‘Physical activity is crucially important for improving overall health and fitness levels, but there is limited evidence to suggest that it can blunt the surge in obesity,’ public health scientists Richard S. Cooper, MD and Amy Luke of the Stritch School of Medicine at Loyola University, Chicago, wrote in the International Journal of Epidemiology.
‘…This crucial part of the public health message is not appreciated in recommendations to be more active, walk up stairs and eat more fruits and vegetables. The prescription needs to be precise: there is only one effective way to lose weight – eat fewer calories.’
Fewer than ever. For, once we women hit our fifties, we only need around 65 per cent of the calories we needed in our twenties. This is because every year over the age of 40 our Basal Metabolic Rate (BMR) – the rate at which we burn off calories – slows down. Meaning, if we ingest 1000 calories before the menopause we will burn about 700 of them and store around 300. Post-menopause we may store 700 while, gulp, burning only around 300.
But is it all bad? It is not. Whether it is the HRT or my body settling into menopause or a combination of both (or neither), two years on I do not have the appetite of a pre-menstrual teenager any more. A modicum of control has definitely been regained since those ravenous peri-menopausal years, now that I know exercise on its own is not going to make me thinner. Meanwhile, I find myself liking it, loving it, actually, for very different reasons. How come I never realised it was such an effective way to get me away from all the traffic in my head? Is this what they call mindfulness? Because if it is, then, finally, after ploughing mindlessly through all those mindfulness manuals… I get it. Another thing to take on board: exercise increases muscle mass and muscle takes more calories to burn than fat. But you knew that.
It is true I cannot fit into the clothes I fitted into at my thinnest pre-menopause and I feel a little weird these days in skinny jeans if my bottom isn’t covered. But then maybe skinny jeans aren’t appropriate for a woman who is four years shy of 60 anyway?
Believe me, the menopause is a great time to re-evaluate your wardrobe, to throw out those things you’ve let languish there in the vain hope that once you lose that pesky spare tyre you’ll be able to wear them again. Time to re-evaluate the 10-day juice fasts and the spenny detox retreats as well. If you have been to one you will know the uniquely joyless experience of drinking your 200th cup of herbal tea in some fancy-schmancy hotel room while staring miserably out at some Toblerone landscape, willing the week to be over. All for what? Maybe two kilos? Which we will put on, and then some, within a fortnight? And sisters, the time wasted on self. At this stage of our lives, when we haven’t really got that much left to make the world a better place than when we entered it, I mean, it seems almost unholy.
Not that you need to give up on yourself. Not at all. Those ladies in that poem ‘When I Am an Old Woman I Shall Wear Purple’ who ‘grow more fat… and eat three pounds of sausages at a go’ – they are not us. (Which reminds me. I must stop wearing my prescription sunglasses in the cinema. There is a difference between eccentric and mad. As P. J. O’Rourke once said: ‘Never wear anything that panics the cat.’)
There is a difference, too, between taking pleasure from eating, full stop, and taking pleasure from eating because it feels like there is nothing else to take pleasure from any more. If, like me, you’ve always been a Labrador on the food front as opposed to a cat, if it is your natural inclination, if no one is looking, to plate-lick, then, to be brutal, it is probably time to get a grip. Overeating, especially on the baked goods front, isn’t just bad for us physically, it may also make us sad. According to a study by the Department of Psychiatry at Columbia University, a diet high in refined carbohydrates with very high glycaemic indices (e.g. white rice, white bread, processed cereals and soft drinks) might lead to a greater risk for new-onset depression in post-menopausal women.* Other studies show that obesity in the menopause may be linked to heart disease and breast cancer. Being fat isn’t good at any stage of life for anyone. But it is particularly injurious for us women in menopause.
I am sad, however, when I think of how much time I have spent as an adult in ‘if only’ mode, wanting to mould myself to clothes as opposed to the other way round, fantasising about and sometimes even splurging on clothes that will never suit my particular body shape whatever size I am. Only very recently have I come to understand that, if you pay that much money for something, it has to work for you rather than you for it.
