Fasting for Healthy Longevity

New Directions for Women in Menopause

By: Felice Gersh, M.D.

The following arti cle is not endorsed and/or supported by The American Academy of Anti -Aging Medicine. The purposes of this publicati on do not imply endorsement and/or support of any author, company or theme related to this arti cle.

Menopause is a universal event for women. The exact age varies somewhat, but the eventual permanent loss of ovarian hormone production is inevitable. Although a natural and “normal” event, the menopausal transition and subsequent years in a menopausal state do not benefi t women’s overall health. This is especially true for cardiovascular health.

Cardiovascular disease is the number one killer of women in the United States and the risk of a cardiovascular event is directly related to decreasing levels of estrogen as women progress through the menopausal transition. Women who experience menopause early, before age 40, are twice as likely to suff er from a non-fatal heart attack, stroke, or angina before age 60 compared to women who go through menopause at ages 50 or 51, which is the U.S. average. 1 They are also more likely to suff er from fatal cardiac events and have an overall lower life expectancy. 2 In contrast, women who go through menopause after age 51 have lower rates of cardiovascular disease and enjoy longer life expectancy.

Menopause, and the resulting state of permanent estrogen defi ciency, is a powerful risk factor for cardiovascular disease that is greatly underappreciated. Loss of estrogen causes systemic vascular infl ammation, immune dysregulation, loss of glucose homeostasis, and gut microbiome dysbiosis. 3 These dysfunctions set the stage for metabolic disease and ever escalating cardiovascular risk.

Typical therapies off ered to women to reduce cardiovascular events are pharmaceuticals, such as blood pressure drugs, statins, and diabetes medications. Although pharmaceuticals can be warranted and valuable in certain situations, they don’t access the body’s innate mechanisms to maintain metabolic homeostasis and don’t address the multitude of dysfunctions developing in the menopausal female body.

Hormone therapy is also available, but the FDA does not yet recognize or endorse the use of hormones in women to reduce cardiovascular risk. This is despite a substantial body of science supporting the benefi cial impact of hormones on the cardiovascular system. 4 However, even if the implementation of bio-identical hormones becomes routine for women transitioning into menopause and thereafter, the reality is that we cannot yet administer hormones in a way that replicates the complex hormonal levels and rhythms of a healthy 25-year old woman. Too many women, including those who use hormones, suff er from cardiometabolic diseases.

Fasting has been an integral part of the human experience since the beginning of our species and plays a signifi cant role in many religions and societies.

Simply put, fasting is any time one is not eating. There are several variations that are associated with diff erent health benefi ts. “Time-restricted eating” refers to an extended and habitual overnight fast lasting 12 or more hours. When a person fasts for 16 to 24 hours, that is called “intermittent fasting.” If a person fasts for a few days up to a week, that is labeled “periodic or prolonged fasting.” Women in the menopausal transition and up to around age 65 years can gain signifi cant health benefi ts from all forms of fasting. Combining time-restricted eating with a regular program of periodic fasting is likely the most advantageous combination

Time-restricted eating is the easiest form of fasting because the majority of the fast coincides with time spent sleeping. This is, in fact, why it is so benefi cial. Overnight fasting bolsters circadian rhythm in both pre-clinical studies and human observational studies.

As with all creatures, humans are governed by time. We have a master clock in our brain that sits atop the optic nerve and senses light and dark, plus nutrients, to track the 24-hour day. Throughout our bodies, we have clock genes that govern most metabolic functions, and these peripheral clocks, in alignment with the master clock, keep all the organs of the body working in beautiful synergy. Unfortunately for menopausal women, estrogen plays a major role in the proper functioning of the master clock.5 As menopause progresses and estrogen production declines, women succumb to circadian rhythm dysfunction, essentially a state of perpetual jetlag that substantially increases risk for diabetes, heart attacks, weight gain, insomnia, cancers, and mood disorders. Time-restricted eating utilizes the power of the peripheral clock genes to reset the clocks in the organs and maintain the synergy that the master clock promotes. By eating at regular fi xed times, the body can re-establish metabolic unity and harmony and prevent weight gain and metabolic disruption as seen in clinical and pre-clinical studies 10,11

Time-restricted eating can be easily paired with caloric timing—eating more calories earlier in the day and fewer in the evening. Clinical studies have shown that the body is more receptive to food in the morning when insulin sensitivity is high. During a morning meal, glucose enters cells readily and insulin levels

rise only minimally, which reduces weight gain, lowers the risk of diabetes, and contributes to metabolic synchrony.9

If a woman in menopause eats a large, healthy breakfast, a moderate lunch, and a very light, early dinner, and if she fasts every night for approximately 13 hours, she can avert circadian rhythm dysfunction.

Intermittent fasting refers to 16 to 24h fast. In the common 5:2 intermittent fasting diet, participants fast or eat fewer than 500 calories for two non-consecutive days every week and eat normally on the other fi ve days. Data shows that such fasting is especially helpful for weight loss. Not consuming any calories or eating fewer than 500 calories for two days a week is associated with signifi cant weight loss over time, and for women carrying extra pounds, the benefi ts can be quite substantial.

