Metabolism and Menopause: What Does Research Suggest Is the Best Dietary Strategy?

After my recent post on keto for women, I got a lot of feedback. One of the most common themes: “But what about menopause?” I heard from dozens of women in both the comment section and in emails who were having trouble losing weight and dealing with the varied symptoms of menopause. Was keto the answer? Was Primal? Were they doing something wrong?

Rather than start with the assumption that going keto or Primal is the best way to deal with menopause, I figured I’d start from ground zero, drawing on the extensive scientific literature on diet and menopausal symptoms to see if I could arrive at some general trends and make recommendations.

But first, why do we even experience menopause? In the big picture, menopause is rather rare. Besides humans, orcas and pilots whales are the only other species where the females live significantly beyond their reproductive age. The average age of menopause hovers around 50, and most women can expect to live another 30 years or so. That indicates its importance. It wouldn’t have been uniquely established and preserved in just a couple species if it didn’t provide huge benefits to those species. And sure enough:

  • The presence of grandmothers in a population enhances maternal survival during childbirth.
  • They provide childcare so parents can be more productive, whether it’s going back to work in the office or foraging for nuts and tubers in the bush.
  • They impart wisdom to the youngsters—and to the community as a whole.
  • And, though parents probably wouldn’t count this as a positive, they spoil grandkids rotten.

To boot, many women I know say menopause ushers in the most focused, creative time of their lives. If their reproductive years (particularly perimenopausal ones) were characterized by hormonal chaos, they often find themselves grateful to be free of the perpetual fluctuation. But mostly they say they’ve entered a time of life when they feel more confident and self-possessed. (Joan Erikson, wife of noted psychologist Erik Erikson as well as author, psychologist, teacher, and artisan, writes insightfully about this transition.)

All this said, menopause can also present its share of physical difficulties for many, if not most, women at some point. But do these effects need to be as unpleasant as they often are? I’d venture to say no. I have a few posts in mind here, but let’s dig into dietary strategy today.

First, let’s establish what changes physiologically during menopause. What are the most common symptoms of menopause? And what does the evidence say about how diet affects those symptoms?

Weight Gain

This might be the most common complaint women have during and after menopause: Weight goes on more easily and is harder than ever to scale back. Nothing seems to work, even the dietary interventions that previously did.

Why is weight loss so hard after menopause?

  • Energy expenditure and basal metabolic rate both drop with menopause.
  • Lower levels of estrogen increase appetite and reduce satiety.
  • Lower levels of estrogen reduce activation of brown fat, the metabolically-active body fat which burns energy.
  • If you’re experiencing another common side effect of menopause—insomnia—your sleep-deprived brain’s reward system will be more susceptible to the allure of junk food.
  • You’re older. As we age, weight becomes easier to put on and harder to remove for both men and women.

Despite these roadblocks, there is hope. Something has to work. And even if it doesn’t work as well as you’d like, there’s something that works less badly than the others.

For one, glycemic load matters. Many studies find that the glycemic load of a postmenopausal woman’s diet is a strong predictor of her fat mass. Remember that glycemic load is often a roundabout way of indicting carbohydrates without saying “carbohydrates.”

What really does seem to work is the classic paleolithic diet: lean meat, fruit, nuts, vegetables, eggs, berries, and fish with no grains, legumes, sugar, dairy, potatoes, or added salt. 40% of energy from fat, 30% from protein, 30% from carbohydrate. Over 24 months, menopausal women on a paleo diet lost more fat, more waist circumference, and more triglycerides than those on a standard “healthy” diet.

Perhaps it’s the protein. Another study found that postmenopausal women who ate the least protein (under 0.8 g protein per kg bodyweight) had the most body fat and were physically weak. Those who ate the most (over 0.8 g per kg, 1.1 g/kg on average) had the least body fat and were more physically capable.

What’s clear is that weight loss has beneficial effects on menopause symptoms. It reduces inflammation, improves cancer biomarkers, regulates sex hormones, and improves endothelial function—to name a few. What’s also clear is that weight loss can have negative second-order effects in menopausal women, like bone mineral loss and loss of lean mass. So, it’s worth doing, and doing right. You have to strike a fine balance between losing weight and avoiding muscle loss. As your satiety signaling is likely thrown off, you might have to make a more conscious effort to track your food intake and make sure you’re not overdoing it.

Heart Disease

Before menopause, most women are protected against heart disease, at least compared to men. Once menopause sets in, a woman’s heart disease risk goes way up. A good diet for menopause, then, would have to reduce heart disease risk. What does the evidence say?

In overweight post-menopausal women, high-fat diets (where the fat came from cheese or meat) improved atherogenic biomarkers compared to a high-carb diet. Both the cheese-based and meat-based diets increased HDL and Apo-A1; the high-carb diet did not.

Meanwhile, high-carb diets were persistently linked to chronic low-grade inflammation and an elevated risk of heart disease in postmenopausal women.

Moving beyond broad macronutrient ratios, are there any specific foods or nutrients that play an outsized role in menopasual women’s heart health?

Dark chocolate may help with reduced endothelial function, another risk factor for heart disease. Postmenopausal women who consumed high-cacao chocolate saw their endothelial function improve in one study.

Green tea appears to help postmenopausal women reduce fasting insulin, a major but underappreciated risk factor for heart disease (and a host of other bad conditions).

Bone Loss

As estrogen plays a big role in the maintenance of bone mineral density and overall bone health, bones get weaker and lose density during menopause. A woman’s risk of osteoporosis, fractures, and other bone-related incidents skyrocket during and after the transition.

Intake of long-chain omega-3 fatty acids—found in fish, shellfish, and fish oil supplements—is associated with higher bone mineral density at the hips and spine (the most crucial parts for aging people) in osteopenic women. Osteopenia is lower than normal bone mineral density. It isn’t quite osteoporosis, but osteopenia can often progress into it.

Glucose loading actively impairs bone remodeling in postmenopausal women. The problem doesn’t go away just because you exercise, either. And it gets worse the higher your postprandial blood glucose goes.

The normal bone-relevant nutrients become even more relevant after menopause:

  • One study in postmenopausal women found that yogurt fortified with vitamin D3 improved bone mineral density, while regular yogurt without the vitamin D3 worsened it.
  • Another found that a gram of calcium a day wasn’t enough to stave off bone mineral loss in menopausal women during weight loss; they needed at least 1.7 grams per day.
  • Another study found that a collagen supplement increased bone mineral density in post menopausal women.

Brain Fog

Everyone’s heard of “pregnancy brain.” There’s also “menopause brain.” It’s characterized by brain fog, memory loss, lack of focus, and other cognitive symptoms.

Postmenopausal women who ate low-glycemic breakfasts had better cognitive function than those eating high-glycemic breakfasts.

Some research also suggests a role for micronutrient supplementation in menopausal cognitive symptoms:

  • Vitamin C can help. In one study, postmenopausal women who took 500 mg of vitamin C a day improved verbal recall, naming, and repetition. These improvements were accompanied by reductions in beta-amyloids linked to Alzheimer’s disease.
  • Resveratrol may help. In one study, it increased cerebral blood flow and improved overall cognitive performance during a series of tests, particularly in verbal memory.

Hot Flashes

Both fish oil and soy isoflavones have been shown to reduce hot flash occurrence, with soy acting faster on severe hot flashes and fish oil doing a better, but slower job of targeting both moderate and severe hot flashes.

Folic acid supplementation reduced the severity, duration, and frequency of hot flashes. A better source for folic acid are folate-rich foods, like leafy greens or liver.