What we must obsess about now, if that is the word, what we must take time (and money) over, is making life less, not more, complicated on the clothes front, creating a kind of uniform for ourselves, a mixture of things we have come to know via trial and error will always work for us on fat, thin, bad- and good-hair days, no matter what. It’s a lovely feeling, being sartorially true to oneself. I now know, for example, what I can never have enough of – silk cashmere cardigans, cotton gauze check shirts, midi-length A-line skirts with pockets; and what there is no point in even trying on – day shoes with heels any higher than 2in. I now know, too, there is no point in buying the item that will work brilliantly when it’s got different buttons / is a smidgeon looser / is dyed a different colour. Unless you’ve got a live-in seamstress, or are a clothes manufacturer, conditional purchases never work.
Am I there yet myself? In this serene, self-accepting super-sorted-out space? Do I practise what I preach? Not quite. It is probably time for me to get a grown-up haircut, for example. But I cannot quite make the leap yet. The jeans I can no longer fit into, I know I need to make a ceremonial funeral pyre for them (or better, give them away), but have not yet got round to that either. I am, though, looking forward – kind of – to being in my sixth decade, to getting out of my neither-here-nor-there fifties, to comporting myself as an older, elegant and not completely asexual lady. I have a few role models, too. Carine Roitfeld, 61, the former editor-in-chief of French Vogue. Jane Fonda, obviously. Diane Keaton – now there’s someone who has perfected her look over the years. Then there is my super-trim, super-stylish friend Charlotte, 68, mother of four, author, hotel proprietor and general all-round blueprint for the sexy, cool, older English lady. She exemplifies for me that Japanese concept of Shibui. I learnt about the term from that same wonderful story by Helen Simpson, in which two menopausal women discuss whether there is beauty in ageing. Liz likens it to flowers past their prime. ‘I leave anemones in their vase for as long as I can, tulips too, for those wild swoops they do on their way out, the way their stems curve and lunge and shed soot-dusted petals. In fact I like them best at that stage.’ Me too. But I think Shibui can mean all sorts of things.
My understanding of Shibui is innate, old-school cool that has been honed and polished to subtle perfection over the years. The opposite of flash or ‘common’, as my grandmother would have called it. Because Charlotte looks so swell (in the American sense of the word), it is comforting to hear her describe her journey through the menopause in the mid-90s while living as a single mother in a remote part of Spain, as ‘at least seven years of pretty good emotional hell…
‘Because I had no friends or magazines or a mother or a sister out there, I just didn’t know what the hell was going on and just bashed on alone, waking up in soaking sheets and feeling all wrong. My doctor gave me antidepressants and Valium which helped a little. I’m pretty sure I overate, overdrank and smoked those few years to offset the depression, which, thinking back, I’m sure had something to do with not being fertile or feeling fanciable any more.
‘But I did recover. My energy returned, so did my good spirits and it was wonderful not having monthly troubles any more. Of course now I am nearly 70 what I worry about is losing my mind not my looks.’
* American Journal of Clinical Nutrition, Aug 2015.
4
SILICON VALLEY NUNS AND HOT FLASHES
Haight Ashbury, San Francisco’s former hippy enclave with its tatty head shops and psychedelic signage and strip joints, seems an unli
kely place for a cloistered convent. Yet here I am, sitting in one, waiting to meet some of its inhabitants. I am accompanying Doctor Sohila Zadran, a biotech entrepreneur whom I first heard about via my hot-yoga buddy, Ingrid.
Ingrid, who, in real life manages other people’s multi-million-dollar portfolio funds, had heard Zadran speak at the prestigious Milken Conference in LA about her start-up, IgantiaTherapeutics, her pioneering research into the menopause and hot flashes (as they call them in the States) and had a hunch we’d get on. Here we are then, the pair of us, me a slightly jet-lagged 55-year-old, she a beautiful 29-year-old neuroscientist, about to meet a bunch of menopausal nuns.
