Other articles by Andrew Weil:

Ask Dr. Weil : Growing method doesn't determine nutrition value Ask Dr. Weil : Monitor toxins that body burden tests measure Ask Dr. Weil : Nasal-spray flu vaccine is safe for kids over 2 Supersweet, natural stevia appears to be safe Olive oil adulteration is a tough problem to solve Registered dietitians and certified nutritionists No reason to buy supplemental bovine colostrum No clear evidence on cell phone's long-term risks Soy eaten in whole, unrefined forms is preferable Chemical used for sterilizing almonds a concern

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Q Is weight gain at menopause inevitable? I've put on 14 pounds and can't seem to lose them. Any suggestions?

A Menopause doesn't necessarily lead to weight gain, but the hormonal shifts underlying this change of life definitely affect body fat distribution. Weight tends to shift out of the hips and thighs to the abdomen, turning some "pear-shaped" women into "apples." I've read that the average woman puts on 2 to 5 pounds during the menopausal transition, but I know that many women complain of greater gains.

Part of this problem has to do with issues that are unrelated to menopause. First of all, as we get older, we need fewer calories because there's a shift from lean muscle mass to fat and a consequent slowdown in metabolism. If you want to maintain your weight as you get older and avoid menopause weight gain, you have to cut back your food intake by about 200 calories per day; this applies to men as well as women.

The other part of the equation is exercise. Ample evidence suggests that regular exercise prevents menopause weight gain. And at this time of life, exercise is particularly important for a number of other reasons: Weight-bearing exercise such as walking can keep your bones and heart strong and also lower your risk of breast cancer. Regular physical activity may also help reduce hot flashes, counter depression, sharpen your thinking and promote good sleep.

Calcium and vitamin D supplements may also help prevent postmenopausal weight gain. A study published in the May 14, 2007, issue of the Archives of Internal Medicine found that women who took both supplements gained less weight than those who didn't. Researchers from Kaiser Permanente Northern California- Oakland, studied more than 36,000 women of ages 50 to 79 enrolled in the Women's Health Initiative, a large U.S. government-sponsored clinical trial. The women were randomly assigned to take either 1,000 mg of calcium plus 400 IU of vitamin D or a placebo daily. They were weighed every year during the seven-year course of the study. Although the differences at the end of the study were not large, the women who took the supplements had a lower risk of gaining small amounts of weight and a higher likelihood of staying within 2.2 pounds of their initial weight. I recommend that women take 500 to 700 mg of calcium citrate in two divided doses, taken with meals, for a total daily intake of 1,000-1,200 mg from all sources, and 1,000 IU of vitamin D3 (cholecalciferol) with the largest meal.

Q What do you think about the sea-salt flush? Do you suggest another method of cleansing?

A Sea-salt or saltwater flushes are promoted for internal cleansing and for treatment of colds, high blood pressure and other health problems. The drill is to add a teaspoon (or 2, depending on the plan you're following) of sea salt or non-iodized salt to 1 or 2 quarts of water, drink it, and wait for it to run through you, taking "toxins" with it. Depending on the plan, you do this daily for a week or longer.

I once tried a flush of half seawater and half freshwater, which did cause a pretty rapid flush (that is, a watery bowel movement within 30 minutes). I am concerned about the sodium load of this and the sea-salt flushes I've seen described online. A single teaspoon of salt gives you 2,400 mg of sodium, more than enough for a day's intake (I recommend limiting your daily intake to 1,500 mg of sodium).

In evaluating claims for flushes and other cleansing regimes, be aware that the body does a pretty good job of cleansing and purifying itself. If you focus on good nutrition, regular exercise and other healthy habits, you won't feel the need to do this sort of thing.

If you really want to do an intestinal cleanse, I suggest a daylong or weekend "juice fast," plus some powdered psyllium seed husks to give your intestines bulk. Stir a tablespoon of the powder into a big glass of water, drink it, and then drink another glass of plain water. Do this once a day, preferably in the morning. While you fast, take 100 mg of vitamin C twice a day, but skip your other supplements.

Drink at least four 8- to 12-ounce glasses of juice daily plus at least four 8-ounce glasses of water and, if you like, some unsweetened herbal tea. If possible, prepare the juice yourself from organically grown fruits and vegetables. One combination I like is apple, carrot and lemon juice, diluted with plain or sparkling water.

If you can't make your own juices, buy natural ones without added sugar, and dilute them to your taste with water. While fasting, a daily sauna or steam bath can help the body eliminate unwanted materials through sweating (be sure to drink extra water during and after). Be sure to eat lightly and carefully when you end your fast and make the transition back to your normal diet. Going straight to pizza or enchiladas will almost certainly cause discomfort.

By the way, I don't recommend colonic irrigation for "purification." The entire lining of the colon sloughs off and is regenerated every day. If you are eating well, drinking enough water and getting enough physical activity, your regular eliminations will be sufficient to keep the colon clean and in good working order.

In evaluating claims for flushes and other cleansing regimes, be aware that the body does a pretty good job of cleansing and purifying itself. If you focus on good nutrition, regular exercise and other healthy habits, you won't feel the need to do this sort of thing.

Dr. Andrew Weil