weight management in menopause: two experts weigh in on a ... · menopause and weight gain • for...

Weight Management in Menopause: Two Experts Weigh in on a Master Metabolic Hormone

Presented by

Caroline Cederquist, M.D.+ &

Felice Gersh, M.D.+

+Our medical advisors are retained consultants for Pure Encapsulations.

Speaker Disclosure

Caroline Cederquist and Felice Gersh

We are paid medical advisors for Pure Encapsulations. We have no other conflicts of interest to disclose.

The Company assumes no liability for presenter’s information, whether conveyed verbally or in these materials. All presentations represent the opinions of the presenter and do not represent the position or the opinion of the Company. Reference by the presenter to any specific product, process or service by trade name, trademark, or manufacturer does not constitute or imply endorsement or recommendation by the Company.

Seminars, teleconferences and webinars such as this are for educational purposes only and are intended for licensed health care practitioners.

These therapies are not substitutions for standard medical care. Practitioners are solely responsible for the care and treatment provided to their own patients.

Dr. Caroline Cederquist - My Practice Approach

All new patients are seen by a medical staff member. Evaluation and labs are ordered and specific lifestyle program is recommended.

Patients who agree to work with us commit to a three month program of weekly visits that focus on dietary changes, lifestyle modification and correction of metabolic issues and nutritional deficiencies.

Many patients continue to work with us after the three month initial program, in continued three month care increments.

Many patients remain active patients for five years or more. Many patients remain in our care for almost twenty years.

Insulin Resistance

Adequate Protein &

Weight Management

Menopause and Weight Gain

• For most women, weight gain after menopause is common • Weight gain in women in the U. S. over the years that span

perimenopause and menopause is significant, in the range of 15-30 pounds

• Medical texts have attributed the cause to decreased activity and

increased caloric intake with aging

‡These statements have not been evaluated by the Food & Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

More than just weight… 90% of the women in my practice have laboratory evidence of insulin resistance

My Clinical Model

Key Targets

1. Adequate protein

2. Micronutrients

3. Exercise

4. Glucose homeostasis

Common Assessments

• Complete Blood Count (CBC)

• Comprehensive Metabolic Profile (CMP)

• Fasting Serum Insulin

• HbA1C

• Lipid Profile

• TSH, Free T3 and Free T4

• Serum vitamin B12

• 25-hydroxy vitamin D

• Magnesium RBC

• Genetic assessment (such as PureGenomics® SNP Analysis)

PureGenomics® nutritional information is not intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease.

1) Adequate Protein – The MD Factor Meal Plan Basics

1. A prescribed amount of lean protein

2. Control the amount and type of carbohydrates

3. Control the amount and type of fats

How much protein?

• 25-30 grams of lean protein with every meal

• 10-15 grams of protein with snacks.

o 2 - 3 snacks per day

o E.A.T.S. - Essential and Tasty Snacks

By contrast, the RDA for protein is 0.8 g per kg per day, which equates to only 54 g of protein per day for 150 lb person.

Adult Women: 100-120 grams/day


Protein & Fiber

6 grams of soluble and insoluble fibers along with prebiotics to promote weight management†‡

25 grams of vegetarian protein and metabolic cofactors to support healthy weight management†‡

†Provides weight management support as part of a healthy lifestyle with a reduced calorie diet and regular exercise.

2) Micronutrients

• Obesity is closely associated with low plasma concentrations of vitamins

A, C, D, E, zinc, magnesium and selenium

• Popular diet plans often lead to inadequate intake of various vitamins

and minerals (including B1, folate, magnesium, calcium, iron, and more)

Hosseini, B, et al. Biol Trace Elem Res. 2016 Jun 22.

Amara NB, et al. Genes Nutr. 2014 Jul;9(4):410.

Gardner C, et al. Am J Clin Nutr. 2010 Aug; 92(2): 304–312.


