TODAY’S DOSE OF HONESTY

How to deal with midlife
BELLY FAT. (And the hormone you need to know about.)

Here’s my dose of honesty about belly fat: Every single woman will have to deal with it around menopause and afterward. And before you sigh and roll your eyes at the same time, let me skip to the silver lining: Knowing it’s REAL, and knowing the reasons behind it and what can work to address it, means we can beat belly bulge…even if it’s not easy to do so! 

First, the science: As estrogen and testosterone levels start to drop (and drop dramatically) around menopause, many factors combine to create a FUPA—a “cute,” street-slang-like acronym for (not cute) Fat Upper Pelvic Area. Menopause increases body weight and fat mass, specifically in visceral areas aka belly fat, while decreasing lean muscle mass. This shift in fat accumulation to the midsection (which accounts for 15-20% of total fat stores) expands waist circumference and reduces the amount of muscle in the body. So many women have told me, “I haven’t changed how I’m eating or exercising, so why is this happening?” Guess what? I believe them—because there’s science behind it, and I have experienced it myself. And it stinks. But it’s not insurmountable, and the solution is definitely NOT to eat less. (Good news!) 

The answer, in part, involves an exciting compound called irisin. It’s a hormone-like protein released by muscles during exercise. It was only discovered in 2012—that’s recent in medicine—and is often called the “exercise hormone” because it helps convert white fat (energy-storing fat) into brown fat (energy-burning fat), which helps regulate body weight and metabolism.

Irisin plays several important roles in the body:

• Fat metabolism: Promotes the browning of white fat cells, increasing energy expenditure.

• Brain health: Supports neurogenesis (the growth of new neurons) and may protect against neurodegenerative diseases like Alzheimer’s.

• Bone health: Stimulates bone formation.

• Insulin sensitivity: Helps improve glucose metabolism, reducing the risk of diabetes.

• Anti-inflammatory effects: May help reduce inflammation in the body.

It makes sense, then—especially if you are in the menopause transition—to increase your body’s levels of irisin. Here are some proven ways to boost its production.

1. Regular exercise. The hormone is primarily released during physical activity, particularly exercises that challenge your muscles. These include:

• Aerobic exercise: Activities like running, swimming, cycling, or brisk walking can increase irisin levels.

• Strength training: Muscle is the primary source of irisin production. Activities that preserve or build muscle mass, such as resistance training or bodyweight exercises, are essential.

• High-intensity interval training (HIIT): Short bursts of intense activity followed by rest or low-intensity periods are particularly effective at boosting irisin. By intense, I mean that this should be difficult and strenuous.

2. Exposure to cold. Cold exposure activates brown fat, which is linked to irisin. Regular exposure to cold environments (for example, cold showers, ice baths, or spending time outdoors in cold weather) can increase its production. Some published data suggests that even a short walk in cold temperatures without a coat can activate brown fat.

3. Healthy diet. While irisin is primarily exercise-induced, a diet rich in whole foods can support overall metabolic health and enhance the effects of exercise on irisin production.

4. Avoiding sedentary behavior. Prolonged inactivity can lower irisin levels. Incorporating movement throughout the day, like walking, stretching, or light activity, helps maintain muscle activity and irisin production.

There’s growing interest in the therapeutic potential of irisin for metabolic and neurological conditions. However, supplements or treatments for increasing irisin aren’t yet available. And in the U.S., a standard test for measuring irisin levels in the body is not commonly accessible to doctors in clinical settings. Irisin is still primarily a subject of research, and while tests do exist for its measurement, they are mainly used in laboratory and experimental settings rather than in routine healthcare. So, the best way to enhance it is through an active lifestyle with consistent exercise.

The rest of my prescription for dealing with midlife and postmenopausal belly fat involves equal attention to the big 3 factors: food, cardio, and resistance training. Eating a diet high in protein and fiber and low in added sugar is critical, as is doing all kinds of cardio (both high and low intensity) and core strength-building exercises. Getting enough consistent sleep (7-9 hours a night) and taking hormone replacement therapy have also been associated with lower visceral fat. 