Breast Cancer

A woman’s risk of breast cancer rises after menopause. After menopause, the inflammatory status of the breast goes up almost as a general rule. This explains at least part of the elevated risk for breast cancer postmenopausal women exhibit, and it’s true whether or not the woman is overweight or not. Menopausal breast fat is inflammatory fat.

Among Japanese women, those who ate the most noodles and other carbohydrates had higher levels of estradiol, which other studies have found correspond to a higher risk of postmenopausal breast cancer. Those who ate the most fish, fish fat, and saturated fat had lower levels, which correspond to a lower risk. Of course, the authors opine that this suggests eating more fish and say nothing about saturated fat, but we can’t really expect them to contradict decades of propaganda—I mean, evidence.

Oxidative Stress

Menopause is generally inflammatory; along with waist circumference, menopause status is an independent predictor of low-level inflammation and elevated hs-CRP (one of the most fundamental markers of inflammation). There’s a low level simmer going on, and it can cause a lot of problems. Diet can make it worse, or make it better.

High-glycemic diets—also known as diets high refined carbohydrates—are associated with more oxidative stress in post-menopausal women (for what it’s worth, the same is true in premenopausal women). Intakes of insoluble fiber and PUFA, including omega-3s and healthy sources of omega-6s like nuts, were linked to lower levels of oxidative stress.

Paleolithic diets, on the other hand, reverse inflammatory markers in postmenopausal women.

Folate supplementation reduces oxidative stress and normalizes blood pressure in postmenopausal women.

Genetics matter, of course. A growing body of evidence indicates that various genetic variants can influence the effects of some of these dietary interventions on the symptoms and risks associated with menopause.

Among Japanese and Japanese-Brazilians, for example, soy isoflavone intake protects against breast cancer only in those with certain genetic variants. It’s neutral otherwise.

There’s more to managing menopause than just diet, of course. Lifestyle decisions matter too. But that’s beyond the scope of today’s post. Maybe in the future.

So, can we make any recommendations? What are the takeaways? We see some trends emerge.

Dietary Takeaways

Avoid Refined Carbohydrates

Pretty much every study that looked at fast-digesting, low-nutrient sources of carbohydrates found they have a negative effect on most concerns of menopause, including bone health, breast cancer risk, heart health, weight gain, inflammation. Now more than ever, don’t eat them.

Limit Carbs To Only What You Use

If you’re an incredibly active woman, someone who CrossFits and runs sprints and swims laps and plays with grandkids, you can get away with more carbohydrates, and may even thrive with a few extra. But make sure you actually need those carbs.

Soy Isn’t a Bad Idea

I know, I know. Soy is evil, or something. But a number of studies indicate that soy can improve the overall menopause experience. Stick to whole soy vs isolated soy components. (And avoid GMO.) If you can include something like natto—fermented soybeans—a few times a week, you’ll get the benefits of soy isoflavones and vitamin K2.

Drink Green Tea

Several studies show that green tea (or green tea extracts) counters or ameliorates multiple menopause symptoms.

Eat Leafy Greens

Greens are a great source of folate and calcium, critical nutrients for postmenopausal health.

Eat Adequate Protein

1.1 g/kg should be the lower limit.

Eat Fish

A can of sardines (bone-in) provides omega-3s, calcium, and excellent protein.

Lean Toward a Higher-Fat-AND-Protein, Lower-Carb Diet

Make sure to stick with Primal foods.

Menopause isn’t easy for most women. Things are changing, hormones are in flux, and eating strategies you once employed may no longer work the same way. There’s no magic diet that fixes everything, but there are lots of little changes that can tilt the scales in your favor.

Try them out and let me know what you think.

In the meantime, I’d love to hear how you’ve handled menopause via diet. Thanks for reading, and take care, everybody.

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

If you'd like to add an avatar to all of your comments click here!

105 thoughts on “Metabolism and Menopause: What Does Research Suggest Is the Best Dietary Strategy?”

Leave a Reply

Your email address will not be published. Required fields are marked *

  1. Thanks for this article. I am taking notes, no where near menopause yet. But being prepared is a plus.

  2. As a menopausal woman, I’m grateful for such thorough coverage. I’ve been wondering specifically about protein — will increase it for sure. Thanks so much, Mark!

    1. I recently had a total hysterectomy, the only way I now lose weight is by being very strict with my nutritional system that I use- this is my new lifestyle for the last year; I have been able to lose 30lbs pre-surgery and 22lbs post surgery. High proteins and low carbs are key. If you’re not on a good nutrition system please look into one, be sure the ingredients are sources responsibly and are clean ingredients (not all proteins are the same quality ?).

  3. Was doing fine on a keto diet, but I slipped into eating too low carb and I broke out in a horrid rash! I’m trying balance out to add more carbs – black cohosh & vitamin e with mixed tocopherols work wonders for my hot flashes!

  4. I’ve been primal for a decade but in May decided to give keto a try when my doctor ran out of ideas to help with my joint pain. Keto has allowed me to drop a few pounds, improved my mood dramatically and invigorated me. When my newspaper carrier quit in June, I took over the route. I’m up at 5am and have delivered my papers by bicycle by 6am. There is no way I could have done that pre-keto.

    1. Hi Suzanne the fact that you went from primal to Keto, which is moderate protein, did you follow that protocol or are you keto with your protein on the higher end? I have been keto for over 5 years, but my menopausal symptoms are crazy. I dont have the weight issue because of keto, but have been wondering about the amount of protein I should be eating.

      1. Hi Susan,

        I feel best on paleo, but there are paleo-friendly foods which increase the number, duration, and intensity of my hot flashes. I’m not certain whether this is one of the symptoms you struggle with. These include nuts, avocados, olives, coconuts, and eggs. A lecithin supplement clearly aggravated them after 1 dose, as did a collagen powder. Tea seems to increase frequency, but coffee doesn’t. Sadly, chocolate does. Sugar and grains do when I choose to make that poor choice. When they are really rolling any hormonal change sets them off – any emotion, eating, needing the toilet, falling asleep and waking…it’s endless. And it’s been almost 8 years. I’ve slowly gained some weight but am by no means obese at 150lbs and 5’9″.

        It means I don’t get to use mayo, or avocado oil (which gave me hot flashes even when I only used it as a body lotion), but what the heck! It helps to stay on track if I allow myself the occasional infusion of dairy cream (which I tolerate very well), and very occasionally a croissant, as white flour gives me fewer symptoms than more fiber filled ones. As long as the croissants are very occasional, I have no problem from them. Sugar is a killer, though, for hot flashes, and chocolate is a gateway drug and hot flash enhancer; I have no control there. On the flip side, if I’m very cold, I know exactly how to bring on a hot flash to warm up, which is a kind of plus I guess.

        Does anyone else have insights about their symptoms, hot flashes in particular? In the summer heat even being strict doesn’t help. Soy doesn’t seem to help either, or any of the usual herbs. My current theory is that I should work on gaining muscle mass and losing some of my adipose fat.

      2. Although it is counter to every diet, including Primal or Keto try removing all vegetables from your diet for even a few days and see if inflammation improves. I found that nightshades cause joint pain. In switching to other vegetables I added in more almonds, kale and spinach…didn’t help made it worse. Removed those and inflammation improved. Rotation is the key never eat the same foods everyday.

  5. Those saturated fats (from animals) like bone marrow, tallow, butter and egg yolks are absolutely critical, raw ingredients that the body and brain use to make and optimize the sex hormones, including estrogen.

