June 1998

CyberHealth Index

CONTENTS:

1. What makes women fatter: HRT or hormone deficiencies?
2. PEPI results on weight gain
3. Chubbiness versus chest hair: DHEA and weight loss
4. “Hugging the Horse”: a Taoist weight-loss exercise
5. The Underworld Goddess: a dialogue with Dr. Miriam Robbins Dexter, Part I

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Weight and Menopause: is that like death and taxes?

Doctors constantly assure women that it’s “normal” to gain weight after menopause. We all (or almost all) tend to gain weight with aging, as muscles gradually atrophy and the metabolic rate decreases; the decade of menopause is generally the time of the most rapid weight gain (meaning “fat gain”).

Around 65-70, individuals who are not on hormone replacement tend to start losing weight as the process of atrophy accelerates — hardly a “healthy” weight loss. It’s rather atrophy, a kind of general shriveling up. So when an older person starts steadily losing weight, that’s actually much worse than anything that happens in the decade of the menopause. That means you’re getting close to losing ALL of your weight.

A bleak picture, I know: first you get fatter and fatter; then you are likely to either die prematurely due to obesity (the #2 killer after cigarettes), or you eventually get skinny in an atrophied way, and then you die as a little old lady or a little old man. And it’s not just humans: when you look at pets, the young cats and dogs are lean and active, while the older animals are fat and sluggish.

But it’s certainly not the policy of CyberHealth to get you depressed over aging without showing you some way or ways to improve this situation.

But first we must clearly see what really happens. I’ve heard the following from various women: “I don’t eat any more than before, I exercise as often as I can, so why am I getting so tubby? Why does my stomach stick out as never before? This must be hormonal.” Or something to that effect. The desperate cry is: why this sudden accelerated weight gain?

The doctors’ assurance that this is “normal” for middle age and the jokes that the definition of middle age is that your middle starts spreading like molten lava simply don’t help. Wistfully remembering how “when I was twenty, I could eat anything I wanted and stayed skinny” just rubs in the unpleasant fact that after menopause it seems to take all the dieting you can endure and all the exercise you can do just to PREVENT weight gain, to stay in the same place, in the face of hormone deficiencies and slowed-down metabolism.

Just because the phenomenon is virtually universal in the Western world (except for those who are genetic “string-beans”) doesn’t make it less of a pathology. The same goes for the rise in blood pressure and insulin; don’t fall for any reassurances that these are “normal.” That’s like Dr. Love’s idea that we should “accept bone loss as a normal part of aging.” We shouldn’t. All these pathologies are PREVENTABLE.

Of course the tendency to gain weight can be seen already in one’s thirties, as DHEA and growth hormone decrease, there is the beginning of bone loss and muscle loss, and often an increase in insulin resistance; in addition, some women begin to show signs of being hypothyroid. Likewise, women who have to deal with a lot of stress, which these days means most of us, have elevated levels of cortisol, a stress hormone implicated in abdominal obesity.

But real blimping out typically happens after forty. After 45, many women lament that there is just no stopping it. And they haven’t even reached menopause yet!

Only a retarded individual would fail to grasp that this is hormonal. But just because we more-or-less understand the hormonal control of body weight doesn’t mean that we address the problem accordingly. My favorite analogy is with acne. Everyone knows that the cause of acne of hormonal. That’s why it’s treated with antibiotics.

Muscle atrophy, related both to hormone deficiencies and lack of weight training (aerobic exercise does not prevent age-related muscle loss), accounts for much of weight-gain problem. After 35, the average sedentary woman loses half a pound of muscle a year, and gains 1.5 lbs of fat. It takes close to 40 calories a day to maintain a pound of muscle, and only two calories a day to maintain a pound of body fat.

IS IT BECAUSE OF LACK OF EXERCISE?

It’s not just a question of being sedentary. It’s been confirmed that even those who jog or run every day tend to gain weight and inches around the waistline as they age. They don’t gain as much as sedentary individuals, and their resting metabolic rate doesn’t go down quite as much, but still it cannot be denied that the “slowing down” of the body with aging means weight gain if one continues to consume the same amount of calories without increasing the amount of exercise.

In other words, regular aerobic exercise does not appear to prevent age-related weight gain any more than it can prevent age-related muscle loss. It slows down that weight gain, it minimizes it, but it doesn’t prevent it. It might prevent it if the amount of exercise was adjusted according to age; the older you get, the longer you have to run.

By now everyone has probably discovered that a typical exercise regimen doesn’t usually work for weight loss. Sure, exercise that is intense enough (at least at the beginning) to switch metabolism from glucose burning into fat burning and sustained long enough to burn off a significant amount of body fat does work. But just taking a nice sunset walk every day will not make you lose weight, though it is by all means to be encouraged since at least this way you won’t gain as much weight as you would by being completely sedentary. Any exercise increases insulin sensitivity, so by all means take that lovely sunset walk. In fact, try to walk after every meal to pump that glucose into the muscles and lower your insulin, that superstar of the fattening hormones.

THE LOW-FAT, HIGH-CARB PRESCRIPTION FOR OBESITY

The disease-producing, life-shortening effects of obesity were noted long ago by life insurance companies, who were the first to note that this is not just a cosmetic problem. Nevertheless, it is also true that 95% (or more) of diets and exercise regimens do not work. What makes all this worse is that diet gurus have convinced the aging American population to cut down on fat and increase carbohydrates: grains, grains, grains! 16 servings of processed carbohydrates a day! Just as blood sugar and insulin levels rise with age anyway, people are eating more insulin-raising high-glycemic carbohydrates. Not realizing that most of their stored body fat originates from excess carbohydrates, they keep on pouring gasoline on the fire, so to speak, and most diet gurus urge them on.