Bottom line: We can triumph to some degree over the FUPA, with both science and realistic expectations!

SYMPTOM SOLUTIONS

The best ways to “winterize” your skin.

Unless you live in the tropics, this season can pose some challenges for your skin. And, generally, the older your skin is, the more it will feel winter’s effects.

As the temperature drops, there’s less humidity in the air, making skin more susceptible to dryness, inflammation, and irritation. Chapped lips, dry cheeks, cracked hands, and flaking and skin tightness become common complaints as the cold air combines with dry indoor heating to sap moisture from the skin. For older adults, who may experience reductions of natural oils and decreased cell renewal in their skin, winter’s chill can be even tougher.

These seasonal skin issues are common, but they’re not inevitable. When cold air blows in, we simply need to adjust our skincare routines a bit to accommodate the drier conditions. Here is some good “skin winterizing” advice I’ve gathered from my dermatologist colleagues.

Keep up with the sunscreen. While you might be tempted to put these applications on hold during winter, don’t. The sun’s UV rays are still hard at work, even when it’s cloudy. Choose a broad-spectrum sunscreen with an SPF of 30 or higher, and don’t forget ears, neck, and hands, if they’re exposed.

Ease up on cleansing and exfoliation. Doing this too often can dry out skin, especially during winter. Washing your face once a day (before bed and with a product formulated for dry, sensitive skin) should be sufficient, with a cool water rinse the next morning. Exfoliate once a week, or even once a month if your skin is really dry. Use more care with retinol and alpha hydroxy acid (AHA) applications as well; they can irritate dry skin.

Use a good moisturizer. You’ll want one with more emollient, which will create a thicker moisture barrier to keep your skin hydrated. Look for products with hyaluronic acid, glycerin, ceramides, and fatty acids. If your skin is really sensitive, steer clear of alcohols and fragrances, which may cause irritation.

Protect your lips. When choosing a lip balm for winter, prioritize one with ingredients such as beeswax or shea butter, which form a moisture-locking barrier to help prevent your lips from dryness and cracking.

Keep hot showers short. Luxurious as they are, long, hot showers can dry out your skin. Opt for lukewarm showers and baths if possible and limit your time to 5-10 minutes. Use care when drying off—pat rather than rub vigorously—then apply a thick moisturizer or slather on coconut or olive oil (I keep both in my bathroom). Similarly, run cool or lukewarm water for handwashing and follow with hand cream.

Dress for your skin’s sake. Outfitting yourself warmly helps shield your skin from winter harshness. Layer with breathable fabrics (think cotton and silk) next to your skin before donning wool and heavier items. Gloves are especially beneficial, whether you’re braving the cold outdoors or tackling tasks that involve getting your hands wet, such as washing dishes or cleaning. Finally, ’tis the season for soft, comfy hats: Besides keeping your head warm, they protect your hair and scalp from cold weather-induced dryness that may trigger seasonal hair loss.

Stay hydrated. Yet another reason to drink enough water: It may help your skin retain moisture on its own. Shoot for 2.5 liters daily.

Keep your thermostat at “cool & comfortable.” Heat compounds the effects of dry indoor air, so set the temperature to somewhere between the mid-to-high 60s and low 70s.

Run a humidifier in your home. Prioritize the bedroom, since skin regenerates more rapidly while the body sleeps; your complexion will benefit from that extra shot of hydration. Aim to keep indoor humidity levels between 30-50%. If you’re unsure of your home’s humidity, you can purchase a digital humidity meter; there are many nicely priced options on Amazon.

If you continue to experience dryness, discomfort, and redness despite trying these interventions, it’s time to consult a dermatologist. You might require a prescription-strength moisturizer to combat winter’s harsh effects on your skin, or your dry skin could indicate an underlying condition that needs professional attention.

❄️ ❄️ ❄️

COMMUNITY

“Can I contract bird flu from drinking milk?”

Obviously, the news about bird flu being found in the U.S. milk supply was disquieting for many people. To provide you with the most up-to-date information on this development, I asked our Core Expert, infectious disease specialist Dr. Simone Wildes, to answer a few questions.

