Menopausal Women and Weight Loss: The Real Science and Solutions with Dr. Paul Arciero

Susan Sly (: 00:00

So, the question I have is why is it so hard for perimenopausal and menopausal women to lose weight? Are we doing the wrong things with the right intentions? Well, my guest today is not only an expert in this area, but he is also one of the most well-cited, researched PhDs on the subject of nutrition. So, my guest today is Dr. Paul Arciero. He is the author of Amazon's number one bestseller, The PRISE Life book, which is based on his peer-reviewed scientific research. His earliest research was done on perimenopausal and menopausal women.

I've known Paul for over 15 years. His research has been featured in Nature Communications, The Obesity Journal, The Journal of Applied Physiology, The American Journal of Preventative Medicine, BBC World News, BBC Reels, WebMD, Fortune, The Today Show, USA Today, The Wall Street Journal, Time, The American Heart Association, and so much more. In this episode, we are going to talk about his research. We’ll discuss things that women in perimenopause, menopause, and even post-menopause can do right now. What he recommends is so accessible—it’s common sense but it’s also proven. And guess what? You can start today! Depending on what you have in your fridge—or by ordering some groceries—you can get started. It’s just ground truth, and that’s what excites me.

So let’s go ahead and get started with this episode of The Menopause Health Podcast with my guest, Dr. Paul Arciero.

Voiceover (: 01:52

The opinions expressed by the guests on this podcast are their own and do not necessarily reflect the views of the show or its hosts. This podcast is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific health needs. Welcome to The Menopause Health Podcast, your go-to resource for practical advice brought to you by credentialed health professionals and industry experts. Here is your host, Susan Sly.

Susan Sly (: 02:35

Well, Paul, welcome to The Menopause Health Podcast. It’s so great to see you! I know we get to see each other all the time, and I’m so excited that I feel like the world gets to have a sneak peek into the conversations we have over coffee or a protein shake.

Paul, so many people look at menopause as something that just affects women. But here you are as a researcher, an entrepreneur, a scientist, and one of the things I always say is menopause affects all of us. Can you think of a menopause story, whether it’s a subject from one of your studies or a family member, where someone has been deeply impacted with their health, whether mentally or physically, due to menopause?

Dr. Paul Arciero (: 03:25

Susan, first of all, thanks for having me. This is such a treat to share with everyone, and with you. Like everyone, I’m sure we all have stories of someone who’s been through menopause or is going through it. I have a couple of stories, but one that really rings loudest is my wife, who is currently experiencing hot flashes—and I mean that literally! Physically, she’s attractive, but she’s also battling hot flashes and has been for several years now. Let me back up a bit. As she was evolving into menopause during perimenopause, I remember she went for a doctor checkup. She came home looking distraught, so I asked, “How did it go?” She said, “I don’t know what to make of this,” and she’s someone who’s always been fit and active.

She was diagnosed with fatty liver disease, and her initial reaction was, “I thought only men or women who are alcoholics got fatty liver disease, or those with severe disease.” That diagnosis really hit us hard. At the time, she’d gained a little bit of weight, which she hadn’t noticed. That’s another challenge for women as they enter menopause. But what makes the story have a happy ending is that after three months of following a commitment to a new lifestyle and protein pacing, she went back for a checkup. She was 54 years old at the time, and her doctor was blown away by her progress—her fatty liver disease had completely reversed without any medical intervention.

Susan Sly(: 07:38

What a beautiful story and what a tough thing to go through. Share with everyone how long you’ve been married.

Dr. Paul Arciero (: 07:45

We just hit 34 years this past May. Yeah, that was a big achievement.

Susan Sly (: 07:55

That’s significant. And thinking about it, you know, here’s your love, your best friend, mother, and now grandmother, but not then, and to see her go through this—that must have been hard. One of the things I’ve heard time and again, Paul, is that we’re going to pay for our health at some point. We can either pay for it proactively, which costs less, or we pay for it reactively, which always costs more. How great it was that it was early enough for you to be somewhat proactive, even though there was a reactive piece.