In the last decade, Americans have massively switched to low-fat products and artificially sweetened soda pop, and thus have become the fattest people in the world, and in the history of the world. This obesity epidemic has generated an epidemic of adult-onset diabetes. It all started about 1980.

As for life expectancy, U.S. is #17, a shocking statistic for a developed nation.

I think this country is about to have an explosion of heart disease and cancer cases because of the huge increase in obesity, including childhood obesity (25% of American children are obese). I mean serious obesity. Convinced that what makes them fat is dietary fat, people are drinking fruit juice and eating bananas, pasta, low-fat cookies and other munchies, and carbohydrates in general as if these had zero calories. A non-fat bagel can’t possibly make you fat, right?

The main problem I see is ignorance — most people still don’t realize that it’s stored unburned carbohydrates, not fats, that are the source of most of our body fat. As Dr.Willet pointed out in his ground-breaking public TV interview in which he tried to warn against margarine and promote olive oil, people who cut down on fat and substitute more carbohydrates (snacking on junk food all the time because they are hungry sooner after a low-fat meal) end up in much worse shape and gain more weight than those who stay with the traditional diet.

If you need more convincing, here is Dr. Barry Sears, author of “The Zone”:

“Eating fat does not make you fat. It’s your body’s response to excess carbohydrates in your diet that makes you fat. Your body has a limited capacity to store excess carbohydrates, but it can easily convert those excess carbohydrates into excess body fat.” (p. 11)

How do you know if you’re consuming excess carbohydrates in relation to your activity level? A look in the mirror will usually be enough. But those who like medical proof can have their triglycerides measured. Excess carbohydrates, high insulin, and high triglycerides all go together.

Another sign of consuming excess carbohydrates is feeling hungry every two or three hours.

If your job requires that you sit at the keyboard for hours on end rather than work in the fields all day, you can’t afford to eat lots of rice, bread, and potatoes, much less cookies, doughnuts and so on.

So yes, of course age-related weight gain is hormonal — the anti-obesity hormones decrease, and the fattening hormones increase with age — but it’s also that low-fat apple pie, those non-fat rice cakes, those daily corn flakes, corn chips, cookies, bread, pasta, rice, mashed potatoes, and so on.

In a nutshell, the age-related gain in body fat results from the deficiencies of anti-obesity hormones combined with a rise in pro-obesity hormones, combined with excess consumption of insulin-provoking processed carbohydrates.

HORMONE DEFICIENCIES AND FAT GAIN

We already have a few excellent books explaining the connection between carbohydrates and obesity, but there is still a huge amount of ignorance about the impact of hormones. Typically, women do not think in terms of hormone deficiencies and weight gain, even though they can see what happens just before and especially after menopause. The decade of the menopause is known to be the time of the most rapid weight gain.

Farmers and pet owners may be familiar with the phenomenon of castrated animals growing fat, but somehow we don’t extrapolate this to humans losing their gonadal function, be it suddenly (women) or gradually (men). In fact, the irony is that women tend to blame their female hormones for making them fat, not the loss of those protective hormones. Never mind that men tend to start growing pot bellies already in their thirties, long before most women do.

Men become “stout” or “portly”; they are not held to the ideal of youthful slimness. Women often start waging the battle against weight gain already in their teens. They see boys eating mountains of food and staying slender (a period of hormonal grace that comes to an end by mid-thirties at the latest). I get to watch teen surfers, and they are nearly skeletal! And not because they avoid pizza, burgers, or beer — anyone can see how much they eat. Teen surfers pigging out in pizza joints and staying near-skeletal are such a blazing illustration of the power of the right hormones combined with exercise that they make all diet plans look ridiculous.

At the same time, teen girls see themselves “filling out.” So they conclude that female hormones must be to blame.

Many women avoid the pill and postmenopausal hormone replacement out of the fear of gaining weight. In the popular mind, estrogen and body fat are synonyms.

It is undeniable that estrogens govern the feminine distribution of body fat. When we think of a handsome man, we think of muscles; when we think of a beautiful woman, we think of curvacious “padding” in the right places. A man with very little body fat looks masculine as long as he has good muscles. A woman with truly insufficient body fat looks uncurvacious, unsexy, unvoluptuous, and simply unfeminine; she may in fact be described as having a “boyish” body.

The ideal percentage of body fat is regarded as 12-15% for a man, and 20-22% for a woman. It is not healthy for a woman to have too little body fat. It’s likely to result in early menopause, and early menopause means premature aging. (Hopefully good nhrt helps to counteract that, but all agree that the body running on its own hormonal power does it better.)

It is also undeniable that men have an initial anti-obesity advantage with their greater muscle mass and their higher metabolic rate. Yes, in youth they can afford to eat a lot — at least as long as they have enough testosterone, growth hormone, and DHEA to build and maintain that muscle mass, and burn off excess calories through the production of heat.

And yet in the long run it’s women who have a hormonal advantage. As long as they maintain sufficient levels of estradiol, their weight gain is “in the right places,” and not mainly around the waistline. Fat around hips and thighs is easy to carry and doesn’t create serious health risks. So please don’t fall for the alternative schlock articles that bewail the fact that pear-shaped women have 9 times the fat receptors in their buttocks and thighs than anywhere else in the body, making those “the problem areas.” I invite all my pear-shaped sisters to join me in a deep prayer of thanksgiving for these wonderfully placed fat receptors. The only true “problem area” is the death zone around the waistline. Location, location.

