Weight Gain In Torso As We Age...
What's driving this frustration tsunami and the emergent role of Follicle Stimulating Hormones (FSH).
Most medical books used to say that the average weight gain around peri and post menopause was 8 pounds. Dream away! Most ladies complain of gaining approximately 20 pounds. Or… more. Ugh!
I asked a seasoned internist who I worked with for years, what the most common complaint he got over the decades, was from women when they start to age. Without hesitation, he said, “resistant weight gain”.
What’s up with that?
Hormones!
As we age our follicle stimulating hormone (FSH) elevates. This is part of aging.
As sex hormones wan with aging, such as estrogen levels going down, down, down. FSH starts to go up, up, up.
Pharmaceutical companies are looking to create patentable medications to lower FSH.
Why? Lowering FSH helps lose weight (among many other benefits as you read further down in this article).
But, what effectively lowers FSH naturally? Hormonal therapies. Meaning “estrogen replacement”.
Results in The New England Journal of Medicine and Cell Metabolism have revealed the rise in FSH at the time of menopause is greatly responsible for some of the waist-thickening weight gain!
Thus, as FSH levels soar, the weight gain phenomenon in menopausal women starts to drive ladies crazy.
Keeping FSH lower than 20-25 helps keep waistlines thinner. Maybe not like Scarlett Ohara, but closer to your younger self.
In studies of mice, blocking FSH increased calories burned. Abdominal fat was also reduced. Wow.
Plus, get this, even physical activity, the motivation to really “move” more, was also boosted! Another wow.
Dr. Mone Zaidi, a professor of medicine at the Icahn School of Medicine at Mount Sinai in New York City, has also noted that soaring levels of FSH also correspond with a loss of bone density.
In fact, Dr. Zaidi created an antibody that blocked FSH in female mice whose ovaries had been removed. They expected this to make the bones of the mice less dense and the bone marrow to fill with fat - as usually happens after the removal of ovaries.
However, when the mice received the antibody, so FSH could not elevate, the bone marrow did not fill with fat. The mice also lost weight.
This means that if one can keep FSH levels lower, this helps maintain a healthier weight, plus healthier bones.
The research was then repeated by Dr. Clifford J. Rosen, a bone specialist at Maine Medical Center Research Institute.
Two and a half years later, Dr. Rosen confirmed Dr. Zaidi’s original findings.
Replicated research is the golden rule of science. if a different lab comes out with the same results, this makes the outcomes “heavy” or science we should respect.
It’s worth noting that these results are yet to be reproduced in humans in randomized trials.
But… we see these results in ladies on bioidentical hormone replacement and especially when their FSH levels respond to appropriate dosages by going below 20 to 25 mIU/mL in simple blood lab tests.
It makes a lot of physiologic sense. Dr. Angela DeRosa, a hormone expert, has clearly shown that lowering FSH levels in postmenopausal women, to pre-menopausal levels (below 20-25) creates “anti-aging” magic on multiple tissues.
I have seen this with my own patients.
How can these amazing findings be explained?
This is partially due to the fact that there are two different types of fat in the body, white and brown. (BTW I have a huge article coming out on fat cells, adipocytes, in the “Townsend Letter” in the fall - so stay tuned).
Brown fat burns calories and creates heat – we have more of this when we are younger so our bodies stay leaner, while brown fat often shrinks when we age.
White fat stores energy. Brown fat burns it.
The elevation of FSH blocks brown fat.
The blocking of the FSH (or lowering its levels in the blood) converts white fat to brown fat.
Thus, the lowering of FSH seems to turn white fat back to brown. Helping us fit into our younger sized clothes in the back of our closets.
In other research from the University of Colorado, healthy premenopausal women were given a drug that blocks the production of estrogen, putting them into a reversible state of menopause.
Within five months, the women’s fat moved to their abdomens, increasing by 11% on average. They also burned 50 fewer calories per day. Ugh.
When we are low in estrogen, fat moves to our gut. We get less benefit from exercising. We get bloated, stubborn, torso fat.
But estrogen replacement lowers FSH. Which lowers belly fat.
If you are on adequate levels.
Without having to take a drug, but by hormone replacement, you burn more fat as your FSH lowers.
But hey. Big pharma doesn’t want to hear that. They want a patentable drug to lower FSH. To make money.
High FSH levels + low estrogen levels = keep pounds on. Your belly holds fat.
Menopause is the loss of ovarian function.
Peri-menopause (could be up to 10 years) is when periods become irregular, FSH levels increase. This is an attempt by the body to stimulate the ovaries to overcome the negative inhibition they normally exert.
Measuring FSH in the blood gives one index of ovarian status. FSH goes up and down for a while. This fluctuation increases 4-5 fold at the climacteric (a period of time when hormone levels are changing as ovarian function declines, but has not ceased altogether).
Medically, menopause is regarded as a period of 12 months since periods fail altogether and FSH levels eventually remain stable at an elevated level (above 20-25 mIU/mL).
Continuous elevated FSH demonstrates cessation of ovarian function. FSH levels increase erratically but progressively. They remain elevated after menopause.
Elevated FSH is now even linked to “cognitive decline”. In rodent studies, blocking FSH improves cognition, which means better thinking.
FSH is easily measured in the blood.
Part of the goal of a successful hormone therapy regime is to bring the FSH level below 20-25 mIU/mL.
So - new info that helps you achieve optimal hormone replacement levels, is getting your FSH measured. With the goal being below 20-25 mIU/mL and even closer to 5 mIU/mL.
This is part of the missing aging puzzle!
Reference: Blocking FSH 'may help menopausal women fight weight gain and boost bone health' Total Health Obesity BMI Mon, 08/21/2017 - 13:42
Mount Sinai Mount Sinai Researchers Develop a First-in-Class Humanized Antibody Targeting Bone and Fat https://www.mountsinai.org/about/newsroom/2020/mount-sinai-researchers-develop-a-firstinclass-humanized-antibody-targeting-bone-and-fat-p
A novel follicle-stimulating hormone vaccine for controlling fat accumulation. Theriogenology. 2020 May;148:103-111. doi: 10.1016/j.theriogenology.2020.03.005. Epub 2020 Mar 5. PMID: 32171969.
Blocking FSH induces thermogenic adipose tissue and reduces body fat. Nature. 2017 Jun 1;546(7656):107-112. doi: 10.1038/nature22342. Epub 2017 May 24. PMID: 28538730; PMCID: PMC5651981.
FSH blockade improves cognition in mice with Alzheimer's disease. Nature. 2022 Mar;603(7901):470-476. doi: 10.1038/s41586-022-04463-0. Epub 2022 Mar 2. PMID: 35236988.
Dr Berkson, this is another of your articles that I needed to read & learn from, THANK YOU!
Thank you for the interesting information in this read. One of my girlfriends and I were just talking about this issue yesterday. Have you written anything about pre-diabetes in postmenopausal women? Is this common? Or is there any information out there about this?
Secondly, I was on BHRT in 2016. But I gained 25 lbs and that freaked me out. So I discontinue the regime. I'm 60 now and I am reconsidering it again because I feel miserable. This article has helped with my decision process. But I'm wondering if my weight gain situation years ago was just a weird outcome? Or I wasn't on a good program? Or I wasn't a good BHRT candidate? My diet was strict at the time, meaning it was considered in the program at the time. Any ideas? Thank you again.