Weight gain is extraordinarily common in peri- and post-menopausal women. When estrogen levels plummet, the body’s ability to transport glucose into cells declines and the capacity to burn fat for energy decreases. This causes the body to rely on infl ammatory metabolic processes to store excess energy as visceral fat in the abdominal cavity.

Visceral fat gives women the dreaded “apple shape” and is a sign of metabolic dysfunction. Because these abdominal fat deposits are themselves infl ammatory, they also contribute to increasing metabolic in a vicious spiral of ever-increasing infl ammation and weight gain. In addition to damaging health, these fat deposits can damage women’s confi dence and sense of self. Women watch their bodies transform, seemingly without cause, from the sexy, curvy look of their reproductive years to the matronly look of the menopause years.

Intermittent fasting eff ectively addresses this problem of fat accumulation. Unfortunately, such a diet plan is extremely challenging, and few women can maintain such a rigid fasting regimen over months and years.

Periodic or prolonged fasting, a fast that lasts three to seven days, done about three times per year, off ers comparable weight loss benefi ts to intermittent fasting without the demanding every-week schedule.

Most people can’t, and really shouldn’t, undergo a multi-day water fast, but fortunately, there is a variation of periodic/prolonged fasting that is safe and eff ective for most people—the fasting mimicking diet. Certain foods, sometimes called stealth foods, can provide nutrition without triggering the body’s nutrient sensors. If a person eats small amounts of these stealth foods for several days, her body will think that she is fasting. She will get all of the amazing benefi ts of periodic fasting, but she won’t experience the physical stress and discomfort of actually fasting. Additionally, she won’t lose muscle mass, which is a risk of a true water fast and is very detrimental for menopausal women.

The fasting mimicking diet is a fi ve-day researched diet plan that mimics a four-day water fast. It was developed at the University of Southern California’s Longevity Institute under the directorship of Professor Valter Longo. I collaborated with Professor Longo at the time the diet was being formulated, and currently, I am on the speaker’s

bureau for the company it spawned.

The fasting mimicking diet is an innovative concept for menopausal women because data supports that periodic/prolonged fasting is a benefi cial form of fasting for long term health and vitality. Certain cellular functions can only be activated by a longer fast. Pre-clinical studies have confi rmed that healthy cells undergo a process called autophagy, a powerful form of cellular rejuvenation. These cells breakdown their internal components, called organelles, and reconfi gure them into new organelles, thereby rejuvenating the organs they comprise.6

Studies show that when people follow the fasting mimicking diet once a month for three months, they lose body weight, trunk, and total body fat; lowered systolic BP; and reduced IGF-1. 8

Every woman must transition through and into menopause, a state that may encompass a full half of her lifespan. Menopause, marked by permanent estrogen defi ciency, is complex and the impacts on a woman are chronic and body-wide. Treatments must likewise be multifaceted and aimed at the root causes of a woman’s symptoms. Pharmaceuticals may have their place, but they don’t address underlying metabolic dysfunction. Bioidentical hormones are benefi cial when given properly, but we cannot create the fl uctuating hormonal rhythms and levels seen in naturally menstruating women. Lifestyle—sleep, diet, exercise, and mindfulness—is a critical component of any health plan. It’s time for fasting to take its place as an additional powerful therapeutic for menopausal wellness.

In my practice, combining time-restricted eating with the fasting mimicking diet has helped my many menopausal patients maintain their health and vibrancy. When women can control their menopausal symptoms, lose weight, in addition to physical wellness, they gain optimism.

Helping women lead optimally healthy lives after the onset of menopause requires accessing all the therapeutic tools we have. Happily, fasting can be incorporated into that toolbox to support a healthy longevity for the vast majority of our menopausal patients.

REFERENCES

1. Bernhardt et al. 2019. The Lancet; 4 (11) PE539-E540. 2. Ossewaarde et al. 2005. Epidemiology; 16. 556-62. 3. Choi et al. 2017. J Microbiol Biotechnol; 27(12): 2228-2236. 4. Naftolin et al. 2019. F1000Research; 8, 1576. 5. Hatcher et al. 2020. Eur J Neurosci; 51(1):217-228. 6. Alirezaei et al. 2011. Europ J of Neuroscience; 33(2): 197-204. 7. Bianchi et al. 2015. Impact Journals; Oncotarget; 6(14): 11806-11819. 8. Wei, et al. 2017. Sci Transl Med. 9(377). 9. Hamid R Farshchi, et al. 2005. The American Journal of Clinical Nutrition,

Volume 81, Issue 2, February 2005, Pages 388–396 10. Corey, et al. Nutrients 2019, 11, 2442; doi:10.3390/nu11102442 11. Natali, et al 2017 Volume 77, pp. 199-215

AUTHOR BIOGRAPHY:

Felice Gersh, M.D. holds dual board certi cations in OB-GYN and Integrative Medicine. She is the founder and director of the Integrative Medical Group of Irvine. Follow her on Instagram Dr Gersh is an L-Nutra advisor. @dr.felicegersh.

Contact info:

fgersh@integrativemgi.com (949) 753-7475

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