Susan Sly (: 08:35

You mentioned the hot flashes. We joke on the show. I always say the room has to be at 67 degrees, and that’s my upper limit! I would rather have it at 65 or even lower. When we’re at our Montana house in the winter, I’ll open the windows. I don’t care! When I was a practicing nutritionist in the ‘90s, I had clients going through this, and they would talk about hot flashes. I empathized, but I didn’t fully understand it. Now, I get these heat surges, and it’s unreal.

Dr. Paul Arciero (: 09:10

Yes, I know exactly what you mean. Every day we drive around in the car, and both air conditioners are pointed directly at her. Her windows are open, and I have the heat on just to balance things out!

Susan Sly (: 09:33

Yes! I’ll say to my husband, Chris, “I love you, but no snuggling—it’s too hot!” Last night, I was holding his hand, saying, “I love you, but this is as close as it’s going to get. I’m just really hot right now!”

Dr. Paul Arciero (: 09:55

Yes, it’s real! And it’s not just the person experiencing it. When my mother had forced menopause with a complete hysterectomy back in the mid-to-late 1970s, I remember watching her progression and thinking, “Something needs to improve.”

Susan Sly (: 10:27

Yes, and research shows that the earlier women enter perimenopause, the higher the risk for conditions like cancer and dementia. It’s prolific. This leads me to wonder: If we could improve lifestyle earlier on, could we offset a lot of these symptoms? It’s a hypothesis, and we don’t have the answer yet, but lifestyle plays a big role.

Susan Sly (: 10:50

Let’s talk about your research. When we first met, I was reading your work and was absolutely awestruck. Your research was done on perimenopausal and menopausal women. I remember our first conversation—I asked, “Why did you choose such a tough group?” Many researchers will pick easier groups to get better results, but you went straight to the hardest group. So, why is it so hard for women in late perimenopause and menopause to lose weight? What’s going on in their bodies?

Dr. Paul Arciero (: 12:07

That’s a great question. Everything you just said is spot on. During my graduate training in the mid-1980s to early 1990s, it seemed like every study I read was done on young, healthy men. I thought, “What about everyone else?” This group of women, particularly those in the transitional perimenopausal and menopausal phases, carries so much responsibility—personal, social, and professional—on top of going through a massive lifestyle transition. How could we not do more research on them? It was an easy choice for me.

When I started conducting clinical human trials, I knew this was the group I wanted to work with. These women are in one of the hardest life transitions. It’s been my career path to identify and create, through scientific trials, lifestyle strategies that allow women to live healthier, better, and to thrive.

Susan Sly (: 14:35

And the thing I love is—and we’re going to get to what the women did—but first, I want to talk about outcomes. The word I want everyone to think about is accessible. When I first looked at the outcomes, it was mind-blowing. We’re talking about stubborn fat loss, and we’re going to differentiate between adipose tissue, visceral fat, and so on. But when I looked at the other outcomes—endurance, strength, stamina—I thought, “Oh my goodness.” Sometimes we overlook what’s simple and accessible, right in front of us.

So let’s talk about the outcomes of the studies, and then we’ll talk about where those studies ended up being published. But first, Paul, can you explain to the laypeople listening the difference between visceral fat and standard adipose fat because not everyone will know that.

Dr. Paul Arciero (: 15:35

Susan, timing is everything. This is a bit scary because I just opened my email and got a request from a journalist asking me to comment on a study about this exact topic. The title was “Years of Endurance Exercise Training Remodel Abdominal Subcutaneous Adipose Tissue in Adults with Overweight or Obesity.” The question you asked is so important—what’s the difference?

White adipose tissue, or subcutaneous fat, is located under the skin. It’s easily accessible and found all over the body—on the hips, thighs, and abdominal area. Women tend to accumulate it in the hips and thighs, while men more so in the abdominal region. But visceral fat is different. It’s located around vital organs—like the liver, pancreas, and heart—and it’s more dangerous because it impedes the healthy function of these organs. Visceral fat is less accessible; it’s sticky and more challenging to burn off.

