Nutrition
The 40s and 50s. It is the near mid-life time where many changes are happening and the thought of experiencing and preparing for menopause may be weary for some. In the midst of questioning life choices, creating meaningful routines and battling chronic health conditions, it’s valid to feel that our health does not appear as bulletproof as our earlier years.
Before we get into nutrition for menopause, I want to express that growing older can be seen as a privilege. While weight gain and weight loss are experiences of perimenopause and menopause and can take up our attention in these years, it is far more valuable to nurture our nutrition holistically so that we can be healthy, have endurance and enjoy living our life. Here are some inspirational words of wisdom from the American talk show host herself:
“ Of course, I want to look my best. I want to feel strong and vibrant. But I know for sure that the pathway to your best life isn’t the route of denial. It’s owning every moment. Staking claim in right now. And with gratitude, embracing the age you are.” -Oprah Winfrey
With that in mind, let’s shift the thinking on healthy eating and healthy aging to how we can best nurture our bodies to live the life we desire. This means including emotional, social, psychological and spiritual health. Today, we will cover:
Menopause is a natural occurrence for women between the ages of 45-55. It is defined as starting at 12 months after the last menstrual period. While most women experience menopause during this time, any history of chemotherapy, smoking, autoimmune conditions as well as having low body fat is linked to experiencing early menopause (1).
The time up to this point is called perimenopause and can vary in the start date, from the late 30s to the early 50s (1). During perimenopause, an important hormone called estrogen starts to decline and women will start to have periods which are on and off. Eventually, the drops in estrogen alongside progesterone causes the menstrual cycle to come to a stop. The decline in estrogen levels is the culprit of some undesirable symptoms. You may have heard of women experiencing hot flashes, poor concentration, headaches, joint pain and irritability during this time (2). There is also significant variation in the severity and duration of these symptoms depending on the person meaning they can last from months to years! Are there ways to manage some of these through food? That’s where you’ll find out more next.
As we age into the years of perimenopause and menopause, it is not uncommon to experience the above symptoms while running into other complications. Thankfully, there are a few roles that balanced nutrition can play in maintaining good health to prepare us for these years. But first, what are some common changes that can arise in the years leading up to menopause when estrogen levels start to drop off?
Even in the years before menopause, women start experiencing changes to organs and functions of the body. At around the age of 30 is the time when women can obtain their highest bone mineral density (9) with the help of calcium from the diet. Up to the 40s, bone loss gradually occurs and after which new bone can no longer be built (2). Why does this happen? Before menopause occurs, estrogen is a key helper, protecting our bones in the process of building it. That means it’s not a surprise that a decline in estrogen as women age leads to an increased risk of osteoporosis (2). In fact, 5 to 7 years after menopause the loss in a women’s bone density can be as much as 20% (3). This is heightened with inadequate intake of the bone- building nutrients such as calcium and Vitamin D.
Think of our bones as a ‘calcium bank’ much like the money in our savings account. We save money in our earlier years so that we can prepare for a potential rainy day. The key is that we have deposits/funds to take from. The same idea applies to the calcium that we get from our food. We aim to save calcium in our bones over the early years so that we don’t run into trouble later. However, if we don’t save enough and we’ve already reached the peak age, our body still needs some calcium for essential functions like regulating muscle cells and brain cells (that’s right, not just for bones!). Our body can then start to take away from an already low storage of calcium in the bones. This is what gradually leads to softening of the bones (osteoporosis risk), resulting in the formation of pores and overall, increases the risk of fractures and falls.
While calcium is often seen as the hero for optimal bone function (for good reasons), let’s not forget about the other players which also support the building of our bones including Vitamin D, Magnesium, Zinc, Protein, Vitamin K and Vitamin C.
#1 Have a balance of supporting foods containing these nutrients:
#2 Be mindful of sodium intake.
#3 Weight bearing exercise.
#4 Consult about additional risk factors.
The key here is to be as best prepared as possible with adequate bone density before entering menopause with the help of nutrients above and then supporting what we have as we enter menopause.
As women reach over 40 years of age, they can experience changes in weight. Similar to the other changes, the decline in estrogen levels play a role here. The changes in hormones changes how the body stores and metabolizes fat (particularly visceral fat which surrounds the abdomen and subcutaneous fat) (6). When this happens, the body’s insulin response and sugar metabolism switches, increasing the risk of cardiovascular disease and diabetes (7). However, weight gain is also a result of loss of lean body mass along with decreased physical activity in the older years. Naturally, our lean body tissue uses more energy (are more metabolically active) compared to our fat tissue. Therefore, a change in tissue body tissue composition changes the energy balance in our body and can show up as a change in weight. This is where the balancing acts of both good nutrition and physical activity come in handy.
While weight gain and weight loss are experiences of perimenopause and menopause, which can help one become more mindful of our nutrition, it is just as important that it does not take up significant attention to pull us away from our overall health. Our bodies do so much more than what one might be receptive of, however the privilege of aging and finding ways to nurture what we have now is far more valuable towards living a joyous and healthy life.