Give us the mini-med school on bird flu. What causes it, and how does it affect organisms?

Bird flu, or avian flu, is a viral infection caused by avian influenza Type A virus that primarily affects wild birds and can infect domestic poultry and other animal species such as cattle. While instances are rare, the virus can infect humans as well. Here are a few facts:

• Avian influenza viruses are classified as high pathogenicity avian influenza (HPAI) or low pathogenicity avian influenza (LPAI) in birds. Both HPAI and LPAI can cause a variety of human diseases that result in mild to severe illness. The H5N1 and H7N9 subtypes have been associated with the most significant public health impact.

• The incubation period for the bird flu virus is usually 3 to 5 days but can take up to 10 days.

• The virus can affect infected individuals differently, with experiences ranging from no symptoms to severe illness with multi-organ failure and occasionally death.

• The most common signs and symptoms include fever, cough, breathing problems, muscle or body aches, headaches, and fatigue. Those who are severely ill may develop pneumonia, acute kidney injury, and confusion along with other complications that will require hospitalization.

How does the bird flu virus spread?

Bird flu can spread as a direct infection from exposure to saliva, mucus, or feces from infected birds, or from contact with surfaces contaminated with the virus by infected birds. People working closely with infected birds or with prolonged unprotected contact are at the highest risk of contracting bird flu.

How many cases have been found in humans? Should we worry about a widespread epidemic?

In the U.S., there have been 60 confirmed human cases to date, most of which have occurred in California. Globally, there have been just 904 cases of human infection with bird flu from January 2003 to September 2024, according to the World Health Organization (WHO). At this time, the public health risk is low, and there is little concern about a widespread pandemic. However, the U.S. Centers for Disease Control and Prevention (CDC), the U.S. Department of Agriculture (USDA), the U.S. Food and Drug Administration (FDA) as well as state public health departments and animal health officials are monitoring the situation closely.

What is the connection between bird flu and the U.S. milk supply? What’s being done? Should we not drink it?

While fragments of bird flu have been found in samples of the U.S. milk supply, according to FDA reports, milk is still considered safe as there was no live, viable virus in these samples. The USDA has initiated H5N1 testing of the nation’s milk supply and dairy herds, which should go a long way toward controlling the spread of the virus nationwide and giving consumers more confidence in the safety of the milk supply.

Any other ways to stay safe from this virus?

The most effective way to prevent bird flu is to avoid exposure whenever possible. That means staying away from dead or sick birds, poultry, or other animals. Here are a few more tips:

• Make sure your milk is pasteurized, which will kill any harmful pathogens and ensure it’s safe to consume. Don’t consume raw milk or milk products, especially from animals with confirmed or suspected bird flu.

• Cook eggs thoroughly to help eliminate any chance of infection.

• Wear personal protective equipment if you must have direct contact with dead or sick birds.

• Avoid touching surfaces or materials contaminated by wild or domestic birds that have confirmed or suspected bird flu.

• Maintain good hygiene and follow safe food handling measures.

• Contact your healthcare provider immediately if you become sick due to close contact with a potentially infected bird.

OUR CORE EXPERT

Simone Wildes M.D., F.A.C.P., F.I.D.S.A., is associate director of infectious disease at South Shore Health, and a clinical assistant professor of medicine at Tufts University School of Medicine, where she also served on the school’s Anti-Racism Committee. Dr. Wildes is actively involved with the Massachusetts Medical Society as an executive board member; she also served on the Massachusetts Department of Public Health Equity Advisory Group and Massachusetts COVID-19 Vaccine Advisory Group.

ABOUT DR. JEN

In her former roles as chief medical correspondent for ABC News and on-air cohost of “GMA3: What You Need to Know,” Dr. Jennifer Ashton—”Dr. Jen”—has shared the latest health news and information with millions of viewers nationwide. As an OB-GYN, nutritionist, and board-certified obesity medicine specialist, she is passionate about promoting optimal health for “the whole woman.” She has authored several books, including the national best-seller, The Self-Care Solution: A Year of Becoming Happier, Healthier & Fitter—One Month at a Time. And she has gone through menopause…

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