As you mentioned earlier, the lifestyle interventions I’ve created are highly accessible and easy to incorporate into a daily routine. But targeting visceral fat specifically—that’s the real challenge. My goal over the last 38 years has been to not just target white adipose tissue, but to develop strategies that address that stubborn, sticky visceral fat.

Susan Sly (: 19:11

That’s so powerful. You’re never one to shy away from the hard stuff, Paul! Often, when you see commercials for weight loss products, they’ll say participants lost X pounds, but we don’t know where that weight came from. Was it visceral fat? White adipose tissue? And people need to understand that as we age, our metabolism slows down. After 25, we’re losing about a quarter to half a pound of muscle per year. That tees up the next question—why is it so important for women in perimenopause and menopause to do resistance training?

As a former cardio addict myself, I used to run for an hour, then do hot yoga in the afternoon, thinking it would make me leaner. But in reality, without adequate protein intake and resistance training, I was wasting muscle.

Susan Sly (: 20:54

Can you share a summary of the results from your studies? I want everyone listening—especially women in perimenopause and menopause, and those who love them—to hear these results because they are comprehensive. We’re talking about gaining muscle, losing fat, increasing endurance, and strength. Go for it, Paul.

Dr. Paul Arciero (: 20:54

This is the fun part! As we’ve talked about, a lot of research shows that you can lose weight through various means. I always say, you can diet on Coke, Dunkin’ Donuts, or other unhealthy food and still lose weight. But that’s not where health begins to thrive. What we focus on is body composition—the balance between lean muscle mass and fat.

What we’ve found in nearly four decades of research is that when women follow this paradigm—which we’ll discuss in a bit—they see significant proportional increases in lean body mass. In as little as four to eight weeks, they experience increases of 6 to 9 percent in their lean body mass. That’s almost unheard of! At the same time, they experience a minimum of a 33 percent reduction in visceral fat.

When I talk about visceral fat, I’m not sure how much that resonates with people. Through our sophisticated lab techniques, we can quantify changes in visceral fat to the gram. Without exercise, we’ve seen participants lose kilograms of visceral fat. This reduction of at least a third of their visceral fat is far more significant than other diets or nutrition plans.

These changes—losing visceral fat and gaining lean body mass—lead to drastic improvements in health. When you reduce visceral fat, your risk for diabetes, cardiovascular disease, neurodegenerative conditions, inflammatory conditions, and musculoskeletal issues plummets.

Susan Sly:

That’s incredible! Releasing visceral fat isn’t easy—it’s the most toxic and dangerous fat. Sometimes people who appear lean may still have a lot of visceral fat around their organs. Most people don’t even measure for it. I remember seeing videos from your lab of women squatting and sprinting. Can you talk about the increase in physical performance as well? A lot of women look at this stage of life as an ending rather than a beginning. I’ve been committed to following your research, and in May, I ran my fastest 10K since my 30s—I’m 52 now! I’m leaner, and people say, “Wow, you’re so lean.” But it’s really about following accessible research.

Women are so busy and overwhelmed, and they don’t want to have to think about it. But it does require a paradigm shift, right? Can you talk about the strength and endurance gains? That really excites me.

Dr. Paul Arciero (: 27:00

These are great points. And for the audience listening, if you haven’t seen Susan’s calf muscles—you walk the walk! Those are calves that are the envy of many men, including myself. So yeah, there’s no doubt it’s about making it accessible, making it easy, but most importantly, making it quality. That’s the key word here, Susan—quality.

Many people think it’s all about quantity—reducing the quantity of food and increasing the quantity of exercise—but that misses the point of achieving optimal health, especially for women in perimenopause and menopause. Something has to be done, and we’re so fortunate that we now have this lifestyle approach that is highly accessible and effective.

The changes in fitness levels are astounding. As impressive as the body composition changes are—6-9% increase in lean body mass and a 33% reduction in visceral fat—there’s even more that happens when you add exercise into the mix. In our lifestyle paradigm, which we call the PRISE protocol (Protein Pacing, Resistance, Interval, Stretching, Endurance), the focus is on quality movement.