It is only estrogen-deficient women who lose their “girlish waistline” and, if their insulin is too high due to excess carbohydrates and deficiency of insulin-lowering estradiol, they become androgenic “apples.” They are the ones who are likely to develop high blood pressure, diabetes, and cardiovascular disease; unlike “pears,” they also have an increased risk of many types of cancer. (Lung cancer is an interesting exception: it’s seen more often in thin people.)

As for men, who are essentially all “apples” (except for those who became obese already in childhood, before testosterone kicked in), no one is surprised to hear of yet another man dropping dead of a heart attack in his forties and fifties. It starts happening in the mid-thirties. By forty, heart disease is already the #1 killer of men.

Until menopause, the gap in cardiovascular mortality between men and women is like the Grand Canyon. Men’s abdominal obesity isn’t the only reason for it, but it’s an excellent biomarker of the cardiovascular risk.

But what about the fattening effects of the Pill? Some of it, maybe 2-3 lbs, is water retention, but surely not all of it.

Here women forget that the Pill doesn’t just contain a synthetic estrogen. It also contains a progestin. It’s the progestin that increases insulin resistance, resulting in higher levels of insulin, the fattening hormone. Women taking the progestin-only pill or shots are the ones who gain the most weight. OvCon is the least fattening; some women even lose weight on OvCon. Depo-Provera, on the other hand, is notoriously fattening. As for the large doses of progestin sometimes given to breast cancer patients, ravenous appetite and huge weight gain are taken for granted as side effects.

 

THE FATTENING AND THE “SLIMMING” HORMONES

PROGESTERONE CAN BE FATTENING

This should give you a hint about the fattening properties of progesterone. Any hormone that raises insulin levels is indirectly fattening, since insulin is our fat-storage hormone. In addition, progesterone slows down the motion of the intestines so that more calories can be absorbed.

On the other hand, progesterone is thyroid-friendly, so that these fattening effects are offset somewhat by higher thyroid activity (hence the rise in temperature after ovulation). So perhaps it’s only at pregnancy levels that we can call progesterone a fattening hormone. After all, young women don’t gain a few pounds of body fat with each luteal phase, even though it has been shown that they do indeed consume over 200 more calories per day when progesterone starts rising. The increased metabolic rate, as reflected in higher body temperature, is apparently able to compensate.

One study that clearly showed the opposite effects of estrogens and progestogens on the accumulation of body fat was the 1996 monkey study by Wagner. Ovariectomized monkeys given only Premarin weighed the least and had the least abdominal obesity and the lowest insulin levels. But monkeys on combined Premarin and Provera (medroxyprogesterone acetate) showed more fat gain, and their insulin levels were even higher than those of ovariectomized controls receiving no hormones!

For a very interesting human comparison, see the 1997 PEPI study on weight gain and HRT, the reprint of which follows.

HOW ESTROGENS HELP YOU STAY SLENDER

Estradiol lowers blood sugar and insulin, and speeds up the intestines. After menopause, it’s not only cholesterol that goes up; so does blood sugar and insulin. Adequate replacement brings down all those values. (DHEA does the same, except that it lowers HDLs together with LDLs, while estrogens’ great cardiovascular magic is the ability to raise HDLs while lowering LDLs).

In addition, by increasing serotonin, estradiol also acts as an appetite suppressant.

And by lowering cortisol, estradiol helps prevent abdominal obesity and the cortisol-induced loss of muscle tissue.

Last but definitely not least, estradiol stimulates the release of growth hormone.

I know that this statement will come as a shock to most women, but the evidence is in: estrogens help a woman stay slender. This may well include even phytoestrogens. In fact, scientists think that it’s chiefly because of genistein (the chief phytoestrogen in soy) that Asian women manage to stay so slender even after menopause.

I repeat: it is well-known that estrogens protect against obesity through the following mechanisms: lowering insulin, lowering cortisol, speeding up the passage of food through the intestines, stimulating the release of growth hormone, and suppressing appetite through increased serotonin. In addition, estrogens create the gynoid (feminine), a.k.a gluteofemoral or pear-shaped fat distribution; pear-shaped obesity is regarded as much less dangerous than the “android” (masculine) a.k.a abdominal, visceral or truncal obesity (“Your waistline is your lifeline”). The hourglass figure, even if chubby, signals clean arteries; the pot belly signals atherosclerosis and increased diabetes risk.

DHEA FIGHTS OBESITY

DHEA lowers insulin and increases heat production (thermogenesis). Thus, instead of being converted into body fat, excess carbohydrates, or at least a portion of them, are diverted for increased production of body heat. The consensus is that DHEA can be called an anti-obesity hormone, although the weight-loss results in animals have been more dramatic than in humans.

On the other hand, it could also be argued that megadoses of DHEA have not been adequately tested in humans. While we already know that such studies should be confined to male subjects, there is still promise here for an effective anti-obesity hormone for men (see the article on DHEA in this issue), one that builds muscle mass and decreases fat mass without the costs and risks of growth hormone therapy. Women might profit from a DHEA metabolite or analog that can’t be converted into testosterone and DHT (the new 7-keto-DHEA promises to increase thermogenesis without causing acne).

THYROID HORMONES

Thyroid hormones are well-established as anti-obesity hormones, since they increase the metabolic rate and speed up intestinal motion. Rapid weight loss is one of the first symptoms of hyperthyroidism . Dieters lose more fat if supplemented with thyroxine or T3. But doctors frown on the use of thyroid for weight loss, and it’s hard to blame them in view of possible side effects.

