Menopause, Muscle and Nutrition: What Does The Research Show?

In this episode, we’ll examine research on muscle changes during menopause. How much muscle mass is lost? Does it affect all individuals the same way? And most importantly, what interventions—such as exercise, protein, vitamin D, and creatine—are actually effective? Let’s break down the science and highlight key takeaways for dietitians and healthcare professionals.

Check out the Women's Health Nutrition Learning Hub at whnlearninghub.com

* Correction: Most experts agree that 1-1.2 g protein/kg body weight is what most women will benefit from in perimenopause and some may benefit from higher levels of up to 1.6-2 g protein/kg body weigh. 

**Not intended as medical advice

References:

Greendale, G. A., Sternfeld, B., Huang, M.-H., Han, W., Karvonen-Gutierrez, C., Ruppert, K., Cauley, J. A., Finkelstein, J. S., Jiang, S.-F., & Karlamangla, A. S. (2019). Changes in body composition and weight during the menopause transition. JCI Insight, 4(5), e124865. https://doi.org/10.1172/jci.insight.124865&#8203

Silva, T. R., Lago, S. C., Yavorivski, A., Ferreira, L. L., Fighera, T. M., & Spritzer, P. M. (2020). Effects of high protein, low-glycemic index diet on lean body mass, strength, and physical performance in late postmenopausal women: A randomized controlled trial. Menopause: The Journal of The North American Menopause Society, 28(3), 307–317. https://doi.org/10.1097/GME.0000000000001692&#8203

Thornton, M., Sim, M., Kennedy, M. A., Blodgett, K., Joseph, R., & Pojednic, R. (2024). Nutrition interventions on muscle-related components of sarcopenia in females: A systematic review of randomized controlled trials. Calcified Tissue International, 114, 38–52. https://doi.org/10.1007/s00223-023-01157-1&#8203

Lemieux, F. C., Filion, M.-E., Barbat-Artigas, S., Karelis, A. D., & Aubertin-Leheudre, M. (2014). Relationship between different protein intake recommendations with muscle mass and muscle strength. Climacteric, 17(3), 294–300. https://doi.org/10.3109/13697137.2013.829440&#8203

Silva, T. R., & Spritzer, P. M. (2016). Skeletal muscle mass is associated with higher dietary protein intake and lower body fat in postmenopausal women: A cross-sectional study. Menopause: The Journal of The North American Menopause Society, 24(5), 502–509. https://doi.org/10.1097/GME.0000000000000793&#8203

Erdélyi, A., Pálfi, E., Tűű, L., Nas, K., Szűcs, Z., Török, M., Jakab, A., & Várbíró, S. (2024). The importance of nutrition in menopause and perimenopause—A review. Nutrients, 16(27). https://doi.org/10.3390/nu16010027&#8203

Nahas, P. C., Rossato, L. T., Martins, F. M., Souza, A. P., Branco, F. M. S., Carneiro, M. A. S., Teixeira, K. R. C., Orsatti, F. L., & de Oliveira, E. P. (2019). Moderate increase in protein intake promotes a small additional improvement in functional capacity, but not in muscle strength and lean mass quality, in postmenopausal women following resistance exercise: A randomized clinical trial. Nutrients, 11(6), 1323. https://doi.org/10.3390/nu11061323&#8203

Seimon, R. V., Wild-Taylor, A. L., Keating, S. E., McClintock, S., Harper, C., Gibson, A. A., Johnson, N. A., Fernando, H. A., Markovic, T. P., Center, J. R., Franklin, J., Liu, P. Y., Grieve, S. M., Lagopoulos, J., Caterson, I. D., Byrne, N. M., & Sainsbury, A. (2019). Effect of weight loss via severe vs moderate energy restriction on lean mass and body composition among postmenopausal women with obesity: The TEMPO Diet randomized clinical trial. JAMA Network Open, 2(10), e1913733. https://doi.org/10.1001/jamanetworkopen.2019.13733&#8203