Dr. Paul Arciero (: 31:00

So, to break it down—PRISE stands for Protein Pacing, Resistance training, Interval training, Stretching, and Endurance. First, with protein pacing, we ensure that the women are getting adequate protein throughout the day. Then, we focus on functional resistance exercises. It’s not about bulking up but maintaining and building lean muscle mass, which is so important as women age.

Next comes high-intensity interval training (HIIT). It’s absolutely critical, but it’s also brief and doesn’t require a ton of time. Then, stretching with yoga, Pilates, or even Tai Chi—something that enhances flexibility and mobility. Finally, endurance-based aerobic exercise, but not as a primary focus. These four components together have proven to be highly effective.

I’ve had women come into my studies frustrated because they’ve devoted themselves to aerobic exercise and are still experiencing weight gain and low energy. When we introduce the PRISE protocol, focusing on resistance training and HIIT, they come back a week or two later with a new hop in their step and a sparkle in their eye. It’s amazing to see the transformation when their physical body changes and their hormonal balance improves.

Susan Sly (: 31:40

That’s incredible, and I love that. Let’s go a little deeper into that. Paul, you were published in Nature Communications, which is such a huge accomplishment. I was so excited for you, like I was the one published! I want to jump into the concept of protein pacing because many women in this age group are not getting enough protein. They may be doing a lot of cardio, but their carbohydrate-to-protein ratio is too high. A simple shift, making sure you’re getting protein at regular intervals, is one of the core principles of your research.

I’ll just share something funny here—if anyone is watching a snippet of this video, I’ve got a homemade protein ball on my desk! I put protein powder, organic coconut oil, and almond milk into a mix, make little balls, and put them in the fridge. I travel with protein balls and shakes. So, let’s jump in—how does protein pacing work, and how can someone listening implement it today?

Dr. Paul Arciero (: 33:16

I love that—you’re making me hungry just hearing about those protein balls! So, protein pacing is really quite simple. The first and most important thing is to consume the highest quality protein you can obtain. We want to aim for sources like grass-fed, pasture-raised, wild-caught, and ideally full-fat versions. The research now shows that full-fat options are better, especially if they’re grass-fed or pasture-raised—whether it’s beef, chicken, pork, fish, eggs, dairy, or Greek yogurt. Even plant-based sources like quinoa, lentils, and beans are great.

I’m also a huge proponent of supplements—high-quality meal replacement powders and bars are essential. With busy schedules, traveling, and family obligations, it’s difficult to always have the perfect food available. So, non-perishable options that are high-quality are essential. I recommend grass-fed, undenatured whey protein as the best option because it’s the highest bioavailable protein for the body to absorb and use effectively.

You want to bookend your day with protein—consume the highest quality protein first thing in the morning and last thing at night. Then you evenly space your protein intake throughout the day. For most people, this means eating every 4 hours, though for some, like you, Susan, 2-3 hours might work better. The idea is to keep protein intake steady, allowing your body to assimilate it effectively and improve health outcomes.

Susan Sly (: 36:31

I love that you emphasized flexibility! For me, I do 2-3 hours between meals, and the research showed 4, but it’s all about what works for you. I’ve been a long-distance triathlete for years, so I’m accustomed to eating every 2-3 hours from my training days. I travel a lot, so I always have protein shakes and bars with me. I’ll put protein powder into a shaker cup, and as soon as I get to a hotel, I’ll grab some water, mix it up, and have a shake. That way, I don’t overeat at dinner events.

So, let’s talk about meal sizes and protein amounts—how many grams should women aim for?

Dr. Paul Arciero (: 38:01

That’s a great question. It really depends on factors like gender, age, and activity level. I’ve developed algorithms that take about six factors into account, and we’re always refining them. But generally speaking, most people should aim for 30-50 grams of protein per meal.

As we age, starting at age 40, our bodies lose the ability to utilize amino acids from protein as efficiently, so we actually need more protein as we get older. The general range is about 0.7 to 1.1 grams of protein per pound of body weight. So, depending on your weight, you want to aim for around that range per day, distributed evenly across meals.