TESTOSTERONE FIGHTS OBESITY IN MEN, MAY HELP WOMEN

In men, testosterone stimulates greater release of growth hormone, increases the metabolic rate, and helps build muscle mass, and thus it can be called an anti-obesity hormone. In women, however, higher than normal testosterone is associated with insulin resistance and abdominal obesity.

Normal amount of testosterone, however, may help women maintain muscle mass and increase energy production; thus even in women testosterone can act as an anti-obesity hormone, especially if combined with weight training. So conservative testosterone replacement is to be encouraged. As Pete Hueseman of College Pharmacy says, “A little dab will do.” As I constantly say, dose is everything. (Yes, T cream is best for both sexes. Forget oral T.)

ADRENALINE FIGHTS OBESITY

Adrenaline “turns up the heat” by unlocking the fat cells and allowing the stored fat to be burned for energy and heat. It is definitely a thermogenic, anti-obesity hormone. That’s why it’s so important to get your adrenaline going if you are using exercise for weight loss. You need to exercise for a while at sufficient intensity to trigger the adrenaline release; then keep going at a moderate pace as long as you can. You are now in the fat-burning stage even though you’re “taking it easy,” so the longer you can keep it up, the more body fat you’ll eliminate.

You may have noticed that the excitable “live-wire” type of person tends to stay slender. That’s adrenaline at work.

Stimulants that increase dopamine and adrenaline were the first wave of weight-loss drugs. Basically, the drug industry has concentrated on manipulating neurotransmitter levels for appetite suppression.

LEPTIN, THE NEW WONDER HORMONE

Remember leptin? Its discovery was announced with great fanfare in 1994. It’s a protein hormone produced by the “ob gene.” High leptin levels are supposedly the answer to obesity, since they turned even the super-obese rats into anorexics completely uninterested in food.

But it turned out that obese people already have high levels of leptin. They keep on eating in spite of the chemical scream to stop. Are they as “leptin-resistant” as they are insulin-resistant?

Still, it does seem that if obese patients are injected with leptin so that their levels become extremely high, even they eventually respond by losing interest in eating. Right now all we have is the results of the first clinical trials. It is too early to tell if leptin will become an important anti-obesity treatment.

Back in 1994, there was initially a huge popular interest in leptin because people want a magic hormone that will allow them to eat anything they want, as much as they want, and still stay slender. When the word got out that leptin works by making you lose interest in food, the enthusiasm quickly waned.

INSULIN, THE DOUBLE-WHAMMY FAT-STORAGE HORMONE

So much has been recently written about the crucial role of insulin in making us fat that I simply want to quote Dr. Sears: “The insulin that’s stimulated by excess carbohydrates aggressively promotes the accumulation of body fat.” (p.15)

And since high levels of insulin also prevent the release of fat from the fat cells, you stay fat. As Sears observes, “It’s a double whammy, and it can be lethal.” (p.15)

To keep insulin low, you need to keep each meal under 500 calories, reduce or eliminate high-glycemic carbohydrates such as bread and pastry, increase fiber, and consume sufficient fat.

CORTISOL IS FATTENING: STRESS AND WEIGHT GAIN

Excess cortisol acts as a pro-obesity hormone. It tears down muscle to raise blood sugar, which in turn stimulates the release of insulin, producing the fattening cascade.

So the answer to the question, “Does stress help to make you fat?” is yes. Not the kind of acute, temporary stress that often leads to a bout of diarrhea, but all types of daily nastiness that keep your cortisol higher than it should be and depletes your beneficial sex steroids.

A separate problem is the fact that some women and men turn to the fattening “comfort foods” when under stress.

Since meditation lowers cortisol and increases serotonin, it might actually be a more effective weight loss measure than exercise.

GROWTH HORMONE: AN ANTI-OBESITY MIRACLE?

As I’ve already mentioned, growth hormone is probably the supreme fat-loss hormone. Growth hormone users universally show a reduction in body fat, particularly around the waist, and an increase in muscle mass even without increased exercise. Actually the results of growth hormone replacement make a mockery of all our heroic dieting and exercising: give someone enough growth hormone, and fat loss and muscle gain happen effortlessly!

Growth hormone deficiency manifests itself in the accumulation of body fat in the worst places: around the waist and on the back of the neck (the so-called “buffalo hump”). Some say that fatty bags under the eyes are also a biomarker of this deficiency.

I suspect that we’ll never conquer the current epidemic of obesity until growth hormone replacement (or the use of growth hormone releasers, probably a safer solution) becomes affordable.

Whether growth hormone or keto-DHEA, we need to understand that unless we utilize our knowledge of how hormones control body weight, we won’t get anywhere.

So yes, to a huge extent it is the hormones. The deficiencies of the good ones and the excess of the bad ones, which is an essential syndrome of the process of aging — and, as Regelson says, aging is the ultimate disease that underlies practically all other diseases. Just as we know that centenarians don’t get to live that long by eating two pounds of broccoli a week or doing any of the other things that Dr. Weil recommends, so we also know that if we could TRULY restore the youthful hormonal state at its peak (around age 20), middle-age spread would not be happening.

SUMMARY: WHICH HORMONES ARE FATTENING, AND WHICH FIGHT WEIGHT GAIN

In a nutshell, here is why we get fatter with age: as sex steroids, growth hormone, and often thyroid hormones decline, muscle mass and metabolic rate decline with them. At the same time, insulin and cortisol tend to rise with age.

