Why Belly Fat in Perimenopause Is Different — And What Actually Works

Belly fat in perimenopause and menopause isn't a willpower problem. It's a hormone problem. And a lot of the advice we've been following for years is quietly making it worse. Johanna breaks down what's actually driving visceral fat in midlife, why undereating and over-exercising are both backfiring.

🤩The Model Health Show

https://podcasts.apple.com/us/podcast/the-model-health-show/id640246578?i=1000763738884

Transcript

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Hello my friends and welcome back to Not Your Mother's Midlife. I am uh your host, Joanna, and today we are talking about belly fat, specifically why it shows up in perimenopause and menopause, even when you feel like you are doing everything right, and why so much of the advice we've been following for years is actually making it worse. Yes. Okay, so let's start at the beginning because I think it helps to actually understand what we're dealing with before we talk about what to do about it. Not all fat is the same. The fat that tends to show up around our middles during menopause and perimenopause is called visceral fat. Visceral fat sits deep inside the abdominal cavity, wrapping around your organs, your liver, your intestines, your stomach. It's not just sitting there passively, like baby fat, you know, soft, cute little baby fat. It's metabolically active, which means it's doing things, releasing inflammatory compounds, messing with hormone signaling, driving insulin resistance, affecting cardiovascular health. Most importantly, it does not respond to the same inputs as regular subcutaneous fat, which is why everything you did in your 30s to lose weight is not working now. So, what actually drives visceral fat accumulation? The short answer is cortisol, your stress hormone. I think most of us understand stress in a very narrow way, like work is crazy, the kids are feral, life is a lot. And yes, that is stress, and that stress counts, but physiological stress is just as important. And this is where so many of us are unknowingly making things harder for ourselves. Your body cannot tell the difference between emotional stress and physical stress. To your hormones, it's all just threat. And the things that register as psychological stress include not eating enough, doing too much intense exercise without enough recovery, not sleeping well, and chronic low-grade inflammation. All of those things spike cortisol. And cortisol, in sustained elevated amounts, tells your body to store fat, specifically visceral fat, specifically in the abdominal region. It's almost insultingly targeted. Even stressing about trying to lose weight is causing you to make more of this fat. It is cruel. Estrogen also plays a huge role. Before perimenopause, estrogen actually helps direct fat storage to our hips and thighs, which is its job, as annoying as that is. As estrogen declines, that protective effect disappears and fat redistribution shifts to the belly. This is just biology. Knowing that doesn't make it less frustrating, but it does mean we can stop blaming ourselves and start working with what's actually happening. Now, the advice that backfires, because this is the part I really want to make sure you understand. For most of our lives, we've been told that weight loss is simple. Eat less, move more. Calorie deficit equals fat loss. And look, that's not entirely wrong as a concept, but in perimenopause and menopause, applying that logic in the way we've always applied it actually makes visceral fat worse. And here is why. When you undereat, uh when you're running on a significant calorie deficit, your body reads that as a stressor, a threat. It raises cortisol and goes into conservation mode. And in conservation mode, your body preferentially holds on to fat, particularly visceral fat, while it breaks down muscle tissue for energy instead. So you end up losing muscle, which is the last thing you want, while the belly fat stays put or it gets worse. Your metabolism slows down, your hunger hormones go haywire, and you feel terrible, which leads to stress, which raises cortisol again. It is a spectacular cycle of everything going wrong all at once. The other piece of this is intense exercise, the long cardio sessions, the relentless back-to-back hit classes, the kind of training where you're wiped out afterwards. That is also a cortisol driver. Done occasionally, your body can handle it. Done consistently without adequate recovery. It keeps your cortisol elevated, which keeps your body in fat story mode, which means you can be working incredibly hard and getting the opposite of the results that you want. So, what actually does work? Well, let's talk about protein first, because this is the single most important dietary lever that you can have right now. It supports muscle retention and growth. Essentially, when our bodies are naturally losing muscle mass as estrogen declines, it's the most satiating macronutrient, meaning it keeps you full for longer and reduces the likelihood of overeating later. And it has a high thermic effect, which means your body actually burns more calories digesting protein than it does digesting carbs or fat. Adequate protein intake supports a reduction in visceral fat over time. And how much are we talking? The current research points to somewhere between 30 and 40 grams of protein per meal. Not per day, per meal for women in this age group. That's higher than most of us have been eating, I know, and it might sound like a lot. Um, but to give you a sense of what