Tan, T.-W., Tan, H.-L., Hsu, M.-F., Huang, H.-L., & Chung, Y.-C. (2023). Effect of non-pharmacological interventions on the prevention of sarcopenia in menopausal women: A systematic review and meta-analysis of ra

Transcript

0:01

Hi, and welcome to the Fem Health Nutrition Podcast. I'm Nilu Deylami, a registered dietitian and founder of the Women's Health Nutrition Learning Hub, a platform where dietitians and nutrition professionals can learn, connect, and collaborate on all things related to female health and nutrition. If you haven't already, you can check out the website at whnlearninghub. com. The link will be provided in the episode description as well. This is the first podcast episode where I'll be diving into some educational content. And I couldn't be more excited to explore today's topic with you. And that is muscle and menopause. So lately I've had more and more clients coming to me and expressing concerns about their muscle mass and how much muscle mass they're losing in perimenopause and menopause. And many are increasing their protein intake sometimes, you know, up to 120, 140 grams per day. They may be starting strength training, based on the advice that they're seeing on social media. So today I want to really look at The science behind what happens to muscle mass during perimenopause and postmenopause and we'll look at things like how much muscle mass is actually lost, does it affect everyone in the same way and most importantly, what interventions like exercise, protein, vitamin D and creatine are actually effective in Increasing muscle mass and strength, so let's break down the science and highlight some key takeaways for dietitians and health care professionals. So we'll first start by trying to understand the changes in muscle mass that happen in perimenopause and menopause. So most of you may be already familiar with this, but perimenopause marks that transition period, uh, before menopause. It can last anywhere from four to even up to 10 years. And it's a time where estrogen and progesterone levels are fluctuating but are on a. downward decline. Menopause itself is defined as the point at which a person has gone 12 months without a menstrual period. And at this time, estrogen levels will drop significantly and they will remain low. Now why this is important is because estrogen does play a role in maintaining muscle mass, bone density, and metabolic function. And with this decline in estrogen, muscle protein synthesis can decrease, fat mass can increase, and insulin sensitivity can also decline at this time. And there's an overall shift in body composition that happens. It is important to recognize, though, that not all muscle loss is just because of menopause. Aging itself does play a role too, and we also see this kind of gradual loss of muscle mass in males as they age as well. So it's not just women who are experiencing this. loss of muscle mass because of menopause age is a huge factor. And I really find that this nuance is often overlooked in social media messaging where menopause seems to be blamed for everything these dates. Another factor to consider is physical activity levels. So many of the individuals who come to me and some other dietitians as well, particularly women in midlife aren't regularly engaging in resistance training, which does further compound that muscle loss. So when we look at the big picture, these changes we are seeing in lean muscle mass in midlife and women. are likely related to a combination of menopause related hormone changes, aging, and also lifestyle behaviors like lack of resistance training at this time of life as well. So let's take a look at what is actually happening to muscle mass or lean muscle mass during perimenopause and postmenopause. The research shows that muscle mass loss tends to accelerate during the menopause transition or perimenopause because of that declining estrogen. However, the extent of this loss is not as dramatic as some fear. There's a study called the study of women's health across the nation or the swan study. And it's a longitudinal study that tracks midlife women's health. And it's been tracking it since, 1996. In this particular study, they examined over 1, 200 women from premenopause to postmenopause, and they found that lean mass begins to decline at an accelerated rate around Uh, perimenopause. So the most significant losses occur in the two years prior to the final menstrual period, with women losing approximately 0. 2 to 0. 4 percent of their lean muscle mass per year. And this tends to stabilize around 1. 