To oversimplify things a bit: anti-obesity hormones decline with age, and pro-obesity hormones rise.

Let me use a quotation here in scientific terminology. “High levels of cortisol and insulin combined with low levels of growth hormone and sex steroids can cause lipid accumulation. Patients who are deficient in either testosterone or growth hormone show a reduction in visceral (abdominal) obesity when their hormone levels are normalized.”

This author (Bjorntorp) is concerned with men when he mentions testosterone; we know that for women adequate estrogen replacement can act the same way, restoring their waistline.

In men, the bigger the belly, the lower the testosterone; in women, the bigger the belly, the HIGHER the testosterone. This has to do with insulin-driven excessive androgen production in women, and the hormonal control of fat distribution.

I’ve already discussed the ambiguous status of progesterone. We do know that if women are put on high doses of progestins, they do gain weight. Doses typically used for hormone replacement do not have that result, although it is women who take ONLY estrogens who stay the most slender (see that article that follows).

DHEA fights obesity by increasing insulin sensitivity and diverting carbohydrate metabolism into the “wasteful” thermogenic pathway (more heat production).

 

TEN STEPS TO SUCCESS:

1. Build up your muscles. The more muscle mass you have, the more calories you burn even at rest.
2. Eat less (large meals cause a greater insulin release)
3. Walk more (exercise lowers insulin)
4. Exercise intelligently: after the intense adrenalin-releasing phase, sustain a moderate level of activity.
5. Don’t smoke: even though nicotine increases the metabolic rate, it also depletes estrogens and thus leads to a thick waist.
6. Take good hormone replacement. If you can afford growth hormone, go for it (the low-dose, high-frequency mode is safest).
7. Keep your cortisol low and your serotonin high by giving yourself enough time for pleasure and relaxation
8. Eliminate processed carbohydrates; emphasize RAW carbohydrates, which are naturally less glycemic and contain more fiber; consider substituting monounsaturated fat (olive oil, avocados, almonds) and medium-chain triglycerides as your energy sources for part of the carbohydrates (medium-chain-triglycerides, abundantly present in coconut oil, are burned for energy and resist being turned into body fat; they also increase heat production, thus helping fat loss).
9. Men especially should include a glass dry red wine with the heaviest meals (both lunch and dinner is fine for men; the consensus is that women should limit themselves to one glass a day). In moderation, DRY WINE LOWERS INSULIN LEVELS and thus helps prevent fat gain. The French consider wine the reason for their famous slenderness. (As for Asians, it may be their high consumption of green tea, which slows down the digestion of starch. But I’d also give credit to high intake of semi-raw vegetables.)
10. Try deep-breathing exercises. I know it sounds too easy, but it’s been shown that breathing exercises enhance fat loss when combined with exercise and diet. It’s possible that better oxygenation improves the metabolic rate.

It is not enough to eat less. Diets that rely merely on calorie-restriction do not work. You must change the quality of your meals, not just the quantity of food on your plate. Different carbohydrates: raw vegetables, tart fruit such as cherries, green apples, berries, grapefruit. Different fats: olive oil, almonds, avocados, medium-chain triglycerides.

Alas, until growth hormone therapy becomes commonplace, in order to stay slender in midlife and beyond we must limit or avoid high-glycemic carbohydrates such as cereal, bread, pastry, snack foods, pasta, white rice (rice cakes are particularly deadly), or mashed potatoes (extremely glycemic), since with our sedentary lifestyle and the current inadequate hormone replacement we just can’t deal with foods that provoke a large release of insulin. Such foods literally kill us. That’s the truth of the old observation that most people dig their graves with their fork and spoon.

What people must understand that it’s not fat that makes them fat; it’s insulin trying to lower high blood sugar, triggering the conversion of glucose into body fat and keeping that fat locked up in storage. And glucose leads us back to carbohydrates, which is another name for sugars.

There was never any scientific basis to the belief that complex carbohydrates are harmless and non-fattening, and thus we should avoid only “simple sugars.” In the late eighties, studies showed that bread, breakfast cereals, rice, potatoes, and even cooked carrots and corn were extremely fattening, more so than the much-maligned table sugar (which is still to be avoided, being empty calories).

A small percentage of people do not gain weight as they grow older. There is the tall, lean string-bean type, who is genetically lucky and never produces much insulin; there is the “live-wire” type with a lot of adrenaline in his/her body; and then there are those who are as hormonally disadvantaged as the rest of us as we grow older, but who “fight back” with the right diet, exercise, and, increasingly, the right hormone replacement.

Though it is still rare, you CAN find people in their late seventies who have a beautiful physique. In my observation, men who stay slender and muscular into old age are typically weight lifters, tennis players, or serious mountain hikers, while the women are usually dancers. Or else they lead passionate, productive lives and hardly even seem to have the time to eat. As Casanova said, “A true lover doesn’t eat.” So fall in love.

(Source: Bjorntorp P. Endocrine abnormalities of obesity. Metabolism, 1995; 44: 121-23;

Sears B. The Zone. Regan Books, 1995; Kalergis M et al. Attempts to control the glycemic response to carbohydrate in diabetes mellitus: overview and practical implications. Canadian J Diabetes Care1998; 22: 20-29;

Wagner JD et al. The effects of hormone replacement therapy on carbohydrate metabolism and cardiovascular risk in surgically postmenopausal cynomolgus monkeys. Metabolism 1996; 45: 1254-1262)

Research assistant for this feature: Dr. Andrea Vangor

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Dr. Andrea Vangor comments:

Gaylord Hauser’s ideas parallel your own quite closely. He had Gloria Swanson etc. living on greens and tiny steaks.