    Don’t forget that higher cholesterol is also correlated with longevity in women. Once again, look to the native wisdom of our early ancestors (40 to 70% fat w/ tons of nourishing cholesterol) which included nose-to-tail eating. Most people can incorporate these delicious fats but too many skip the organs. At the very least, have a nice big serving of Liver once a week.

    Grass Fed Tallow not only supplies fatty acids like CLA, oleic acid and palmitic acid but also contains vitamins A, D & K. This combination provides the matrix for absorption and assimilation of the fat soluble activators which supports and affects virtually every biological system… yes, it’s that fundamental!

  6. Very good article Mark! Validates my way of eating; I lost over 80 lbs. after menopause. I actually started educating myself via Gary Taubes book and yours! “…the classic paleolithic diet: lean meat, fruit, nuts, vegetables, eggs, berries, and fish with no grains, legumes, sugar, dairy, potatoes, or added salt. 40% of energy from fat, 30% from protein, 30% from carbohydrate.” is what worked for me. Especially, the eliminations! I have kept it off for 8 yrs, and I feel so much better and I am more active. My doctor and lab tests show I’m metabolically doing very well. Thanks for another awesome article.

  7. Can’t thank you enough for this post (and other posts specifically for women)!!!

  8. Thanks so much for this post. I lost a significant amount of weight a year or two ago going Paleo/Low Carb, but have gained some back (carb. creep occurred). I have since read how “too much protein” is bad, etc., keto is the way. I haven’t had the best luck on Keto, but have upped my protein to 45%, and fats to 45%, still a low 10% Carbs (or less), and that seems to work better for me. My energy levels are back up, and the body composition is getting better, all within a week or two of adjusting.

  9. I am wondering if most of this applies when you have surgical/medical menopause. I’m having a total hysterectomy in 1.5 months(I’m 36) and then probably a 6 month treatment of Lupron and I’m trying to get information on how to avoid the weight gain(which I’ve read is more when you go into surgical menopause vs. natural).

    1. Tamara — I can’t speak to studies, but I am 5 years post-total hysterectomy (at 45) and everything in this makes sense to me and matches my experience. I’ve definitely had weight gain, and a change in body proportions, but I’m nowhere near overweight and have been able to be active and healthy. I also found primal eating mattered a lot in healing from my surgery. I went on bio-identical HRT and found it really helped with symptoms. Good luck to you. If you want to ask any specific questions or chat, reach out through my website. I know what a life-changing experience this can be.

      1. I had a hysterectomy at age 43 due to a huge benign mass that was growing from my right ovary needing to be removed. Since my left ovary was saved, I did not experience full blown menopause until age 52. Somehow ovaries can continue to produce hormones that the body can use even when not attached to a uterus! I have been on bio-identical hormones since then, which has likely helped me avoid most significant symptoms of menopause. However, I think it is important to note that I have been on a pretty strict primal diet since age 50. (I am now 58) I experienced no weight gain and am now at my ideal weight and have good muscle mass. And, this is effortless. I do not miss grains and other high carb foods. I enjoy 2-3 ounces of 88% dark chocolate/day and do not mind eating much of the same foods each day. Probably the main thing that reminds me I am menopausal is that I do not generally sleep as well as I used to, but it has gotten better. I am also very open to questions, though do not have a website. 🙂

        1. I went into chemical menopause at age 49 during breast cancer treatment (chemo and tamoxifen), and unfortunately gained weight because of it as well. I easily lost weight using keto last fall after Mark’s Keto book came out, and am now at a lower weight than I’ve ever been as an adult (125-130 lbs, 5’6″). Have been maintaining for fiber months now, eating higher-carb Primal again, with stints of keto (still experimenting with the best maintenance diet for my body).

          My keto weight loss diet was very high protein (“zero carb” for the last three months of weight loss, approximately 5% carb, 80% fat and 15% protein – I often went well over my recommended 0.7g/lb). I still tend to eat relatively high amts. of protein (75-100g/day), and lower carbs (5-50g/day).

          I get hot flashes from the tamoxifen, but they’re very mild and bearable.

    2. Tamara I too am due to have surgery soon which will result in menopause. I am 36 as well.
      I’m most worried about taking hrt, putting synthetic hormones into my body and my mental state.
      I’ll admit I am so so scared. I’m completely overwhelmed about the options going forward and the implications of premature menopause on future health (increased heart disease, bone health diminishing, increased breast cancer risk and dementia risks). I hope everything goes as well as possible for you

  10. Thank you so much for this post and PLEASE write again, specifically regarding exercise and it’s impact in this phase of life.

    Since starting reading your blog 10 odd years ago I am now well into perimenopause (51 in April, still cycling but battling mid-riff fat gain, fatigue and even more disrupted sleep than my ‘normal’ life-long insomnia, and short-term word memory …); so, many of the ‘symptoms’ you list.

    I know my body is responding differently to the macro ratios and that going keto isn’t a great idea; seems to exaserbate fat hoarding. Phasing carbs that I do have through the day has helped with blood sugar control. None at breakfast, a little at lunch and the most at dinner. This seems to help the nocturnal hypo as well. But I’m above the normal range fasted sugars many mornings, although post-prandial are fine.

    Any further posts eagerly anticipated!

  11. Six years into menopause and I finally found something that’s helping me lose weight – intermittent fasting. And protein cycling. But fasting is sometimes quite amazing. Besides the fact that it’s easier to eat nothing than to figure out what to eat, I have tremendously improved focus.
    Caveats: One has to be somewhat fat adapted to feel good while fasting, in my opinion. And there just times (travel, a poor night’s sleep) where fasting doesn’t work/is not a good idea

  12. I’m bookmarking this. I’m officially in menopause, so this is timely. You didn’t mention keto. Recommended? Not? What about fasting — intermittent and extended?

    I really want to do this right, so I can stay active as long as possible.

  13. Thank you for this! I’m a longtime reader, five years post-surgical menopause, and I’m always on the lookout for how to be healthy, strong, and clear going forward. I welcome more on this as well.

  14. Thank you for the information in this article. I’ve been eating primal for 7-8 years now. Menopause/hot flashes hit me 5 years ago and haven’t left. Haven’t had a good night sleep since then either. Lately my joints have become really loose too, to the point where I dislocate my shoulder just by sleeping on it funny. I have now managed to dislocate both wrists and a bone in my foot. Is there a remedy in supplement or food form that would help me? Apperantly there are exercises to strengthen the ligaments for people in my position. Please comment/point me in the right direction. I’ve been doing Crossfit for 7 years, I thought I’d be spared from stupid stuff like this.

    1. I have the joint problem, too. I hope someone can answer. One of my knees keeps getting dislocated, and one shoulder and one wrist are threatening. They are sore from arthritis, which is either a cause or effect, I’m sure.

  15. Dear Mark,

    Thank you for your web news regarding menopause women and metabolism.

    I especially would like to thank you for writing about “Soy”.
    I am 53 years old and today is 273rd day since my period has been missing. However, I don’t have Hot flash luckily.
    I think that’s because I eat fish (every other day) and natto with flaxseed meal every day.

    Keto, Primal and other dieting website says Avoid Soy, but I really hope traditional Japanese foods, especially fishes and natto comes to be recognized for those women.

    Thank you.

    (Sorry my poor English)

  16. Brilliant post, thank you so much! So needed this!

    I’m 55 and in full menopause. I found out that my hot flashes diminish when in keto. Weight loss is still slow, even though maintaining is easier. I eat a lot of fish, and take a collagen supplement. But after a good workout, or after a night of not so good sleep, I am just hungry!
    The point about protein made me think, so I will try that for a while and see.
    Again – Thanks Mark!