5 years after the final menstrual period. So it isn't like the muscle mass drops drastically overnight. However, over time, even these small changes can add up if nothing is done to address it. We do need to consider that participants in this study are representative of the general population, so they are likely not engaging in as much resistance training or exercise. Now, we do also want to consider the effect of weight loss on muscle mass in this population because a lot of people who will come to dietitians or nutritionists in midlife, especially women in midlife, are looking for weight management help and also I am noticing a lot of peri and postmenopausal women are now starting to use GLP 1 receptor agonists for weight loss. So there was this one study called the TEMPO diet trial, and they looked at how different levels of calorie restriction affected body composition in postmenopausal women who are living with obesity. In this study, there were two groups. The severe energy restriction group restricted their caloric intake by 65 to 75 percent versus 25 to 35 percent in the moderate energy restriction group, and both groups had about one gram of protein per kilogram of body weight throughout the study. Now after 12 months they did find that those in the severe restriction group lost 1. 5 times more lean muscle mass than the moderate restriction group and also they lost more hip bone mineral density as well. So essentially, when we have a client that is on a GLP one, or is making dietary changes to promote weight loss, we really do need to be thinking about things like protein and exercise, which we'll discuss shortly. We'll talk about exercise first and unsurprisingly resistance training is consistently shown to be the most effective way to maintain and increase muscle mass in postmenopausal women. There was a meta analysis of 27 randomized control trials that included Nearly 2000 postmenopausal women and they found that resistance training did significantly improve lean body mass, hand grip strength and knee extension strength. And they found that the most effective protocol involved training at least three times per week for 20 to 90 minutes per session. Over a minimum of six weeks and the benefits of resistance training are dose dependent. So the more consistent and progressive the training, the better the results. Also, when we think of longer term, so reducing the risk of falls and enhancing muscle function, it was more effective when you had that higher training volume and intensity, and that was paired with weight bearing exercise such as walking. So if there's one thing to communicate with clients. In terms of realistic expectations is that we're looking for consistent resistance training, progressive training, and also the amount of time matters so short term programs like programs that are eight to 12 weeks. Improve strength, but longer term training, for example, for more than six months is necessary for those meaningful changes to lead muscle mass. So we'll move on to talking about protein, which is again, another hot topic. on social media right now, where it seems like everyone is aiming for 120, 140 grams of protein per day, but is that really necessary? So protein is, of course, essential for building muscle and maintaining muscle mass. And the current RDA is 0. 8 grams of protein per kilogram of body weight per day. However, there is some emerging research that suggests postmenopausal individuals may benefit from higher amounts. And we see in observational studies that higher amounts of protein intake, so about 1. 2 to 1. 6 grams is associated with greater muscle mass and function. However, these are observational studies, so we can't really establish causation from them. And it's interesting because randomized control trials actually show some mixed results. And the general population. So, for example, in this meta analysis that looked at both males and females, they found that consuming at least 1. 2 to 1. 6 grams of protein per kilogram per day resulted in a 2 to 3. 5 percent increase in lean mass over 12 to 24 weeks, but only when combined with exercise, which is something to keep in mind. So, Higher protein intake with that resistance training tends to help drive that muscle growth and retention. When we look at the data for postmenopausal women, things are a little bit less clear cut. And I think it's probably because The studies out there are not very well designed. There was a six month long randomized controlled trial in postmenopausal women, and these women were a bit older, so they were above the age of 60, And these participants were either on a high protein, low glycemic index diet or a control. Both groups were on low glycemic index diets, but one group was advised to take 1. 6 grams of protein per kilogram of body weight, And the other was advised to do 0. 8 grams of protein. And they found that there was no significant difference in lean body mass gains between these two groups. There was no exercise intervention in this study. So the two things that might have happened here is one that we're looking at older women who have already passed that sort of drop in lean muscle mass. Perimenopause, and we're also looking at groups that are not exercising. And as we've learned so far is that resistance training is really that primary driver of muscle growth and retention. So if it's missing in the study and we're just giving more protein without that resistance training, it kind of makes sense that we wouldn't see that increase in lean muscle mass. And then there was another study that looked at whey protein specifically. So this was a systematic review and they found that when whey protein was provided after resistance