Ivy:

Hollywood seems to have known the secret of fat loss and remaining slim for a long time. Basically it’s the “chicken and salad diet,” or “seafood and salad.” The point is it’s protein, raw carbohydrates (salad), and olive oil and vinegar. Ah yes, sprinkle pepper on your chicken and in your salad because it revs up metabolism. For breakfast, you can hae two soft-boiled eggs and half a grapefruit. Works like a charm. If you stay on this diet indefinitely, you’ll remain spectacularly slender. Amazing how long it’s taken the rest of the country to discover the protein and salad secret. Dateline showed a segment on the “Sugar-Busters Diet,” and what were the authors eating? Some meat and lots of salad.

Gail comments:

I’m afraid you are right about this coming epidemic of consequences of obesity. But I also think that most people are not eating a very low-fat diet at all — despite increased use of low-fat and nonfat foods. Think of all the fatty fast food eaten in this country!!

Ivy replies:

Yes, typically people who really overeat, overeat both on carbs and on fat, as Gail points out. What I’ve noticed about those who are truly obese is that they seem to favor soft fiberless food you don’t have to chew, and fat is one of the ways to create that smooth “mouthfeel.”

There are diets, however, like the French or Cretan or Eskimo, where the percentage of fat is high and even extremely high, but in the absence of excess carbs, and also maybe because much or most of it is healthy fat, there is little or no obesity (The French are the skinniest in Europe; but maybe it’s the wine, which lowers insulin if consumed in just the right “dose range”).

In terms of causing premature aging, excess carbohydrates are a horror, since the high blood sugar that results cross-links with proteins, one of the fundamental mechanisms of aging-related molecular degeneration. Diabetes is linked to runaway premature aging and shortened life expectancy.

An interesting current suggestion is that diabetics should consume mono fats instead of carbs as energy source. I’d throw in RAW vegetables, which don’t seem to raise blood sugar (carrots may be an exception, but even so it’s carrot juice and cooked carrots that are a glycemic monster, not raw carrots). Again, more on the value of raw plant food in CH 15.

I’ll have more on fats, especially the kinds of fats that help one lose weight, in CH 15.

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Because so many of you missed the early issue of CyberHealth that carried an extensive discussion of the PEPI findings on hormone replacement and weight gain, I’ve decided to reprint a portion of it.

WEIGHT GAIN AND HRT: THE PEPI STUDY

The May 1997 issue of The Journal of Clinical Endocrinology and Metabolism brings us the PEPI report on weight gain in the four hormone groups vs the placebo group. Yes, just as expected, the women in the placebo group gained the most weight, and the women on Premarin alone the least, also preserving the most slender waistline. The hormonal regimens (all of them using the low dose of .625mg Premarin), however, provided “only slight protection against postmenopausal weight gain.”

In a nutshell: women assigned to hormonal treatments gained on the average 1 kg (2.2 lbs) less over three years than those assigned to placebo. THE LEAST WEIGHT GAIN WAS NOTED IN WOMEN ON PREMARIN ALONE (.7 kg, or 1.54 lb), together with the least increase in waist girth (1.1 cm, which is slightly less than half an inch). The continuous Premarin/Provera regimen came next. With addition of cyclical Provera and progesterone, the results were a little worse, but the differences were not statistically significant. Women assigned to placebo gained an average of 2.1 kg (4.62 lbs).

Women aged 45-54 showed much greater increases in weight than women aged 55-65.

(Source: Espeland M et al. Effect of postmenopausal hormone therapy on body weight and waist and hip girths. J Clin Endocrinol and Metab 1997; 82:1549-56.)

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CHUBBINESS VERSUS CHEST HAIR: DHEA AND WEIGHT LOSS

Katie writes:

Over the last few years I have run between 170 and 195 with no correlation with anything that I could determine about why I weigh one amount one day and another amount some other day. For many years, my weight had been absolutely stable, but for the last ten years or so it had flucutated wildly within the above range. By watching my diet, I was eventually able to get it down into the mid-170s, with lots of fluctuation within the 170s.

Then I started taking DHEA. Voila! My weight dropped over a couple months to running between 161 and 164, with no fluctuations outside those numbers. Trouble was that I was taking 200mg DHEA daily, with resultant masculinization of body hair.

Dropped to 50mg DHEA daily, and sure ’nuff, my weight started going up within days, up to 172.

Went back to 200mg, and my weight promptly returned to 161-164.

I have been through this cycle several times now, and find it consistent. At 50mg my weight promptly starts going up; at 200 it is stable at a weight that looks good on me but I have more body hair than I would like. Gotta find a happy medium.

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Ivy replies:

Ah, how well I remember the days when I used to take 50mg of DHEA. I felt so energetic, so light — practically weightless. But not only was it one pimple after another, but also in a while I noticed that the hair on my forearms was noticeably darker and more abundant than before.

The famous Yen study of 1994 gets quoted in alternative literature all the time, but one of its findings is never mentioned: that in women, and women only, DHT levels almost tripled.

I tried taking saw palmetto, hoping that I could enjoy the energizing and slenderizing benefits of DHEA without paying a price in androgenic side effects. Surely saw palmetto extract would solve the problem by blocking the conversion to DHT? In theory, yes, but in practice nothing happened. After using the stinging, smelly bleach twice on my forearms, not to mention having to start and end the day with anti-acne salves, I sorrowfully cut my DHEA dose in half.

And the side effects vanished, and with them that incredible lightness of being.