3) Beyond Macro- and Micro-nutrients: Metabolic Gene Targets

• AMPK and SIRT1 assist in the process of glucose uptake

• AMPK and SIRT1 are activated by:‡

1. Calorie restriction

2. Bioactive nutrients & plant metabolites

3. Exercise


Resveratrol & Berberine promote AMPK and SIRT1 levels‡

Resveratrol promotes healthy AMPK and SIRT1 protein levels to support cellular metabolism and glucose homeostasis‡

In a recent randomized, double-blind, placebo-controlled 4-week study, resveratrol supported healthy insulin signaling and antioxidant defenses‡

Berberine enhances the expression and function of insulin receptors‡

In a randomized, placebo-controlled trial involving 116 subjects, berberine provided statistically significant support for glucose, lipid and triglyceride metabolism‡


Metabolic Xtra Supports healthy insulin function and glucose homeostasis‡

healthy insulin function and

4) Exercise – More than just Burning Calories

Exercise:

• Activates AMPK and SIRT1

• Improves vascular function in obese and overweight individuals

• Supports healthy immune activity

• Decreases fat in visceral adipose tissue

Exercise: High Intensity Interval Training (HIIT)

Studies show that interval training improves glycemic control better than continuous exercise


The PureLean® Healthy Weight Management† Protocol ‡

Developed in collaboration with licensed bariatric physician Caroline J. Cederquist, M.D., The PureLean® Healthy Weight Management† Protocol‡ was designed to support metabolic rate, appetite and mood centers of the brain, thermogenesis, energy expenditure, healthy glycemic control, carbohydrate and lipid metabolism, and satiety.‡

Available to download at

PureEncapsulations.com/purelean


The MD Factor Diet

More information including The Best and Leanest Protein Meals visit:

www.MDFactorBook.com


Summary

Healthy weight management† programs require: diet, exercise and lifestyle modifications.‡

Clinical Take-Away

1. Encourage patients to consume adequate protein

2. Address nutritional deficiencies; a major concern for chronic dieters

3. Exercise

4. Support healthy glucose metabolism, through diet, lifestyle and nutritional supplements when appropriate.


Dr. Felice Gersh – My Practice Approach

My practice has evolved from a busy OB/GYN practice to a comprehensive integrative practice

We care for a wide range of health problems, all approached with a blend of the functional, integrative, and holistic medicine.

We take a lifestyle first approach, creating the foundations for optimal health, using sophisticated laboratory testing.

We specialize in the unique medical issues of women at every stage of life, with a focus on the interplay between hormones and complex female health problems


Estrogen,

Circadian rhythms,

Gastrointestinal health &

Weight management

Estrogen is classically thought of as a reproductive hormone…

but, in the beginning,

it was all about metabolism

A long, long time ago…

Estrogen was closely tied to metabolism

- Ancestral estrogen receptor (ER) existed in invertebrates lacking sexual reproductive capabilities

- It played an important role in energy metabolism and survival

Mol Cell Endocrinol 2011;334:31-38.

To this day…

The metabolic significance of estrogen is preserved in humans.

Estrogen is supportive of a wide variety of physiological functions:

• Heightens insulin sensitivity, glucose homeostasis

• Supports microbiome

• Supports adiponectin production

• Moderates appetite

• Supports restorative sleep

• Supports AMPK and SIRT 1, a cellular sensor and enzyme involved in maintaining metabolic health and circadian rhythms


Skin

Bladder

Central nervous system

Liver

Endothelium

Breast

Heart

Mitochondria

Ovary/Uterus

Bone/Joints/Immune Cells

Gastrointestinal Tract

Muscles

Smooth muscle cells

Activated estrogen receptors

1. Influence gene expression

2. Impact non-genomic pathways

Am J Physiol Endocrinol Metab 2008;295:E904-912

Estrogen Receptors are Everywhere!

Endocr Rev. The role of estrogens in control of energy balance and glucose homeostasis.2013; 34 (3): 309-338

1) Estrogen & Metabolic Health

My Clinical Model

Key Targets

1. Estrogen

2. Circadian rhythm

3. Gut

4. Metabolic dysfunction

1) Estrogen & Metabolic Health

Estrogen plays an important role in:

• Insulin function

• Glucose homeostasis

• Fat distribution

• Food intake and appetite

• Energy balance

• Gut microbiota

• Adiponectin, AMP kinase, SIRT1

• Circadian rhythm

2) Circadian Rhythms: What are they?

~24 hr oscillations in physiology and metabolism that allow organisms to predict the availability of food and light.

The Master Clock - the suprachiasmatic nucleus (SCN) detects light and directs the peripheral clocks

Peripheral clocks respond to the master clock and meal timing, and help regulate:

• Insulin response

• Lipid metabolism

• Appetite

• Microbiome

Brain clocks

Bone clocks

Vascular clocks

Liver clocks

Gut clocks

Ovarian clocks

• Cortisol

• Blood pressure

• Many other processes

Circadian Rhythm Disruptors

• Nocturnal light exposure

• Improper meal timing

• Poor or interrupted sleep

• Stress

• Traveling across time zones

• Working night shift

• Endocrine disruptors

• Menopause!