  17. When I saw this headline, I immediately thought “Oh thank God”, as menopause is something else, isn’t it? Seemingly overnight I’ve piled on weight around my middle, have hot flashes, brain fog, can’t remember simple words, loss of energy and will, osteopenia in spine, I could go on. I definitely think what we eat and how we move is only part of it. I’m also trying to figure out the hormone balance, and am sticking to natural solutions. But we also need to find mental peace and everyday presence, so it’s not a case of getting through it, but finding a way to be and feel wonderful when your body changes.

    1. I can so relate to your symptoms. I am 47 and gave been struggling with “perimenopause” for 2 years now. It seemed like my mud section just ballooned overnight. In Jan 2018 I started the Fast Metabolism Diet and list 20lbs by May but am having trouble getting back on track. I have lost all desire to socialize, which is not at all my norm and seem to be incredible irritated with everyone, all the time. Work has become a chore and I’m avoiding most of my long-time friends. I’m considering trying the Macro diet but am just not sure about anything anymore! Thank you for your post….at least now I know it’s not just me!

      1. I’m betting your mood issues are from low progesterone. It can get worse, as it did for me, to the point of dispair, and then fear of the next round. I strongly recommend you see someone who specializes in bio-identical hormone replacement to get you through this, especially if it gets worse. If I had not found out about it through my own research, I would have killed someone, myself perhaps. It can get that serious. I am through peri-menopause now, and menopause is so much easier!

        Although diet is in your control, there are some environmental factors that are not, and can contribute to hormone disruption.

        1. I am a little over a decade past menopause, and I will add my voice on bio-identical progesterone being VERY helpful to me. This was before I knew much about Paleo, but my diet was not overly carb heavy. My main symptom was anxiety, irritability and mood problems, and the progesterone seemed like it simply turned off the “alarm” in my body. I felt so refreshed and relaxed. Oh and it turned off the occasional hot flash I had to zero. Since then I also learned that the less grain I ate, the less depression I felt, and my mood corrected itself. Now at 64 I still battle a belly pudge that improves again with more keto style eating and intermittent fasting. and exercise. I will see how it goes in the next 6 months or so.

      2. I am several years into peri-menopause, and I agree with Aly that low progesterone exhibited as very poor confidence, causing me to panic and cry just before it was time to attend a meeting. I enjoyed bio-identical hormones, however found them too costly and the cost kept steadily increasing. Now I am very happy on Emerita progesterone cream used with Dr. John Lee’s recommendations in his pre-menopause book.

        I like fish oil (5 grams per day) for hot flashes — reduces them but doesn’t eliminate. I also take a mixed supplement with dong quai, black cohosh, and a few others (Solaray Female Hormone Blend SP-7C) which seems to help very well with mood swings.

        I’ve been very low carb, in and out of keto, for three weeks now, and that has helped my mood, strength, energy, sleep, weight (a teensy loss), and mental clarity more than I can say. Thank you, Mark!

        1. Emerita progesterone cream and Dr. Lee’s book were enormously helpful to me also. I tried (and paid) for other bio-identical hormone therapy but eventually dropped it due to expense and the fact that I did not seem to need it. But the over the counter Emerita bio-identical progesterone was a life saver.

          1. Thank you all for the information. I’m going to check on the bio identical hormones. I’m optimistic that this may help with my moods and depression. This article has been a godsend!!

  18. I’m 9 years into menopause, and have been off-and-on Primal for 10 years. I started Keto 10 months ago and have found significant improvement in every health marker, including problems due to low-estrogen.

    I have had great success with intermittent fasting as well. I recently had to fast 36 hours for a medical procedure and had no problems at all – something that would not have been true before I started Keto. Sure, I was hungry, but I did not feel I HAD to eat (good since I was in airports and on a plane with no decent food anyway).

    I was eating .5 gram protein per pound of lean body mass (the same as 1.1g/kg), but about a month ago increased to about .7 grams. My weight loss had stalled and I just “felt” that more protein was the answer. My energy is better and I am losing weight again.

    1. I am very intrigued by Keto and intermittent fasting…but is there a way to ‘figure out’ one’s personal percentage of lean mass?…I wonder too if I’m not getting sufficient protein.

  19. Very helpful, thank you. I wish I could do it all again (not really) and follow these guidelines. Instead I suffered big time. All the symptoms plus some. Please note women, there can be permanent effects so heed Mark’s advice. And question every symptom.

  20. Thank you for this thorough article, as I find myself creeping straight into menopause. Perfect timing 🙂
    It has shed some light on what I’ve been experiencing in the last few months. Thank you again!!

  21. What do you think is better for menopause, having migraines, and being hypothurood? Primal or Keto? I’m still finding the right amount to not be fatigued.with the thyroid.

  22. Great article. Thanks. Look forward to more on this topic. Diet, exercise, sufficient sleep, and stress management have all helped with menopause symptoms. If one is off even a bit, hot flashes/night sweats ensue.

  23. I have been primal for 5 years and the only weight gain issues I have encountered in menopause arose from exercising 5 to 6 hours a week. The resulting appetite caused me to not only eat more carbs but “stray” more to non primal foods. I’m currently working off 7 lbs I gained by being more strict and exercising less intensely,

    All health factors appear to be good. HDL is increased, triglycerides are low, blood pressure normal. Bone density slightly improved rather than worse. Can’t really claim it’s done much for hot flashes. I do still know I am in menopause in that regard.

  24. Thanks, but what else can I try? I’ve been low-carb/high-fat/moderate protein since the late 1990s.

    I hit 50, menopause hit back, and I gained almost 50 pounds in the next 18 months with no change in diet or activity. I was able to lose some of that weight over time, but neverall of it, and then gained all back, and then some.

    Now I’m 63 and at the highest weight I’ve ever been (210 at 5’6″). I eat less than 30 net grams of carbs, I’m not afraid of good fats (I AM afraid of vegetable oils!), and I get a good amount of protein every day, probably between 80 and 100 grams. I’ve tried keto, paleo, you name it.

    I don’t work out because it’s simply not comfortable exercising when you’re carrying a bunch of extra weight. Walking, sure, but nothing more strenuous. I understand strength training is beneficial, but it won’t do anything to get the weight off.

    So why can’t I lose weight? I got even more serious in the past month, going totally grain- and gluten-free, never any sugar (or artificial sweeteners), and dropping net carbs to a max of around 20. I’ve lost a total of 2 pounds (and still the scale bounces down and up those 2 pounds so I’m not really sure I’ve lost even that).

    I’m truly at my wit’s end. My husband says to just not worry about it and eat what I want. If I do that, my weight will spiral completely out of control.

    Also, I take no medications, my lipid panel is excellent, blood pressure normal.

    1. Hi there I read your post on Mark’s Daily Apple and could relate. After post menopausal I put on about 20 lbs. Like you nothing seemed to work, except intermittent fasting. So Mon – Fri I don’t eat anything until noon. I can have water, tea or coffee as long as it has no sugar or cream. I eat at 6:30 pm (supper) and don’t eat again until noon the next day. I take a 20-30 minute walk before noon, and eat a regular lunch and supper. On the weekend I’ll eat a late breakfast/brunch and usually just one other meal. I think you’ll find your metabolism will reset it self, so less insulin resistance, hence less belly fat!!

    2. Kathy, have you dialed in your sleep hygiene? It’s crucial. And while you worry about more weight gain, I wonder if you actually need more carbs? From your description you sound very disciplined so perhaps you could try it.
      The only other thing I can think of might be Vitamin D. In any case I hope you find your answers!

