds. 

Since we are living longer lives, so we are finding out more about the human body. The human body is ultimately trying to protect you and extend your life.

[31:09] Body Image Issues 

Women in menopause and with weight gain will often self-impose food restriction, especially women who have dieted in the past. They get frustrated, because the diets are not working like they have in the past. When women go to the doctor, the LDL and cholesterol is higher, they are pre-menopausal, and the BMI is higher. The message becomes the weight gain did this and you are now at risk for other chronic diseases. However, these symptoms can be just the change in hormones, not the BMI or weight. How a woman reacts can be mentally disturbing. The desperation to lose weight can be troubling.

In a study about Body Image and Aging in Women over 50 years old, 80% of 1,800 American women reported their weight and shape affected their self-esteem. Women are in a change cycle within a thin-obsessed, young-obsessed culture. This is colliding with a stage of self-exploration. Women in this stage of life are empty nesters or have retirement or job changes. In a way, it’s a loss of identity, which affects self-worth.

Positive body image is really out of reach for some. You cannot stand in a Wonder Woman pose and suddenly have positive body image. For some, Amy Cuddy’s Ted Talk, Fake it Till You Make it, may be helpful but not in all cases.

Body image images are tangled up in the experience of our body, embodiment. The experience of our younger years formed how we feel in our body. So, Val says, we don’t have to be ok with what we see but bullying ourselves is not the answer. What is helpful is a voice that is nurturing and supportive, like a parent to ourselves. We wouldn’t talk to our kids in a bullying voice. Ask -how do we care for ourselves at this time in our life? We can take an active role in active selfcare. We can eat healthy and not be on a diet. Things like soluble fiber, moving regularly, not smoking, etc. and help us feel better.

[42:08] Menopause and Eating Disorders

Women in menopause may have eating disorders develop. In one study, 13% of women in menopause reported eating disorder symptoms, while 3.5% reported binge eating. What is disturbing is – how much of this goes unreported? Val and David both regularly see this in their practice.

Anorexia nervosa is one of many types of eating disorders. She sees undiagnosed eating disorders mostly in her practice. Eating disorder studies reference that 34% of the population are  age 30 and above. This is a stark contrast to the stereotype of a young teenager with disordered eating. An older study reported that 20% hospitalizations for eating disorders were within a age range of 45-65 years old.

In the book, Sick Enough, it is clear that doctors don’t know how to spot an eating disorder and so its missed. A large body is definitely dismissed for eating disorder diagnosis, although it is clear that anorexia nervosa can exist in all body sizes.

Another obstacle is depression, which increases in pre-menopause. Women may disappear from care because of life transition. Also, realistically, they don’t want to sit in the room with the 20 year old’s. They end up taking care of the younger patients, when they should be focusing on themselves. This is why Val has a Body Image Group for women of 45 and older. Average age is 55 years old. They have camaraderie. Group classes are so helpful in combination with individualize care. You want to know its not just you. In all self-compassion literature, we learn that kindness and knowing you are not alone is helpful. Validation is very useful.

 

Stay tuned for next week about mid life eating disorders and how to help menopause symptoms.

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Resources:

Val’s private practice: EnlightenU

Val’s previous episode on One Small Bite: Relative Energy Deficiency in Sports

 

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one small bite podcast, david orozco, founder, speaker, author, counselor

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