A janitor leads us through the Lysol-scented vestibule with its bank of gloopy religious paintings (all done by the nuns themselves, apparently) into the waiting room. The Sisters of Perpetual Adoration is a hardcore contemplative order, founded by nuns fleeing the Mexican Revolution in 1928. There used to be 50 of them, now there are only 11. Because they are cloistered – meaning they never leave the premises except, say, when they have to go to hospital, or buy new shoes or the Pope is in town – there is a dividing metal grille in the waiting room which makes it feel a little like we are in prison.
After about 15 minutes, a door on the other side of it clicks and in file four slightly giggly, slightly curious nuns, all of them in black veils and starched white habits, and, despite the hot weather, hands tucked into their bright-red tabards as if to keep warm. There is Sister Maria (46), Sister Betty (51), Sister Carmen (54) and Mother Superior Rosa (58). Three of them are still having hot flushes – including the Mother Superior, even though she has recently undergone a hysterectomy. Sister Maria, the relative new girl, having arrived only a quarter of a century ago, is just starting her transition and therefore has not had any yet.
‘But she will,’ giggles Sister Betty, adding, ‘and we will hear about it because we know every movement of each other!’ – which causes more slightly hysterical giggling. While Mother Superior Rosa is of course the one in charge, Sister Betty is obviously The Popular Girl, a bit of a class clown, if you will. It is hard not to warm to her immediately.
A kind of hybrid Selena Gomez and the actress Anna Faris, with the gait and build of a runway model, Zadran is not quite what I’d expected, but then we are in California. She told me, as we waited, how it took some finagling, getting these visits to happen. Endless letters to the Mother Superior, endless meetings with the Chaplain, plus a crash course in the Bible. ‘I figured, as a Muslim trained in the principle of Darwinian evolution, I had one chance, which was to out-Bible them.’
But it wasn’t the Bible, in the end, that got them to talk. ‘Once I got the Mother Superior to start talking about her hysterectomy, they all started talking,’ Zadran explained. ‘It was like we were bonding over this thing women had been enduring silently. That kind of transcended everything.’
Disappointingly, nobody is ever allowed behind the metal grille, but the sisters are happy to share the details of their day. It starts at 5.15am and, apart from eating and household tasks, revolves almost entirely around prayer, meditation and the ‘adoration’ of Mary Magdalene. (‘Able-bodied’ nuns often have to pray all night to ‘keep the Lord company’ while the others sleep.) Exercise is limited to volleyball (which they play in special aprons) and short goes on the running machine (which, yes, they do in their habits). A little TV is permitted as long as it is religion- or news-based. They are far from fit. Indeed, as Zadran told me beforehand, they all have BMIs in the clinically obese range. But despite the typically Mexican, hardly Blue Zone diet of tortillas, bread, cereal, animal protein, trans fats and coffee – though no alcohol – they live to a ripe old age. The last nun to die here, for example, was 101 and, going by birth and death records, she was no exception to the rule.
What is this down to – ‘The Hispanic Paradox’ (the fact that Latinos living in the US have a higher average life expectancy than whites or Afro-Americans)? Consistency? Having a religious belief? (That’s one of those famous Blue Zone tips, anyway, along with drinking red wine and eating only till you are 80 per cent full.)
Zadran, who teaches a course in ageing at Stanford, thinks it may be something else, too. Maybe longevity is ‘catching’. Female longevity in particular. Maybe the presence of menopausal women in a community or family actually extends the life of the women around her. A ‘halo’ effect, if you will. (Does this mean we are shortening our lives by not insisting on having our widowed mothers and mothers-in-law live with us? Gulp.)
Another thing. Supposing hot flushes themselves have a trigger effect, so that when menopausal women are in close proximity, secluded from other members of the population, they can sync rather in the way female menstrual cycles can sync at boarding schools? (A throwback from when we were on all fours and came on heat, perhaps?)
Whenever Zadran visits, she has an infra-red thermal imaging camera slung around her neck, just in case anyone has a hot flush. Has anyone had any today, she asks? Yes, pipes up Sister Betty, she had one at Vespers today, and it started, as it always does, in the back of her neck, the intense heat then going on to suffuse the rest of her upper body.