      1. Thyroid problems also surface at menopause and can cause weight gain.

        1. I was on Armour thyroid for several years but finally dropped it (doc knows and approves) because it didn’t seem to be helping. Even without the thyroid meds, I’m still around mid-range on TSH (yes, I know there’s more to it than that).

          I’m not on any meds now, but am taking some adrenal supplements, 7-Keto DHEA, probiotics, and liver detox supplements. I don’t take them every day (apparently I’m not yet a responsible adult), but do try.

      2. Thanks, Kathy and Andrea! I typically don’t eat breakfast, and have an “eating window” from around 11:00 (sometimes noon) to around 6:00.

        I get plenty of sunshine in the summer. We have 45 acres in the country, and I mow about 5 acres each weekend, which takes about 3 1/2 hours. I wear a hat, but otherwise just shorts and a tank top. I get plenty of sun then (no sunscreen) plus I try to be outside in the sun during the week at least 30 minutes if not more.

        I might try more carbs, still no sugar or grains, obviously. I’m sleeping well (finally). Andrea, by “dial in my sleep hygiene,” what do you mean. I go through phases, but these days I seem to be sleeping solidly for 8 – 9 hours.

        Thanks for the tips. I hope I find my answers, too!

        1. Hi Kathy, I obviously can’t speak to your situation, but I can tell you about my experience over the past year. I previously followed a primal plan successfully for 2ish years but then slowly started dropping my carbs and increasing my intermittent fasting periods. Eventually I was following a similar eating plan to you: a condensed eating window (12-6) and very low carb/high fat. I started gaining weight and experiencing extreme pre-menstrual symptoms. I went to my naturopath in confusion. My blood work and the Dutch test showed very high estrogen and rock bottom testosterone and progesterone. Additionally, very low levels of T4 and T3. Anyway, my naturopath, among other things, recommended increasing my carbs to two servings a day (berries, sweet potatoes, plantains) and eating three solid meals. I am now on week 6 of the plan we developed together and I feel amazing. Over ten pounds disappeared withing the first four weeks. My energy is incredible and my PMS symptoms are gone. It might be worth finding a holistic doctor and completing the Dutch test and a full thyroid panel, if you haven’t done so already. Best of luck! I know how frustrating it can feel when you think you are doing everything “right” but not experiencing the same results as “everyone else”. I’ve learned that our bodies are all different and it takes experimentation to determine our own optimal lifestyle plan.

          1. Wow! Good to know! I have been seeing an integrative doc for maybe 5 years now (unfortunately for me he’s vegan and wants me to be, too, says red meat will kill me). We’ve done the hormone tests, etc. and I was on bio-identical hormones for 10 or 12 years. Finally I stopped, got tested again, and he said I probably don’t need them anymore. I’m in Maine, and it’s hard to find health-care professionals who advocate low-carb/primal/paleo.

            He also had me do the Elisa food intolerance testing (84 foods included) a couple years ago. I did an elimination diet afterward and actually lost 15 pounds in 3 months. Then it came back on, of course, when I started eating those things again. I’m finally to the point where I want to be an adult again and do the elimination thing. The worst offenders for me are lettuce (crazy, huh?) and tomatoes. Next up are gluten, all dairy, and eggs.

            I was actually amazed I lost weight because I was eating roasted white potatoes and other roasted veggies twice a day (dinner and leftovers the next day), and even 1 or 2 bananas a day, and lost the 15 pounds.

            So as of yesterday, I’m now sugar-free, gluten- and grain-free, egg-free, and dairy free. To be totally honest, I do have a glass or two of wine most nights. I know people will judge me for that and say that’s why I can’t lose weight, but I’ve cut out the wine for lengthy periods numerous times and it doesn’t seem to make a difference for me.

        2. Hi Kathy– by sleep hygiene I mean all the steps we can take to make sure we get adequate sleep! Sounds like you have done that, along with getting your Vitamin D. Katie left you a message about her experience and it sounds like she may be on to something! Hang in there.

  25. Can anyone comment on melasma related perimenopause and if anyone has successfully deuce the hyper pigmentation through diet and supplementation. Thanks

  26. Wtg, Mark. I appreciate how responsive you are to your following. This post is so clear and concise!

    I’m 53, 5’5 (on a good day), approx 117lbs, and am very active: teach hot yoga & Primal OM (HIIT & yoga), practice hot yoga, do INSANITY and Orange Theory, bike, and play tennis. Plus I have four awesome standard poodles that are my primal companions.

    I have never been overweigth, and have always been physically fit and active. Until Sept ‘17 when all hell broke loose and I was de-horsed due to 4 injured cervical discs. Translation: no more running, jumping, looking to the right or down or up, no more anything. As you can imagine, I was devastated. 53 yrs of playing, with my body being the playground.

    I have been officially IN menopause since April 1st 2016 (or was it ‘17 – brain fog!), when I had my first official hot flash. I’d had night sweats previous to this. But hot flashes, are a different animal. I maintained my routine always, until the neck diagnosis, and pain and loss of range of motion, etc. Also, I have been on a primal eating routine for at least a decade, and using intermittent fasting for at least a couple years.

    The point of all this is that once I was no longer able to be physically active, the mental and emotional stress of it was profound; no longer getting my endorphins high, and seeing the results of a fit body; it took its toll. I was on the verge of depression, for the first time in my life. I felt so defined by my physicality. I gained weight and my mid-section got fluffly and soft, and thick. My clothing size did not change.

    I think the stress of it is what caused this. I did not change my eating, but I did self-medicate with champagne and Dry Farm wines, and chocolate mint ice cream. Since January, with a team of practitioners, I have been back in the saddle, avoiding surgery, and just about 100% recovered. So combine lack of physical activity, with stress, and champagne and ice cream, and what do you get? Chubby!

    Today, Aug. 1st, I can boast that after kicking my own butt in the last 4 weeks into more frequent workouts, the right workouts, no ice cream, more greens, more water, fine tuning my supplements, getting out of ketosis (Dr.confirmed I was in it, but to the point of diminished returns = starving, causing my cholesterol numbers to be jacked); and implementing the WHEN principle, I am back to my normal self that I have come to take for granted, fit and able. I still have major hot flashes, (day flashes, I call them), and it seems that my yummy Bulletproof coffee does not help :/ My eating is as clean as anything you preach; even my occasional indulgences are the best, cleanest brands available.

    I have a family history of heart conditions, so am taking all the recommeded supplements, as well as getting my antioxidants and leafy greens.

    This long story is the report of my own experimentation, where n=1. I was determined to find out if this new chubby me was my fate as a 53yo menopausal woman, or if I did all the things I know to do, from years in this industry, would I be able to maintain my athletic performance and physique (egoism, I know). Truth: it is taking me twice as much work and focus to get the same results as when I was in my early 30s, and I started noticing this at age 38.

    I don’t know if this story provides insight to other women like me, but one thing I know for sure is that, the alternative of sitting back and doing nothing, and handing it over to “your age”, as if nothing can be done, is not an option! I agree with everything in this blog post, Mark, and basically do everything you recommend. Thanks!

  27. Great Article, thank you for the info. I am heading into perimenopause and needed some guidance and reassurance there’s something I can do!
    And I’m not trolling or getting the pitchfork out but why can’t Joan be an author, psychologist, teacher, and artisan who happens to be married to Eric? I’m sure you did not intend to define her primarily by her husband but that’s how it reads.

