Should Everyone Fast During Peri-Menopause?

You should read her book before you start shaming her
 

After I ranted (again this week gosh I’m a real terror) about a person giving out woeful peri-menopause nutrition advice on a big-named podcast recently, there were quite a few defensive voices in my inbox on social media. 
 
Before I begin (again), my rants are about the information being put out and not an indication of the individual person. Also, people are allowed to have a difference of opinion and be respectful. The problem being when it’s not a difference of opinion, it’s scientifically incorrect and often, harmful as a result.
 
 
This voice, who has a book to sell, advocates fasting for all peri-menopausal women (amongst other things).
 
Someone said to me she’d bought this person’s book and had tried the protocol for a month now and felt ‘more stressed and completely exhausted so maybe needed a break before trying again’. The answer is not a break and trying again. The answer is not doing it ever again. Peri-menopause can be challenging enough for some people, without adding physical hunger, food preoccupation and micromanaging your nutrition to the mix. 
 
 
A moment on shame
 
Shame isn’t an antidote to change and if you’ve worked with ETPHD or listened to a single episode of the podcast you’ll know we actively work to support you to overcome shame. Even in this case where someone is making a ton of money from awful nutrition advice, I’m not shaming her. That’s not what I do.
 
I do encourage you to be critical of what you read and hear and maybe stop listening to nutrition advice that comes from podcasts that have nothing to do with nutrition and everything to do with reach.
 
 
“Fasting is imperative in menopause”
 
Ignore anyone who makes blanket black and white statements about nutrition and what ‘all people should do.’
 
Let me take off my obvious disordered eating lens for a second because if you are experiencing disordered eating then fasting is always a mistake. A problem here too is that many people aren’t aware they’re experiencing disordered eating habits – emotional eating, overeating, binge eating, over-restriction, food preoccupation, guilt around food – there are all signs that you are.
 
Regardless, the claim that all women should fast in menopause is completely unsubstantiated. Here are some of the claims she’s made. 
 
 
“Autophagy is thought to kick in at 16-18 hours of fasting.” 
 
Are you a rat? (my ex’s don’t read my emails so the answer to this question here is most likely a no). When it comes to actual human people, the effect of fasting on autophagy is to the same as calorie restriction. Autophagy FYI is a term used to describe cell turnover and people love to link it to living until you’re 249 years old and thriving until you arrive in your grave. As of right now, there’s no evidence (unless you are said rat) for this. 
 
 
“Fasting stabilizes blood sugar”
 
Amazingly, your body regulates blood sugar itself (I know this is a v unpopular opinion right now). Unless you’re experiencing insulin resistance, in which case there are myriad other things that do support you – like movement (much harder to do when fasted) and actually, eating more of your calories earlier in the day because of reduced insulin sensitivity (usually the opposite of a fasting protocol that encourages eating more later in the day). 
 
 
“We see weight loss and improved metabolic function with fasting”
 
Fasting does not lead to any greater increases in weight loss / fat loss compared to a calorie deficit and ‘metabolic function’ is a very vague statement – without reference to specifics here I’m left assuming she’s trying to over-complicate it in the hopes of impressing. 
 
 
“Fasting enhances hormones”
 
There is no evidence that links fasting to physiologically relevant changes in hormones during peri-menopause and more so, that these changes in hormones are linked to changes in actual symptoms of peri-menopause. Even in pre-menopausal women, fasting doesn’t seem to impact oestrogen (despite what this same author suggests when she refers to ‘balancing hormones’ throughout the menstrual cycle).
 
 
“Fasting enhances fat burning”
 
The cool thing about our bodies is that we burn the fuel source that’s available to us. I just ate a crumpet, right now I’m using carbohydrates to fuel my rage, not fat. If I’d eaten a spoon of peanut butter, I’d be using fat as fuel. If I hadn’t eaten breakfast, I’d be using some of my stored fat. We ‘burn’ what’s available. But using more fat for fuel has no impact on our health markers or peri-menopause. If that were the case there’d be research supporting high fat diets during this time. There isn’t.
 
As a side note, many people anecdotally say that going keto supports their cognition which can be impacted during peri-menopause. The evidence doesn’t support this for most people above and beyond calorie restriction in those who have obesity (maybe some worth in symptoms in epilepsy and with neurological disease but this is again disputed).  
 
Fat burning does not = fat loss though. You can burn all the fat or all the carbohydrates for fuel that you want. If your energy balance is the same, there’s no difference in body composition or fat loss. This has been shown 1000x over. ‘Fat burning’ is pretty much irrelevant to most people. This also includes the ‘fat burning zone’ when it comes to exercise too (in relation to body composition at least). 
 
 
“Fasting causes growth hormone spikes”
 
Yes, we see a reduction in available growth hormone during peri-menopause and aging in general, but again, the evidence isn’t there that fasting creates a physiologically relevant change in GH or IGF-1 levels more so than calorie restriction (in overweight or obesity) and exercise.  
 
 
This person advocates a ‘manifestation phase’ of fasting
 
As much as I love the occasional rose quartz rub and a smudging of sage every morning before yoga, I do these because of the intention they help me set and act in alignment with, not because they are magic and immediately create love and burn away and neggy vibes (especially right now on my luteal phase there is no amount of sage that will handle this irritability). 
 
During this phase she recommends we “breakdown hormones with a healthy diet”. You can’t ‘breakdown hormones’ with food. It’s physiologically impossible.
 
Think positively, act with intention in line with your values, these will support your action and your health, but upsettingly, you can’t ‘manifest’ anything when it comes to your body. 
 
 
But she’s a doctor
 
The person I’m referring to is a chiropractor (they support muscle, bone and joint pain) and much like I am a doctor of exercise physiology, you trust my advice on fashion or physics at your own discretion. A non-medical doctor of one thing usually means you know a hell of a lot about one small thing. Shockingly, not everything else.
 
 
It’s very convincing, her work. She picks random pieces of research (with no reference to limitations of the work), whilst using herself as anecdotal evidence, and speaks incredibly passionately. She’s also talking to people who may find themselves going through a challenging period of their lives. When this is true for us, we’re more likely to seek support outside of traditional pathways because we really want something to work for us. With my knowledge and critical eye, I can still 100% see why people are buying into this. 
 
It's so hard to navigate. 
 
 
I could take longer to go into every claim but I am running out of time to do my yoga before my first call of the day and like I said it’s my luteal phase and I must do everything I can to avoid turning into a troll.
 
 
Stay critical and compassionate. 
 
I’m always here,
 
Em