Dietary Interventions to Slow Metabolic Deterioration in Menopausal Patients

Dietary interventions in midlife women, particularly with a goal of reducing carbohydrates, may significantly mitigate metabolic deterioration, regardless of estrogen use, during menopause.¹

These data, presented at the American Diabetes Association (ADA) Scientific Sessions in New Orleans, Louisiana, by Shaminie Athinarayanan, PhD, director of clinical research at Virta Health, contradict the widely accepted predicted upward body mass index (BMI) trajectory typically associated with menopause.¹

These changes are driven largely by hormonal and metabolic shifts leading to increased adiposity and can significantly raise risk of type 2 diabetes (T2D), cardiovascular disease, and several forms of cancer. While studies have historically focused on the effects of dietary intervention, primarily in quality and composition, can directly impact weight gain, the effects of these interventions in menopause have received comparatively little study.²

“Usually, when women are going through hormonal transition, they are gaining weight,” Athinarayanan told HCPLive in an exclusive interview. “What we saw is that we’re actually interfering with the weight gain, and these women are actually losing weight and improving their metabolic health.”

In the study, Athinarayanan and colleagues evaluated 1-year BMI, weight, and HbA1c trajectories among female patients aged ≥45 with T2D. These patients remained in a digital nutrition program centered around carbohydrate reduction for ≥1 year. The team then determined whether estrogen therapy modified these patients’ outcomes.¹

A total of 118 estrogen users were retained and compared against 800 non-users, selected via stratified random sampling to preserve the enrollment age, BMI, and HbA1c distribution among estrogen users. The team recorded and analyzed outcomes at enrollment, 6, and 12 months using linear mixed-effects modules with a time x estrogen interaction.¹

Over the course of the study, Athinarayanan and colleagues found that BMI declined from 33.84 to 30.7, HbA1c declined from 7.24% to 6.56%, and weight declined from 200.19 to 181.57 pounds. All changes were statistically significant. BMI and HbA1c both shifted towards healthier and lower-risk classifications, which indicated a broad metabolic improvement. Ultimately, the team concluded that these changes were directly contradictory to the traditional understanding of menopause as an inevitable downward trajectory in metabolic health, highlighting carbohydrate reduction as a potential mitigator for metabolic deterioration with or without estrogen.¹

“This is a strategic opportunity to interfere – it’s a pathway to transition rather than decline, because if we interfere during the menopausal transition, we’re actually improving their health,” Athinarayanan said. “Some may just have obesity rather than type 2 diabetes, and we can reverse their disease trajectory so that they don’t progress into type 2 diabetes.”

Editors’ Note: Athinarayanan reports financial relationships with Virta Health.

References

1. Athinarayanan S, Roberts C, Zoller A, et al. ADA Presidents’ Select Abstract: One-Year Metabolic Improvements in Midlife Women in a Digital Nutritional Program. Abstract presented at the American Diabetes Association (ADA) Scientific Sessions 2026, New Orleans, LA. June 5-8, 2026.

2. Xia T, Haslam DE, Eliassen AH, et al. Optimal Dietary Patterns for Lower Weight Gain and Risk of Obesity Surrounding Menopause. JAMA Netw Open. 2026;9(5):e2613102. Published 2026 May 1. doi:10.1001/jamanetworkopen.2026.13102