Susan Sly (: 40:15

For sure. When I was training athletes back in the day, the research we used was from the 1990s with Tudor Bompa at the University of Toronto. We did a lot of periodization of strength training. For the listeners, you may be wondering how much protein to aim for every day. For me, I shoot for about 120 grams a day. On longer training days, I might go higher, which hits that one gram per pound of body weight. It’s not always easy to get that 120 grams in, which is why I prep my protein balls, shakes, and bars.

I remember seeing in your research, Paul, that if women got hungry at night, they could have a protein bar. I also travel with protein bars—some nights, after a dinner, I’ll have a protein bar while I sit in bed and watch Netflix!

Let’s talk about intermittent fasting. There are so many perspectives on fasting. Some people fast for four hours, others for eight, or they do the 16:8 method. There was even a book called Fast Like a Girl that talked about how women in menopause need to fast differently. What does your research show for perimenopausal and menopausal women when it comes to intermittent fasting? What has had the best effect?

Dr. Paul Arciero (: 42:02

That’s a fantastic question. Time-restricted eating (or intermittent fasting) has become quite popular, but the research shows it’s not the best long-term strategy, especially for lean body mass. Some people fast for 16 or 18 hours or even 20 hours, eating within a 4 to 8-hour window. While it can be effective short-term for fat loss, it’s not ideal for maintaining muscle mass.

In our studies, we use what’s called a nutritionally supported fast. We don’t recommend fasting where you only consume water or completely deprive yourself of nourishment. Instead, we use phytochemicals from plants, antioxidants, and adaptogens that help the body adapt to stress during fasting. It’s like doing a deep clean of your house—you wouldn’t use just water; you’d use something effective but not too harsh. Our nutritional fast includes plant-based compounds that reduce oxidative stress and help the body detoxify.

We recommend fasting anywhere from 24 to 60 hours, with the most common being 36 hours. The body enters a state of autophagy around 18 hours, where it begins clearing out old and damaged cells. By using antioxidants and adaptogens during this time, we support the body's natural detoxification process. This has been the golden ticket for many menopausal women.

Susan Sly (: 45:48

I love the idea of a nutritionally supported fast. When I travel a lot, I use fasting days while I’m on the plane or in transit. Sometimes I’ll be traveling for eight hours, so I sleep overnight, and that counts toward my 18 hours of fasting. Then I’ll break my fast with a shake when I get to the hotel. There are ways to make it flexible, which I think is key. Women in perimenopause and menopause already have enough stress, brain fog, and fatigue. The PRISE method makes it simple, and it’s something you can adjust to over time.

Dr. Paul Arciero (: 46:53

Exactly. And you’ve done so well with this, Susan! It doesn’t have to be weekly or even every two weeks. The great thing about the human body is that it has memory. Once you get to a comfortable point with your body composition and health, you only need to do these nutritionally supported fasts once every two to three months. It’s all about flexibility and individualization—doing what works best for you.

Susan Sly (: 47:55

Paul, we could talk about this for so much longer, and I think we’ll have to do a part two of this conversation! I’m really excited about where this is going. I know both of us are passionate about using artificial intelligence and technology to make these solutions precise for women, based on their schedule, activity, and so on. I can’t thank you enough for the research you’ve done—it’s changed my life. We haven’t solved the hot flashes yet, but I know we’ll get there!

Dr. Paul Arciero (: 48:32

We will solve that! And in the meantime, even with hot flashes, we’ll make sure that women look hot! It’s one thing to have a hot flash, but it’s another to look great while you’re having it.

Susan Sly (: 48:34

Exactly! Thank you so much for being on the show, Paul. We’ll include links to everything we’ve talked about in the show notes. Please share this episode and season one of The Menopause Health Podcast with everyone you know. Thanks again, Paul, for being here.

Dr. Paul Arciero (: 49:02

Thank you for having me, Susan!

Voiceover (: 49:06

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This transcript has been generated using AI technology. There may be minor errors or discrepancies in the text.

The opinions expressed by the guests on this podcast are their own and do not necessarily reflect the views of the show or its hosts. This podcast is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific health needs.