    1. Lynda, glad you enjoyed the post. I agree that Joan Erikson was all of those things in her own right first and foremost. I’ve just long found Joan and Erik Erikson to be a fascinating couple. It’s a shame her work exists in the shadow of her husband’s. Both were incredible thinkers whose work built on the other’s and who together made an incredible contribution to human psychology and healthy (fulfilling) aging.

  28. Thanks for caring about women’s health, I do want to know your thoughts on fasting… should women fast?

  29. As a 51 yr old perimenopausal woman with Hashimotos
    (double whammy) for the first time in my life it is hard to drop weight. I am much better on a low carb, high fat diet. My carb craving at this stage is massively affected by hormones.Can’t stop if I start. Also a lot more sensitive to alcohol.
    This article is very helpful. Makes me think I’m a little low on protein intake

  30. As a post menopausal lady I’ve found that exercise is my friend, HIIT is the most beneficial. Long grueling workouts made my waistline thicker, due to the stress hormone cortisol. I perform resistance training 2 days per week, cardio train 2 days per week, and play tennis 1 day per week. Also on the days I work out I eat a few carbs at my last meal before bed. I noted I slept much better when I had complex carbs (sweet potato, wild rice, brown rice pasta), not bread, crackers, or white rice/potatoes. The only hormone I use is androfeme, a testosterone cream specifically for females. Hopefully this will help others like myself.

  31. I’m post menopausal and never had a hot flash, not one. However, during part of menopause I was a vegan. I ate a lot of soy then and had estrogen dominance symptoms during those years. So if you are not having hot flashes and other severe symptoms stay away from the soy. As soon as I went keto, the symptoms went away.

  32. I was in the midst of menopause with all the usual symptoms (weight gain, hot flashes, emotional rollercoaster, dry vagina, varicose veins) when I decided I had enough and quit sugar and grains…eventually discovered Paleo/then KETO, and am now (at 65 yrs)cycling in and out of ketosis…definitely burning fat and feeling better than I did at 50! My weight went from 145 lbs, I am 5’3”, to 124 and has leveled off right there which feels perfect for me! I stay very active with gardening, hiking, bicycle touring for weeks at a time, mountain biking, skiing (downhill and cross country), swimming, yoga, body weight exercise and Nutritious Movement (see Katy Bowman)!!! I am mostly barefoot from April to October (hey, I live in Canada, eh) or I wear Vibram Five Fingers/Manitoba Mukluks! I love my new feet…and my new awareness of my total body.
    Oh yeah, I very, very rarely drink alcohol. It gave me hot flashes and leg cramps. When I do partake…it has to be organic Red from France or Prosecco/champagne (European),and at that I can only have about 4 ounces.
    Then I make sure to take an extra 200mg on top of the 600mg of Magnesium Bisglycinate that I already take.
    So, there you have it…good luck and thanks for the Article, Mark!

  33. Menopause put me in a funk. Primal for a few years before it happened. Had great success with IF before it was even popular. Then, wham, just couldn’t do it anymore. Sleep and sex were not good. Started doing identical hormone replacement therapy a year ago and, wham, back to IF’ing, no problem. Sleep, sex – yeah! Like Mark says, consider it, don’t dismiss it outright because Grok couldn’t do it. It has made a tremendous difference in my like. Just ask hubby!!!

  34. Mark, thank you for your excellent article. Am 63 and post menopausal for 13 years. Am also hypothyroid (no Hashimoto’s Disease). Have been keto for 10 months. Lost my goal of 20 pounds. Due to your article, realize I ought to increase my protein intake.

    Ladies, it may be necessary for some of us to find a good functional medicine doctor or “holistic” endocrinologist or gynecologist and have the proper testing of hormone levels. Bioidentical customized hormone replacement therapy can be a lifesaver. If you and your health care practitioner have exhausted all other avenues of relief do not continue to suffer. Done and managed correctly bioidentical hormone replacement is quite safe.

  35. Hi Mark,
    Just finished “Metabolism & Menopause.
    I understand the lack of estrogen wreaks havoc, but what do you suggest as a possible replacement or supplement? Food or natural herb would be preferred.
    Thanks so much,
    Tammy ?

  36. Thank you! Obviously a hot topic and an area of need as the number of replies indicate. I look forward to follow up articles!

  37. I know you said you expected this to be a series already, but I’d love to hear more about “menopause brain”. That sounds exactly like my mother. Her neurologists keep telling her that her memory is fine, but those are all symptoms she feels (and we agree) she has. I’d love to be able to help her and steer her in the right direction. (Side note: I believe she is post-menopause, can this carry over longer?)

  38. Hi Mark, thank you so much for being one of the very few people publishing accessibly on menopausal women’s health. As you say, there’s potentially a good 30 years of menopause. I’ve personally been shocked at how hard it’s been to get health information related to menopause – even though menopause does or most certainly will affect half the population, and for decades of their life span! So here’s my other comment: you mention the value of post-menopausal women to the species. I think I understand the sense in which you mean this. But I’d like to offer a caution because the benefits cited are all related to maternity or childcare. These are undoubtedly valuable and true. But there are many other benefits that older women offer to society in terms of our thinking and skills. We’re not only defined by our biological capabilities.

  39. I’m post-menopausal. 5 things really helped me. (1) Thyroid rx. Traditional doctors have a wider range of normal. Went to a naturopath and she treated the symptoms – low energy, tired, cold all the time, couldn’t lose weight – even doing healthy low carb. (2) Real, unprocessed food including plenty of fruits and vegetables. Going too low carb (no fruit) made me miserable, craving sweets – not sustainable. (3) Intermittent fasting. (Although some women seem to have a problem w/ this.). I LOVE it! (4) Bioidentical hormone replacement therapy (testosterone, progesterone, estrogen). I get the pellets inserted every 4 mos. My doctor is Dr. Kathy Maupin who wrote a book about it. (5) magnesium supplements. Google “original chill pill” and read the article by paleo Harvard psychiatrist. I have MUCH less anxiety!!! All of these 5 of these things have changed my life – I’m happier, less stressed, less anxiety, more productive, LOTS of energy, lost the 56 lbs I needed to lose, think better and more clearly, more focused – I feel like I’m in my 20s, only better than ever!!!!

  40. Hey, Mark! You rock for doing this research and writing this article. Not only do we as women become “invisible” around age 50, but our health needs are usually interpreted through the lens of research done with male subjects.

    I found your article to be right on. I went through menopause at 55 (I’m 66 now) after almost 40 years of vegan/vegetarianism. One thing that changed for sure and got me on primal/paleo was that I could no longer satiate myself. I also went hypothyroid. At one point I had some osteopenia.

    With primal/paleo, intelligent quality supplements, good thyroid meds, and lots of activity/exercise, I managed to reverse the osteopenia. I have more stamina and endurance climbing hills on my bike and hiking at elevation than my low-fat/high carb peers. I’m strong for my age and size, and sleep well most of the time.

    I feel great going keto, but have to be careful because my gall bladder starts talking to me (doesn’t that sound old?).

    You are so right on. More women need to rethink their eating along with all of their habits. Menopause is nothing short of a complete rewiring.

  41. Bless you, Mark! So helpful, as you are affirming what I eat is best.

    This inspires me to clean it up where I may have gotten a bit casual. Thank you for the clarity!

    I am 54, def. post-menopausal, definitely struggling with depression (Albeit I lost my dream job standing up to corruption after 7 years, and 6 close family, my entire family, actually has died or soared into Dementia/Alz’s in he past 2 years– so fair enough!). The grief has been an interesting addition to transitioning with Menopause.

