"I've just been so tired but I can't sleep," my 44-year-old patient Brenda complained during our first consultation. "I'm forgetful and have no patience. I don't feel like I even know myself. To add to that mess, I don't even desire sex with my husband anymore. I'm OK once we get started but then..."

Brenda stated exactly what so many women have struggled with in the past, including me. As a doctor of gynecology, I frequently get 40-something women in my office working through self-sabotaging menopausal issues including hot flashes, low energy, near-zero libido, weight gain, and weight loss resistance. Hormonal imbalances contribute to many of these problems. When hormones like estrogen, testosterone, and dehydroepiandrosterone (DHEA) nose dive, you’ve got the perfect storm for menopausal miseries. But it doesn’t have to be this way!

You have more control than you think.

Studies show that how you eat and live contribute significantly to how you transition through menopause. And while Brenda vigilantly monitored her caloric intake, she was eating too much dairy and other inflammatory foods that created hormonal imbalances in addition to living an action-packed lifestyle with few outlets for stress reduction. Meanwhile, her regular, intense cardio workouts spiked Brenda’s fat-storing hormone insulin and stressed out her (already overworked) adrenal glands.

Understandably, she felt frustrated. After all, she felt starved and worked out like a fiend yet she couldn’t lose weight and frequently felt tired, unsexy, and miserable. As a holistic health expert and doctor of gynecology, I’ve found the perfect lifestyle plan for menopause and its complications.

Photo Credit: Stocksy

Over 40? You should consider a ketogenic diet.

For Brenda (and many of my patients), this high-fat, low-carbohydrate diet helped reset her insulin, estrogen, and other hormones. She lost weight, felt better, dialed down her hot flashes, and on her third visit seemed thrilled that finally she was back in the mood again. Especially for menopausal patients, I’ve found these nine hacks help optimally transition into this effective diet:

1. Go alkaline.

When my patients stay in ketosis too long, their bodies become acidic. (When I say acidic, I mean urinary pH, NOT blood pH, which maintains itself.) Acidity creates chronic inflammation that forces their bodies to hold on to fat. That’s why I created the Keto-Alkaline diet and ask patients to shift into an alkaline diet and lifestyle with foods like leafy and cruciferous greens as well as citrus fruits before they go keto, stacking fat loss and other health benefits in their favor. To learn more about how to shift into an alkaline state, please see my guide here.

2. Nix these culprits.

Please don’t shoot the messenger, but caffeine, chocolate, and alcohol (yes, even red wine) can create or exacerbate adrenal stress, hot flashes, and other menopausal complications. Especially during the first few weeks, I ask patients to eliminate these beloved foods and drinks. I promise it’s only temporary!

3. Stop fearing fat.

"How can I eat this much satisfying food and still lose weight?" Brenda asked during our second meeting. For fat-phobic patients (especially those who lived through the low-fat brainwashing in the '80s), ketogenic diets—which are about 80 to 90 percent fat—can initially seem unbelievably decadent. Yes, that’s a lot of fat, but you’ll focus on filling, healthy sources like avocado, wild-caught fish, nuts, and seeds. Yay for foods that we love!

4. Pay attention to food intolerances.

Gluten, dairy, and other food intolerances adversely affect your gut microbiome and pave the way for leaky gut, chronic inflammation, and potential autoimmune disorders. In other words, they can ramp up your already miserable menopausal symptoms. When patients like Brenda pull them from their diets for at least three weeks, they feel better and lose weight easier.

5. Find ways to de-stress.

Chronic stress and anxiety contribute to hot flashes, increase sugar cravings, and raise inflammation, setting the stage for (yikes!) more hot flashes. Brenda found yin yoga worked best to lower stress. You might find meditation, deep breathing, or walking your dog are the best options for you. So find your bliss and do it regularly!

6. HIIT and resist.

Brenda swapped out her adrenal-zapping cardio (which she hated anyway!) for weight resistance and high-intensity interval training. Studies show HIIT helps you lose weight, lower blood pressure, and reduce oxidative stress (all big problems during menopause). Another study found menopausal women who combined a ketogenic diet with resistance training became leaner than those who didn’t.

7. Up your sleep.

Poor sleep becomes a common problem in menopause and can jeopardize weight loss and overall health. Studies show that lowering hot flashes, one of the benefits of the ketogenic diet, can help you sleep better. Brenda could finally get eight hours of high-quality, uninterrupted sleep, leaving her feeling fabulous. Adding a bioidentical progesterone cream at night can really help with sleep, too.

8. Dial down inflammation.

Along with foods like wild-caught fish, Brenda found a green powder with ingredients like maca, turmeric, and other nutrients helped control her inflammation and maintain alkaline balance. She also sprinkled turmeric, which is rich in anti-inflammatory curcumin, on her food.

9. Test, don't guess.

I use urine strips to help determine whether my patients are burning fat (staying in ketosis) and detoxifying (staying alkaline). Your kidneys play an important role in maintaining acid-alkaline balance. Acidic foods can directly affect urine pH, which can be a clue about your health. And while urine testing isn’t completely accurate, it's a great way to stay accountable on a ketogenic diet.


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