that really looks like, just think of a palm-sized piece of chicken breast. That's about 30 grams. Um, two large eggs with some Greek yogurt gets you there. A good protein shake can hit 25 to 35 grams, depending on what one you're using. So it's doable, but you do have to be intentional about it. And this brings me to something called protein preloading, which is one of the most practical strategies going around right now. The idea is very simple. Eat your protein first, before the vegetables, before the rice, before anything else on your plate. Eat the protein first. And what this does is start signaling to your body that it's satiated early in the meal. It stabilizes your blood sugar response to everything else you're about to eat. Research on this approach shows it supports better body composition outcomes, particularly around the midsection over time. So if a plate arrives, or you just make your meal and you put it on the table, you eat your chicken, you eat your fish, you eat your eggs, whatever your protein is, eat that first, and then you can move on to your vegetables. Then whatever else is left on your plate, like your potatoes or whatever, your corn, it's you eat that last. It's not that complicated. It doesn't require tracking, it doesn't require an app, it just requires a bit of mental reframing around the order in which you eat the food off your plate. Some people find it helpful to also start the day with protein before anything else, like before you have your coffee if you can manage that, but definitely before carbohydrates. This sets your blood sugar up for the day and reduces the cortisol spike that often happens when we skip breakfast or eat something high in carbs first thing in the morning. This isn't complicated. A protein-forward breakfast doesn't have to be boring, it doesn't have to be elaborate, just Greek yogurt with some nuts or eggs in any form, um, a protein smoothies, just something that gets you to that 30 plus gram mark before you do anything else in the day. Now let's talk about movement, because the advice here is probably different to what you've been following. As I mentioned, chronic high-intensity uh exercise is not your friend right now if you are dealing with elevated cortisol and visceral fat. That doesn't mean never doing anything intense. It just means that intensity should not be your default. It shouldn't be this thing you'd you're going to do every single day. It should just be occasional and you should be well recovered from it before you do it again. And it shouldn't be your primary mode of exercise or movement. So, what should be your primary mode? Two things, resistance training and walking. We've spoken about this many times. Resistance training first. Building and maintaining muscles is probably the single most important long-term investment that you can make for your metabolism after age 40. Muscle is metabolically expensive. Your body burns calories just keeping muscle tissue alive and functioning, even at complete rest. So the more muscle you have, the higher your resting metabolic rate. This is why two people can eat the same amount and have completely different metabolic outcomes based on their muscle mass. Losing muscle, which happens naturally as estrogen declines and which is accelerated by under-eating and over-training, is one of the primary drivers of metabolic slowdown in midlife. Rebuilding and preserving it is how you reverse that. And you don't need to be doing anything extreme. Two to three sessions a week of proper resistance training where you're actually challenging the muscles with weights that feel hard by the last couple of reps is enough to make a significant difference. And you don't need a gym necessarily, though that helps, but you do need progressive resistance. Endless lightweights and high reps isn't going to build muscle. You need to actually challenge the tissue. You don't have if you don't have weights, then utilize a bench or a step. Step up with one leg, tap the other, then step down, repeat 10 to 15 times on each leg. You can do lunges, squats with a jump in between, jump on a box, or step up and down on like a bench out in the park. There are so many ways to ignite and build muscles. I know recently I've had an arm injury, so I can't actually hold weights. So I've switched to Pilates, which is um fantastic. So it's challenging me a lot. But that's maybe a good alternative. Like if you're having issues with lifting weights and jumping on a box, which is something I haven't done for many years, and it was scary at first, but I thought I'm gonna start doing box jumps again. So it was actually good for my brain and my body, just to um do something that was scary and it's fantastic for your bottom and your legs. Now, walking. I think walking gets completely underestimated. Walking being the most accessible thing that we can all do. It does something that high intensity exercise doesn't. It supports fat oxidation without triggering a significant cortisol response. Your body can burn fat as a fuel source during low-intensity activity in a way that it can't when you're working at high intensity, because at high intensity, you're burning predominantly glycogen. Walking is one of the most effective fat-burning activities available to us, and most of us are treating it like it barely even counts. The research on what a consistent walking habit does for visceral fat is really compelling. Studies have shown meaningful reductions in visceral fat from regular walking just alone, without any other dietary changes. Now I want to tell you