But wait, there is hope — at least for men. Tom Matthews, who answers readers questions for the Life Extension Foundation and also subscribes to CyberHealth, announced that he finally lost his “love handles” when he started taking 90mg of DHEA, together with 30mg of pregnenolone, in divided doses throughout the day (6 times 15mg of time-release DHEA tablet that one can buy from Life Extension Foundation).

In rodent experiments, DHEA supplementation caused mice to lose to as much as one-third of their body fat. So if you’re male, you’re lucky — you can experiment with taking more DHEA, and maybe it will work for you. But don’t forget to reduce or eliminate processed carbohydrates, and the power of the right exercise regimen (with lots of DHEA, you’ll certainly feel like being active).

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* * * THE BEAUTY CORNER* * *

“HUGGING THE HORSE”: A TAOIST THERMOGENIC EXERCISE

During a demonstration of Qi Gung, our instructor said, “You are probably wondering why the motions are so slow. Well, the Taoist sages discovered that the more slowly you move, the more intense the effect. If you want to exercise really hard, stand still.”

Taoist healers were the first life extensionists. They introduced the first kind of hormone replacement: crystallized urine of young men and women, and of healthy young animals. And they devised a system of exercise that seems worlds apart from the quick and strenuous Western regimens. The idea is to be superslow and meditative. And if you want to exercise really hard, stand still.

If you want to experience the power of this exercise, try “hugging the horse.”

1. Stand with your feet apart, but not wide apart: each foot should be more or less in straight line from each shoulder;
2. Bend your knees slightly;
3. Tighten your pelvic muscles as hard as you can and tilt your pelvis forward (important: you are not “sucking in” your belly by holding your breath; the sucking in and tilting forward are achieved through muscle tension in buttocks and thighs);
4. Place your arms in a semi-circle in front of your chest, at heart level; palms are facing toward you, fingertips almost touching;
5. Breathe deeply and calmly;
6. Hold this position as long as you can.

Something very interesting happen as you stand there “hugging the horse”: you feel warmer and warmer. It’s not unusual to start sweating. You’re merely standing still, your belly sucked in, your buttock muscles tight, and suddenly sweat is beginning to trickle down between your shoulder blades. Taoists explain that you’ve created an energy circle, with chi flowing around and around, jumping the gap between your fingertips.

Whatever the mechanism, this is a magnificent toning exercise for the abs, and you can literally feel that you’re burning calories and slimming your belly.

My instructor warned that it’s best to do this exercise in the morning rather than at bedtime because of its energizing effect.

Other benefits include better posture and improved breathing capacity. You don’t have to wait long to see the benefits. This is a very powerful exercise.

The beauty of “hugging the horse” is that you can do a light version of this exercise while standing in a check-out line, for instance. I call it “hugging the pony.” All you do is intensely tighten the pelvic muscles and tilt your pelvis forward. Breathing normally, try to maintain the muscle tension as long as you can. Talk about building those coveted “abs of steel” and “buns of steel”!

I bet you never thought that Taoist sages were interested in life extension, flat bellies and trim, shapely bottoms. No, they didn’t do sit-ups; they devised something better.

Next time: a Taoist breathing exercise that helps you lose fat; toning the lower abdomen with “the reverse crunch.”

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* * * CARE OF THE SOUL * * *

THE UNDERWORLD GODDESS, PART I

It’s somewhat ironic that this topic is being discussed in an issue focused on weight — as though to remind us that one day we are going to lose all of it anyway.

After learning that Dr. Miriam Robbins Dexter (Ph.D., Linguistics; a feminist scholar who teaches at UCLA and Antioch University) is working on a book on the Underworld Goddess, I have been privileged to engage her in an email dialogue on this fascinating topic. Even if you are not grounded in mythology, I think you’ll find at least some parts of it relevant in a universal way: menopause and aging and facing mortality.

It is not a matter of believing in the Goddess and the Underworld, but rather of recognizing universal patterns of experience in mythological motifs. You’re not alone: someone has been there before, already thousands of years ago! Besides, we seem to learn and grow by sharing stories.

In the last two decades there has been an explosion of interest in feminine spirituality, in women’s myths and legends. It has also been called the Return of the Goddess. The emergence of the feminine is one of the most profound cultural and social changes in this century.

A bit of background: Inanna is a Sumerian goddess, the Queen of Heaven also identified with the planet Venus, who makes a descent into the Underworld. At each gate she is stripped of some of her garments, adornments, and symbolic attributes; in the end she enters bowed and naked, dies and is eventually restored to life. For a fascinating discussion, try Sylvia Brinton Perera’s DESCENT TO THE GODDESS.

The myth of Kore/Persephone and her abduction into Hades is more widely known; if you’d like to read more about it, try Jean Shinoda Bolen’s GODDESSES IN EVERY WOMAN.

To me the goddess represents not God as Logos (intellect, or “word”), but rather God as Eros and as Agape (communal love, or loving kindness) — in other words, a connection with the primal emotional side of life. We may try to deal with aging and death intellectually, but the emotional side of our psyche will never be satisfied with that.

Aging and dying — being stripped of youth, beauty, sexuality, health, vigor, memory, the social status that goes with gainful employment, until finally we are stripped of life itself — nothing frightens us as much as that. Practically every religious tradition tries to offer comfort by presenting images of an afterlife. One concept that some feminists have been exploring is that of returning to the cosmic divine mother, or being embraced by a welcoming, benevolent female energy after one has made the dark passage. This image has its roots in the ancient goddess-based religions.