8 days of Circadian Disruption

Eating and sleeping 12 h earlier or later than habitual times

• Decreased leptin (-17%)

• Increased glucose (+6%)

• Increased insulin (+22%)

• “Flipped” daily cortisol rhythm

• Increased mean arterial pressure (+3%)

• Reduced sleep efficiency (-20%)

Scheer et al., PNAS 2009;106(11):4453-8.

Circadian Rhythm and the Gut Microbiome

• Circadian rhythm dysfunction can cause changes in intestinal microbiota, characterized by

o An increase in pro-inflammatory bacteria

o A decrease in butyrate producing bacteria

o Altered bacterial ratio

o Disrupted intestinal barrier function (leaky gut) – endotoxemia ensues!


Inflammation is the driving force of menopausal health ills

Abdominal fat & Adipokines

Insulin resistance

Inflammatory cytokines

Gut inflammation (leaky gut)

Systemic

Inflammation

Obesity and Leaky Gut


The Macrobiotic Ma-Pi 2 Diet

• A unique, clinically researched diet rich in complex carbohydrates and prebiotics designed to modulate intestinal microbiota‡

• Short to medium term use

Falluca F et at. Diabetes/Metab Res. 2014;30(suppl 1):48-54

Falluca et al. World J Diabetes 2015;6(3):403-411

21 day to 6 month study using Ma-Pi 2 Diet found improvements in:‡

- Fasting blood sugar

- HgbA1C

- Plasma lipid fractions

- Plasma insulin

- Blood pressure

- BMI


The Macrobiotic Ma-Pi 2 Diet

Include

- Plant-based proteins

- Healthy fats

- Complex carbohydrates

- Natural fiber and prebiotics

- Probiotic rich foods and supplements‡

- Leafy greens (esp. cruciferous vegetables)

Limit/Avoid

- Low protein (approximately 12%) – from plants

- No animal protein, including dairy and eggs

- Low fructose

- No added sugars or processed foods

Protein: 12% Fats: 18% Carbohydrates: 70%

Macronutrient Composition

Meal Timing: Correct the Clock Meal Timing: Correct the Clock

Correct the Clock: Meal Timing Tips

Eat dinner early

Eat at approximately the same time each day

Limit/eliminate snacking

Eat fewer, but larger meals

Eat breakfast and dinner about 12 hours apart

Periodic fasting (FMDs)


Correct the Clock: Fasting Mimetics

Fasting mimetics are agents that partially emulate the metabolic benefits of fasting by supporting the AMPK pathway‡

Examples:

• Resveratrol

• Alpha lipoic acid

• Berberine

• Exercise

Exercise and the Microbiome

Exercise supports:

• Diversity in the microbiome

• Bacteroidetes-Firmicutes ratio

• Proliferation of bacteria that support mucosal immunity and barrier function

• Proliferation of bacteria that produce SCFAs

Monda V, Villano I, Messina A, et al. Oxid Med Cell Longev. 2017: 3831972.


Hormone Therapy

Conventional Hormones

• Estradiol patch or gel

• Oral micronized progesterone (preferably cyclic)

Rhythmic Hormones

• Estradiol and progesterone creams

• Applied twice daily with variable dosing to mimic a normal menstrual cycle

GI Health is Essential for Estrogen and Endocrine Disruptor Elimination

• Estrogen metabolites are glucuronidated and eliminated primarily through feces

• Microbiotia in the GI tract can de-conjugating estrogen from glucuronic acid, causing the recirculation of potentially harmful estrogen metabolites (and endocrine disruptors).

• Probiotics, Prebiotics and Fiber as part of a healthy diet or through supplementation support gut health and estrogen and toxin elimination


The PureWoman™ Postmenopausal Metabolic Health Protocol‡


Summary

Estrogen plays important roles in maintaining circadian rhythms, gastrointestinal function and metabolic health. After menopause, supporting these key areas can promote health weight management† and other aspects of good health.

Key Takeaways

1. Consider a low protein, high fiber diet to support a healthy gut microbiota

2. Encourage healthy eating habits and lifestyle changes to promote a normal circadian rhythm



Thank You

Dr. Caroline Cederquist Dr. Felice Gersh


Learn more at PureEncapsulations.com/webinars

weight management in menopause: two experts weigh in on a ... · menopause and weight gain • for...

Documents