training, so a range of 20 to 40 grams of whey protein after resistance training, there was increased strength and lower leg lean mass combined to placebo. But this happened only when it was combined with resistance training. Without the resistance training, the whey protein had no significant benefit for muscle strength or lean mass. So essentially what this means is that Exercise remains the primary driver of muscle retention and growth, but when there is resistance training, that extra protein can definitely be helpful. So here, I guess the message to clients would be to not just arbitrarily increase their protein intake, For the purpose of increasing their lean muscle mass, of course, increasing protein intake does have other benefits for appetite and blood sugar control, which is beyond the scope of this episode. But for the purpose of building lean muscle mass, just going and increasing the protein to 120 grams per day without focusing on the exercise piece will not lead to anything. benefits. Now we do want to take a moment to talk about creatine as well. So creatine supplementation has gained attention for its potential role in maintaining muscle mass and aging populations. And there was a meta analysis of about 10 randomized controlled trials that included. 211 postmenopausal women, and they found that creatine supplementation, when combined with resistance training for at least 24 weeks, significantly increased upper and lower body strength. However, they did find that there were no changes in actual lean muscle mass. So lean muscle mass stayed the same. Uh, whereas in the general population and older adults, we find that the creatine may actually help increase lean muscle mass. So what the authors kind of commented in this study was that. They were surprised that it contradicts previous studies that find creatine can increase muscle mass and that it may be related to the sample sizes in these studies because we don't have that many large studies on creatine in postmenopausal women. So essentially we need more studies looking at postmenopausal women specifically and how creatine impacts them. But one thing we did find in the study, as I mentioned, is that there was no loss of lean muscle mass either. So even though there was no gain, there was also no loss. So again, the authors mentioned that the creatine may have prevented some lean muscle mass loss. Generally creatine is safe for the majority of people. The typical dose used in the studies that I mentioned are between three to five grams per day with some protocols. doing a loading phase of 20 grams per day for five to seven days, followed by a maintenance dose of three to five grams per day. And so if there's somebody who wants to try creatine supplementation, for the most part, it is safe. We haven't really found any adverse effects, uh, but it is good to just check on kidney function before starting supplementation. And finally, we'll talk about vitamin D. So there is some research out there that vitamin D may have a role in muscle maintenance, although the research is a little bit less clear. Some studies link deficiency with lower muscle strength, but randomized controlled trials don't consistently show any benefits of supplementing with vitamin D on muscle mass. So for example, there was one study that found that supplementing with 2000 units of vitamin D per day for six months did improve leg press strength by 5%, but didn't have an effect on lead mass. So ultimately with vitamin D, the goal for health in general, including bone health and muscle health would be to prevent deficiency. So we're not aiming for really high doses of vitamin D supplementation. There is no evidence for those benefits, but we do want to make sure that there is no deficiency present. So just some key takeaways that you can use in your practice. One is that resistance training is absolutely essential. So encouraging clients to train at least three times per week with progressive overload and to incorporate weight bearing exercises as well to help with muscle function and balance in the future. Protein needs should really be individualized based on how active the person is. Um, but generally for postmenopausal women, currently the consensus is for the majority of people, about one to 1. 2 grams of protein per kilogram of body weight is where we want to be. Some people might benefit from higher protein levels of 1. 6 grams of protein per kilogram of body weight In terms of supplementation, there is some research that creatine can enhance strength, but we're still learning about its impact on lean muscle mass in postmenopausal women, but this is definitely an area to watch. Just a reminder that creatine is only effective when it is combined with resistance training. And finally, vitamin D supplementation, primarily in those who are deficient can help with musculoskeletal health in general. And that wraps up today's episode. If you found this helpful, please subscribe and share. You can also check out the Women's Health Nutrition Learning Hub for more resources and blog articles. Thank you so much for listening and I'll see you next time.