Ivy: I’ve been pondering how the descent of Inanna to visit her sister, the Death Goddess Ereshkigal, can also be seen as the journey of menopause. The woman’s youth, beauty, sexuality, and fertility are stripped away from her. Even her memory and quick wit are taken away, her resilience in dealing with stress, her sleep and dreams. No wonder in extreme cases some women in the past ended up in mental institutions and/or committed suicide. But even in ordinary cases, being faced with the end of youth and fertility is an encounter with mortality, with the Underworld Goddess.

What really shook me up about menopause was not the hot flashes and such, but the sudden acceleration of aging, including mental decline. Once I had excellent memory; now I couldn’t remember Shakespeare’s first name. It was like a sudden, unexpected rehearsal for “serious aging.” The loss of sex drive was traumatic to me. I no longer felt bright and creative, and that was of course even more traumatic. The term “withering” suddenly had a personal meaning. I was scared to look at myself in the mirror, this sudden aging was happening so fast. Aging as “the gradual loss of self.” It felt like dying.

Then, in a sense, the woman is resurrected, given the “water of life” (hormones or other physical remedies? emotional sustenance?), and though she is changed, it is a positive tranformation and a transition to her power years– in Jung’s words, the second half of life is the time of one’s greatest unfolding. The woman is now more vital and self-confident than before.

As Gloria Steinem observed, women become more radical as they grow older. Most writers agree that postmenopausal women tend to be more independent, daring, and assertive. Men grow more “tame” with aging, but women grow wilder. Already menopause can be a liberation, but some say that old age is an even greater liberation, because now you can be really outrageous and do what you’ve always wanted to do; life begins at seventy! I don’t know if I agree, but I love the spirit of it. It strikes me as being the kind of wisdom I’d expect from a woman who’s made her descent to the psychic Underworld and has managed to ascend again.

Miriam: Very interesting comparison: the Descent and menopause. I like it. And the water of life/hormones — wonderful! A very grounded interpretation.

When I taught the Near-Eastern Goddesses workshop at Antioch last month,

almost all of the women responded strongly to the Descent myth. It affects most of us, since at some point in our lives we all must descend, whether it be due to death of a loved one, addictions, aging. Yes, the Descent is THE myth.

Ivy: Thinking of the Egyptian pre-occupation with the afterlife, does Isis have an underground sister?

Miriam: The thing about Isis is that she is both Upper World and Underworld. She is a goddess of life: she restores Osiris to life just long enough to engender their son, Horus; she is frequently depicted as a mother suckling her child. And she beats her wings in the Underworld to create breath for the dead.

Ivy: Fascinating about Isis. Seem like a super-nurturing goddess. Interesting that there is no life-death split.

Persephone as the goddess of springtime and the Queen of the Underworld is also interesting, though the presence of Hades dilutes her power.

Miriam: I agree — the Greek take on the Persephone myth changes things a lot — she doesn’t exactly have the power of an Ereshkigal.

Ivy: It’s fascinating that women (and probably at least some men) do seem to feel a female presence down in the earth. I’ve even witnessed this. Asked, “Where is the goddess?” a woman said, “Down there,” and pointed down to the earth.

It is also a fairly obvious metaphor to call the earth the womb of creation of all living things and the place of their return; hence it felt natural to have the underworld ruled by a goddess.

But eventually the patriarchal cultures sent the “good” souls up to the sky, to the Heavenly Father, while only the damned went down inside the earth, the underworld now ruled by Satan, a place of punishment, not rebirth.

Miriam: Isn’t it interesting how the underworld slowly became a place of evil. Shows the amazing split wrought by western culture in the last few millennia.

Ivy: Artemis, the Lady of the Beasts and the virgin goddess who is a divine midwife helping women give birth also has a connection with the Underworld through Hecate, doesn’t she?

Miriam: Yes, Artemis is connected with the Underworld — but I think that is a later syncretism with Hecate (Ivy: meaning that Artemis the Virgin and Hecate the Crone started out as separate goddesses, and only later were to some extent merged as two aspects of the same deity).

Ivy: Hecate is a colorful goddess, and the kind of powerful, witchy Crone image that is otherwise lacking in Greek mythology. I like the idea of the independent huntress, Artemis, developing into this radical Crone.

Because of her connection with crossroads, I see her as a goddess of choices, and that’s also another connection with menopause for me: now that a woman is more aware of mortality, of “having a deadline,” she needs to decide in earnest how best to use the time that’s left.

And Hecate is presented as surrounded by dogs — female dogs. I’m not saying that that’s what the ancient Greeks had in mind, but to me that again is the wildness of older women, their outrageous witchy cackle, their daring to be “bitchy” if need be.

Miriam: Hecate is definitely a goddess of choices — including that of maintaining her autonomy. Hesiod writes about her primal importance — even though she isn’t a member of the Olympian pantheon. But I need to show her underworld functions.

Ivy: Do you have a favorite Underworld goddess?

Miriam: My favorite Underworld goddess is Ereshkigal, for two reasons — 1) because she really rules the Underworld — she isn’t just the consort of the King; and 2) because she’s sexy — not withered up by any means. She makes Nergal visit her in the Underworld and they have sex for six days and six nights.

Ivy: What an ecstatic idea: making love in the Underworld! Why yes, presumably Hades and Persephone make love too. How different this is from the later ideas of hell. It reminds us that the Underworld need not be conceived in terms of suffering at all, but rather in terms of hidden, mysterious joy. And this is certainly an icon of the Divine as Eros, and the creativity that follows.

(Part II will follow in CyberHealth 15)