    I have a very present blank-mind, like a “well-shaken Etch-A-Sketch!” Seriously. Just blank.

    But I do eat as you describe and I also take C, B, Fish Oil, CoQ10, Multi with Methyl folate and Methyl B-12, as suggested and produced by my Doctor, Hyla Cass, MD, (, and her Calm blend tablets, and Calm Magnesium powder at night. Always so relaxing and nourishing.

    I eat saurkraut, probiotics, and a 1/2 gallon of raw cow milk weekly, as well as plain yogurt.

    This all helps. Sleeping well, and going to bed early to rise with the sun gives me peace, and lI enjoy lots and lots of barefoot garden care in the jungle, creating food forests, and native Hawaiian gardens.

    I am so grateful for your thorough listing, resources, studies’ links, and hope.
    Mahalo from Maui, Claire

  42. Thank you, Mark!

    I’ve followed you for years and have been eating more or less Primal ever since. I am 63 years old. I’ve been uncomfortable with your earlier assertion that women and men are basically the same when I comes down to eating. So I’m very happy to read this article.

    Menopause, for some of us anyway, is a bitch. It seems no matter what I do, how I eat or exercise, I still put on fat. My husband eats whatever he wants and never puts on weight. I have lower energy and days of brain fog and feeling generally horrible. He has loads of energy all the time.

    We live in Vermont where we are blessed with abundant local, organic foods. We eat local veg, local grass-fed meats, use high-quality fats and fish oil, zero added sugar, moderate fruit & nuts. I love to cook, we eat hardly any kind of packaged food. I’m fat-adapted. I eliminated dairy last month when I realized it contributed to swelling in my hands and feet. I drink wine occasionally at social events (not American wines – one glass makes me feel like s____. )

    I walk a minimum of 3 miles a day. I worked with a trainer at the gym on a consistent program last winter. He measured me at the beginning and again after three months. NO CHANGE.

    I tried very low carb (<50g) for about 6 weeks and felt awful so went back to moderate carbs (+/- 100g). For the last month, I have been limiting to an 8-hour eating window which feels better and much more manageable. We'll see!

    It's all insanely frustrating. I think I'd be OK with the extra padding if I just felt better. I cannot depend on myself at all. If I feel good on Tuesday, I can make plans for next Friday but feel like crap when Friday comes. My brain-power is so variable, it's hard to be consistent in anything. I'm self-employed fortunately, so I'm able to adjust, but sometimes I can't meet my own goals.

    Thanks for listening. And thanks for speaking to us women of a certain age LOL…

  43. Thank you!!! THIS MAKES SENSE! I’m 53 and have gained back 20 of the 40 lbs I worked to lose several years ago following a low carb, mostly paleo diet. After a total radical hysterectomy 4 months ago, I am dealing with inflammation and joint pain. Dr. thinks that bioidentical HRT may help. Any thoughts?

  44. Thank you Mark for this very informative article. I really appreciate the research that you do. Since I am past menopause I will answer your question about how I handled menopause. My Naturopath Doctor got me through this. She was a amazing and I would suggest that the ladies see one for sure. Maybe a Functional Dr. would be worth a try as well. I wasn’t a primal eater at the time but still ate lots of veggies and was a pretty clean eater. One thing that wasn’t mentioned was wine. I know – moan – I can hear it now. As we age alcohol affects us more. Wine keeps you awake at night and also gives you the night sweats. I would suggest omitting or cutting way back on your alcohol consumption and it will help a lot. Hope this will help ladies.

  45. Agreed that 40/30/30 offers a better balance , especially at this stage of my life, with an occasional dip into low carb and keto. I’d like to add that I was able to reverse osteopenia with slow motion and regular weight lifting. Much to the surprise of all my doctors, they immediately thought I took meds.

  46. Bio-identical pellets were a miracle for me. And much to my surprise eating a diet of less calorically dense foods has made the difference. I’m also hypothyroid. I loved eating the high protein-fat low carb thing but I felt as if I were in hibernation and packed on weight that would not budge-and I weight my food and track calories.
    58y old- 1400 cals did the trick with no fewer than 120 net carbs. Everyone has to find their dietary sweet spot. It took me 8 yrs. don’t give up keep records!

  47. Lost 15 lbs. after menopause with paleo and 6+ days a week of exercise! Will try to keep my story short – After adding 10+ lbs, hot flashes, low energy, etc… I (at 56 yrs) hired a personal trainer 3Xs a week. My routine was 45 mins cardio & 1 hour of weights, core, balance and stretching. In between days I cycled, walked, etc.. at least 1 hour a day. For over 8 years my family has been 90% paleo – I was already a pretty “clean eater”, but I cut out cheese, watched my snacking and portions. My cheat is wine (aka sugars!) Now I’m 58 – my BMI went from 24.01 to 21.62, weight 151 lbs, to 136 lbs, glucose 84 to now 77. My life motto is “do something EVERYDAY”! My weekly routine is one hour cardio, and incorporating weights ( prevent osteo) 1 – 2 Xs a week. The harder my workouts are , the better I feel, have max energy, and sound sleep!

    1. JenAgs, congrats on your success, and thanks for highlighting what’s worked for you. It’s amazing what relatively small adjustments can accomplish when they’re well-targeted. Have you ever considered sharing your success story with the MDA community? Best – M

      1. Thanks for the reply – yes, I would love to share!

        I did forget to thank you for the great article! I have forwarded it to many friends either starting, or in the midst of menopause.
        Always full of scientific facts!

  48. Loved reading this article as it confirmed my experiences in this menopausal journey. There is surprisingly little information on how to work this through without the annoyance of hot flashes/night sweats. So, I would like to share with anyone reading what has worked for me in mitigating my symptoms.
    I have always been an active person and I know that helped me through the years with reducing PMS. I am now 52 (53 in September) and have been experiencing low level peri-menopausal changes (no mood swings, etc.) with heavy hot flashes and night sweats over the last one and a half years.
    This last year has been a major breakthrough with the hot flashes.
    I have been flowing between paleo and keto eating for many years (My biggest hurdle being Sees chocolate!) Due to dietary benefits and activity, I am a competitive Olympic lifter and teach kindergarten, I am a lean over 50 woman. However, I still struggled with hot flashes and night sweats that interrupted sleep. Then, about 8 weeks ago, I added powdered collagen and Black Cohosh supplement to my daily intake of fish oil and D3. After about 4-5 days of this addition I am virtually hot flash/night sweat free! I hope this continues to be a positive change for me.
    Has anyone else tried these supplements and had any luck?

    1. Susannah,

      I have been using collagen for years now. I’m exactly a year younger than you and also a lean over 50 woman. ZERO hot flashes ever.

    2. Hi Susannah – I had good luck with black cohosh for hot flashes as well, but found that over time I had to keep increasing the dosage, as I seemed to build up a tolerance to it. I read somewhere that you should go off black cohosh every few months to clear it’s build up from your body. I did this a few times then just never went back to it, although I don’t rule that out at some point in the future. I’ve battled severe hot flashes for about ten years and appreciate relief when I can get it. I am now on bio-identical hormones, which reduced my hot flashes to zero. Such a relief! However this treatment is extremely expensive and so not a permanent answer for me.

  49. Watching my carbohydrates and using Urban Moonshine Digestive Bitters has helped A LOT with hot flashes. I use it about 3 times per day (before meals-can be used up to 6 times according to the packaging). Apparently, a healthy liver is important during menopause. It contains fennel as an ingredient which was recently shown to reduce hot flashes in a study of menopausal women in Iran. Tried it for better digestion and this was a very happy side effect!