Bolstering Zadran’s ‘triggering’ theory, hot flushes have so far proved to be more frequent when the sisters are together in chapel. This is especially problematic because it is hard to fan oneself when devoutly praying. One nun, not present, told Zadran it got so bad she had to leave chapel, remove her habit and then afterwards pray for forgiveness. Thankfully, Sister Betty hasn’t had to do that yet. ‘I offer it up to the Lord,’ she says with a cheerful shrug, ‘I pray, I sweat, I carry on.’
What might be worse for her is nighttime in her ‘cell’ (as their individual sleeping quarters are called). The others titter as she mimics the action of throwing her blanket off, putting it back on again, throwing it off and so forth. Emboldened, she spills a little more. There are the mood swings. The irritability. And then there’s the hunger. Sister Betty is always hungry, especially for candy. Marshmallows, apparently, are her absolute favourite. ‘But why do you think God gave us hot flashes?’ persists Zadran softly. ‘Do you think the heat means anything? Do you think God is sending us messages…?’
‘Oh, he’s sending us messages,’ asserts the Mother Superior, ‘although we may not know what they are…’
‘And you know the way I think of it?’ says Sister Betty, her face suddenly suffused with a rosy glow. ‘I think of it as getting closer to God, of getting closer to eternity! Some people say, “You wanna come back and be born again?” I say, “Oh, no! I want to go to heaven, to see Jesus and the angels of the Virgin Mary! We are all going to be in such awe!”’
While we are talking it becomes evident that the reason they have their hands folded under their tabards on this hottest of days is actually to aerate themselves, flapping the bib part back and forth like a fan, Sister Betty doing it more vigorously than the others. Perhaps, Zadran wonders hopefully, infra-red camera poised, she’s getting a hot flush now?
For Zadran, it is all about the hot flush and has been ever since her own mother went through the menopause. ‘I remember vividly her switching on the ceiling fan in the middle of winter and her going, “Sohila, you have enough science to choke a horse, you have to figure this out,”’ she says. ‘Now my mother is one of the fiercest, strongest women I know, and that was when something clicked. How come nobody had studied the mechanism of action of a hot flash? Could it be employed as a diagnostic? Could understanding it help us live longer? I had to find out, and it became a kind of calling.’
The pair of us are now heading towards her house in Brentwood, a brand new five-bedroom in the Mediterranean style, which she bought for herself after selling her second company and lives in all alone. But then, apparently, the dating scene out here is appalling for women.
The daughter of Afghan refugees, Zadran wanted to be a ballet dancer when she was a little girl but ended up studying quantum theory at Berkeley, and earning a doctorate in
neuroscience from USC. Igantia Therapeutics is the third bio-tech company she has founded (she founded the first when she was just 23) and it has two aims. The first is to build the very first global and digital initiative to analyse and monitor ageing in women, specifically focusing on hot flashes and menstrual cycles. She anticipates recruiting over 200,000 women across the world to track their hot flashes or their menstrual cycles and is already well under way with a user-friendly Igantia app and a hashtag: #iamfury (‘igantia’ is the Latin for ‘fury’ in case you didn’t know).
The second is to develop a series of non-prescription therapeutics for menopausal symptoms such as hot flushes, which you can buy right off the pharmacy shelf. Indeed, she and her team have just developed a peptides-based non-hormonal non-herbal nose spray to stave off hot flushes for up to 18 hours. ‘Think of it as Midol for menopause’ says Zadran, ‘though it’s tricky because intensity is super-subjective. You can’t exactly rank a hot flush by numbers of drips…’
Still. Something that whacks them on the head from daytime to cocktail, with no nasties attached – can the FDA please hurry up and approve it? And should I be getting her autograph in the interim?
Like many a Bay Area techie with a vision, she hasn’t had time to buy much furniture or stock her fridge. There’s a very grand traditional dining room, which her parents gave her and has never been used, and a TV. Our voices echo against the polished wood floors. While she prepares supper for us – grilled salmon, kale chips and pomegranate juice – ‘I’m afraid I’ve always led a pretty pious exemplary life’ – we chat about Silicon Valley’s obsession with immortality.
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