about something called Japanese interval walking, or jingu, I think it's called. It's the jingu method. It's so simple, it almost seems too good to be true. Their technique was developed by researchers at Shinshu University in Japan, and it's been studied extensively, particularly in older adults. The basic concept is this: you alternate between three minutes of fast walking and three minutes of slow walking. Repeat that cycle for around 30 minutes, and that's it. Fast, slow, fast, slow. The fast intervals are fast, like you're late for an appointment, like you're walking with purpose, brisk enough that you're talking is get a little bit of an effort. The slow intervals are relaxed, easy recovery. But this style of interval walking outperformed regular steady pace walking on almost every metric that they looked at. Cardiovascular fitness, leg strength, blood pressure, and importantly for us, it was significantly more effective for fat loss and metabolic health than walking at a consistent, moderate pace. The reason seems to be that the alternating intensity challenges the cardiovascular system more effectively and engages more muscle fiber while still staying below the threshold that would meaningfully spike cortisol. And it's low impact. It doesn't break your joints, it doesn't leave you exhausted. You finish and you feel good, which means you actually do it consistently, which is ultimately the thing that matters most. Recommendation from the research is five sessions for 30 minutes per week. But honestly, even if you did three sessions, that would make a meaningful difference too. Do it on a treadmill. Or if you can get outside for that, even better, natural light and fresh air, because that has its own set of benefits for cortisol regulation and sleep quality, which we're going to come back to. Let's talk about supplements now, because there are a few that are particularly relevant to this conversation, and I don't want to just gloss over them. Berberine is probably the most talked-about supplement recently for a good reason. Berberine is a compound derived from several plants: golden seal, barberry, and tree turmeric, and its primary superpower is blood sugar regulation. It works on something called AMPK, which is an enzyme that plays a key role in how your cells process glucose and fat. Studies have shown berberine to be surprisingly effective at improving insulin sensitivity, blood glucose, and supporting fat loss, particularly visceral fat. Some of the research has compared its effect to metforbin, which is a commonly prescribed diabetic medication, which is saying quite something for a plant compound. Why is it relevant to belly fat? Because insulin resistance and blood sugar dysregulation are major drivers of visceral fat accumulation. When your cells become less responsive to insulin, your body pumps out more of it. And chronically elevated insulin tells your body to store fat. Beverine helps break that cycle. The next one is magnesium. Magnesium is involved in over 300 enzymatic reactions in the body. 300. It plays a role in blood sugar regulation, in cortisol management, in sleep quality, and muscle function, and in the production of progesterone and other hormones. A significant portion of people are deficient in it, and often without even knowing. And the symptoms of deficiency, is this you? Poor sleep, anxiety, muscle cramps, fatigue, sugar cravings, all these things directly or indirectly make belly fat worse. For sleep specifically, magnesium glycinate and magnesium 3NA taken before bed is one of the most evidence-based things you can do to improve your sleep quality. Can't overstate how important sleep is in this conversation. When you're not sleeping, your cortisol goes up, and we know what happens when the cortisol goes up, because that's what we've been talking about. You're hungrier, your stress is higher, your body is in fat storage mode. Fixing sleep isn't just about feeling better. For visceral fat, it is metabolic intervention. I'll link the magnesium that I use in the show notes. Other supplements worth knowing are Ashberganda, which is an adaptogen that has great research behind its ability to lower cortisol levels. Um, another great one is omega-3 fatty acids, which support inflammation reduction. Um there's a really delicious one that we get, um, omega-3 fatty acid fish oil, which um is a lemon flavor that also comes in orange flavor that I get from sprouts, or just find it in any of your um your natural grocers. It's really yummy, it's like a little treat. It's creamy, it's like creamy lemon, it doesn't taste fishy at all. Anyway, if you want to take a deeper dive, um there's a recent episode on the Model Health Show with Sean Stevenson, and it was fantastic. It's what inspired me to write this one. The title is The Menopause Gut: Why Your Metabolism Changes and How to Reclaim Your Body. He's chatting with Cynthia Thurlow, a nurse practitioner and best-selling author who is passionate about helping women take control of their health from midlife and beyond. I will, like always, share the link in the show notes. So take a listen. They go into more ways to get your body back on track. Well, again, thank you so much for listening. If you enjoyed this episode, please share it with a friend, if you who you think would love it too. Subscribe to my podcast and my YouTube channel so you never miss an episode or a video. Leave me a five-star review to help others find me. I'd really appreciate that. And until next week, I'm Joanna Hart, and this is Not Your Mother's Midlife. Bye bye.