  50. Thank you for addressing this. At 53, I’m heading into menopause and the weight gain and sleep issues are bugging me. I know a lower carb diet works for me, but you hear so much contradictory diet information and very few diet-crats address how our nutritional needs change with stages of life and even fewer recognize that so little research has been done on women’s health.

  51. Nice article. In the “Dietary takeaway” section, we need to include calcium sources and in many cases calcium supplementation (along with Vitamin D etc etc). This is very important. I never thought that calcium would be an issue…with my lifestyle and diet, but it is. Crossfit/paleo/healthy all the way. Pay attention to calcium ladies!!

  52. As a woman who is turning 52 in a few weeks, I feel i have to chime in here. I have been following a primal lifestyle for over 5 years, and am keto most of the time. So far I still have regular menstrual cycles and feel amazing. I’m hopeful that my lifestyle will make the transition much easier whenever it starts to happen.

    1. I was keto/paleo as well before menopuase, frequent yoga practitioner, and my symptoms seemed to get worse with menopause – my clean diet just did not seem to help relieve symptoms at all. They just continued to get more severe (hot flashes, night sweats, irritated mood primarily). Somewhere in this thread is a comment from a woman who tracked these symptoms to certain common paleo foods, so I think tracking that is my next project.

  53. Thank you so much for this, I am perimenopausal and feel I am constantly tweaking my diet as my needs change. I have just made a note to myself that I might need to cut back a bit on dairy. A year or so ago, my doctor put me on a higher dose progesterone, as the previous medication had been discontinued and it made a massive difference to how I felt. I do take fish oil, vitamin d, drink green tea and eat 85% dark chocolate. I also take collagen and gelatinised maca in my bulletproof coffee, the maca really helped me with night sweats (I would never take raw, it can give you terrible stomach/gut issues). Thanks again.

  54. Menopause is a very important topic related to every woman. Thanks for dealing with such an important topic “Metabolism and Menopause: What does research suggested is the best dietary strategy”. I liked this blog very much. It helps many women to know more about various aspects of this problem.

  55. I’m new to Primal:low carb and was very interested in this topic. So, now that I’ve had time to get past my primal post-50 value of being a sage, old grandma ?, it’s great information and my true take away is that in this stage of age progression, each of our bodies may need different care and it’s up to us to find the “sweet” spot that is unique to us. That probably varies so greatly due to how we’ve cared for the body up to this point and the healing that is necessary to become well. I’m going to take the Primal 21 day Challenge and see if that helps me. I’ve already given up grains and sugars, know that nuts are a weakness (for now) and that also for now, I can live without the occasional beer. I’m looking forward to fine tuning and finding my wellness.

  56. Thank you Mark for this fantastic post, and for being one of the very few bloggers to so thoroughly track this topic. It is so appreciated! I also appreciate the wisdom shared in the comments. There’s a treasure trove of information there – I read every single one!

  57. Thank you for the awesome article! How many grams of carbs would you recommend an active woman ( weight training/ CrossFit) use as a starting point.

  58. I’ve read through most of the comments thus far and haven’t seen anyone addressing my concerns, so forgive me if I missed it. I am grateful for this post since I’m one of the ones that was thinking “What about menopausal women?” during that other post!

    I’m 53 and very near menopause, though I had a hysterectomy 8 weeks ago, keeping my ovaries. I had a bad experience with VLC years ago and jacked up my thyroid, so I’m scare to go keto again, though I’ve been considering it while I recover. I found the 40-30-30 macro suggestion interesting and thought it might be worth a shot, however, according to my calculations, at my weight of 205 (5’9″) I would have a caloric allotment of 1120 per day. That low number terrifies me because the last thing I want to do is slow my metabolism further, and I’m sure it already took a hit post-op with no exercise but walking.and restricted from lifting more than 8 lbs.

    I would love to hear thoughts on this aspect of Mark’s suggestions. FYI, I sleep “clean” and have built my walking up to 5 miles.

    1. Sara,
      For you, 1,120 calories would be far too great of a calorie deficit, IMO. At your age, weight and height, your BMR (basil metabolic rate) would be 1,622 calories needed a day. That’s the calories your body would need just to lay in bed and do nothing but keep your bodily functions working. If you are mostly sedentary, with little activity (anything beyond laying in bed) your caloric needs, based on the Harris Benedict equation, are 1,946 a day. Taking a standard 20% calorie deficit from that for weight loss, you would base the 40/30/30 macros on 1,557 calories a day. That means 69 g fat, 117 g each protein and carbohydrates. Even at the often recommended 500 calorie deficit, that still puts you at 1,446 calories or 64 g fat, 109 g each protein and carbohydrates.

  59. Turned 51, started HRT then started keto 3 months later. Life changer. Stopped HRT yesterday. Am confident keto will carry me through.

  60. I hate fish with the exception of an infrequent subway’s tuna salad, which I know is probably off limits. every diet says ‘eat fish’. i loathe salmon…. you should start adding on fish alternatives or just say take an omega3 pill. thanks.

  61. Interested to see that you mention Joan Erikson is the wife of noted psychologist Erik Erikson before telling us she is an author, psychologist, teacher, and artisan. She is an author, psychologist, teacher and artisan whether Erik is famous or not. Is her work of less value than Erik’s? Surely she should be mentioned for the work she does first rather than for being the wife of someone of who might or might not be famous?

  62. Many thanks Mark for this post menopause post. It gives those of us in this stage of life a great roadmap to continued health and vitality.

  63. Breastfeed your babies. It will significantly decrease breast cancer risk (and make your babies way healthier!!)

  64. I would like some easy ideas for add-ins to make the can of sardines a bit more palatable; or how to make a good sardine salad.

  65. Hi Mark. I read all your emails. My MD is Gary Foresman. Has been for 20 years. I would like to hear some input for a path for those not wanting to consume animals. We do eat fish and seafood. But I have not had beef, chicken, pork, since I was 18 years old and am now 66.

  66. I’ve been struggling with intense hot flashes since February (six months ago), crazy disrupted sleep and even impacting my strength training workouts, I’ve been Paleo over five years and cyclic Keto the last year and a half, but the flashes were too much. I’d added black cohosh, tried clary sage: still no relief. Then. I read your idea about fish oil and began a supplement protocol. Success! Within two weeks, the intensity and frequency of flashes decreased dramatically. In fact, I’ve not had a flash in over two weeks! I’m sleeping through the night for the first time in six months! Thank you!

  67. whoooo…menopause hit like a lion. Especially if you were a slim, active, healthy-weight woman. After menopause, hot flashes, cant sleep, and weight gain in the core(20 lbs); yikes!!!,Websites like Mark’s Daily Apple give great information on lifestyles changes. So went to eating two medium meals with protein, veggies, and carbs in the A.M. No large meals post 7pm. snacks are portioned nuts or fruits. Took over a year to tweak exercise/food intake to lose the 20 lbs and adjust to new eating style. I learned I had to be consistent with exercise (metabolism) add more days for exercises that challenge my core(planks), which was about 10 lbs of fat !!! swap in incline cardio for those thigh muscles, yoga for balance and strength. I do weights as well. As others have stated, you have to find out what works for body. Lastly happy with results, not 40 anymore, the core has returned to age 40 state and I have lots of energy 🙂

  68. Thanks for this review. As a post-menopausal 66-year old, I sincerely appreciated a more relevant discussion of keto/primal eating and health issues. Please do more. Specifically, information about bio-identical hormones. There is so much controversey.