#1 Physical Activity
There’s no surprise here. Loss of the lean body tissue can begin in the early 30s and 40s, with gradual loss of 1% each year without physical activity (8). To combat this and preserve muscle mass, engage in regular physical activity and at least 150 minutes per week. An average of 60 minutes of activity per day has been shown to help with weight maintenance for the average adult (9). All types of exercises count to support bone density including walking, running and resistance training. These are also beneficial in maintaining steady blood sugar levels and insulin response and reduce risk of developing metabolic disease (10).
#2 Protein and nutrition:
Just as many of us know it to be true, protein is important for optimizing the building of muscle. For adults of all ages, a daily recommendation of 1g per kg of body is used to prevent muscle loss with age (11). It’s just as important to have this amount spread evenly over the meals and snacks in a day. Contrary to belief, more protein in one meal (any more than 30g/meal) is not better and has the same muscle building effect as 3 times as much protein in the same meal (12). In fact, spreading out your protein intake can actually improve building of muscle by 25% (12).
Need some protein rich meal ideas? See our recipe page here!
A notable occurrence with the decline of estrogen is the experience of hot flashes and sleep disturbances. Fluctuating estrogen and progesterone over the later years impacts our body temperature leading to sweating at night and unpleasant waking, disrupting our sleep. Hot flashes can occur at anytime before, during and after menopause with symptoms lasting between 1 to 5 years (13) which can lead to insomnia. In The National Sleep Foundation has found that 61% of women who past their menopause years report having insomnia for 30 days (13).
Not only does this impact one’s mood the next morning, but poor sleep is tied to appetite disruption and imbalance in our hunger hormones. Two of these hormones are ghrelin (which signals our hunger) and leptin (which signals fullness). Regularly having poor sleep raises ghrelin levels and lowers leptin levels which impacts how much we eat in a day and subsequent appetite control and weight.
#1 Limit alcohol, coffee and spicy foods
Caffeine can worsen hot flash symptoms (2) and accelerate our heartbeat leading to a hot flush experience. Caffeine also stimulates excretion of calcium in the urine (which would counteract the function of the calcium bank earlier!). Aim for no more than 2 to 3 cups per day.
#2 Build healthy sleep habits.
This includes:
#3 Do not smoke
Absence of smoking can alleviate hot flash symptoms and reduce long-term health risks (1)
#4 Engaging in mind and body relaxation activities
Engaging in mind and body activities may help with reduce stress and provide some relief from menopause symptoms (1)
A common question is whether eating soy foods helps with managing menopause symptoms. Soy contains plant estrogens called phytoestrogens (specifically the isoflavone group) which are structurally similar to human estrogen when it is broken down in the body. This leads some individuals to believe that the phytoestrogens have the same effect as human estrogen but the effects are not mimicked quite exactly. Thus, relying on soy and soy products to retrieve estrogen to improve menopause symptoms can be questionable. Studies usually indicate either mixed or inconclusive results. In some cases, soy intake has been shown to reduce hot flashes with modest soy intake (15) without any adverse side effects. Others note that since isoflavone metabolization happens relatively fast in the body before having a chance to stay, daily and consistent consumption may be needed before improvement to hot flashes can be seen (15). Overall, the evidence is not conclusive and soy intake may or may not work to reduce hot flash symptoms for some individuals.
That being said, soy is a nutritious option in nature, offering fibre, protein, magnesium and calcium (all of which were discussed earlier!) and can’t be neglected for its contributing health benefits such as blood sugar management and heart health.
Photography with soy and soy milk
Just as how our guts can be sensitive to changes in our diet, changes happening in our parts of our body can also cause a host of gut changes. The changing levels of ovarian hormones and estrogen strike again, presenting with unpleasant gut symptoms for this round. This includes bloating, bowel change and discomfort in the gut. Constipation is particularly common as one ages as a result of menopause, stress and a changing gut microbiota.
#1 Medications
Usual culprits for microbiota changes include chronic antibiotics. As always, speak with your doctor to discuss impacts of specific medications on gut health.
#2 Support a healthy gut through fibre-rich foods and probiotics.
There’s no shortage of foods that the bacteria in our guts thrive on . Particularly having adequate fibre and incorporating probiotics promotes good gut flora balance. Despite not being a ‘nutrient’ that we would absorb, the role of fibre can not be stressed enough. The recommendation of having 25g per day for women is usually not met by most but the benefits of regular intake are plenty: stabilizing blood sugars, lowering cholesterol levels, regulating bowels, regulating the appetite and of course, supporting the gut microbiota. Fiber-rich foods are abundant in the fruits and vegetables, grains and meat alternative food groups (pulses like chickpeas, lentils, beans). If you live on bread like I do (and other foods), I would highly recommend Silver Hills sprouted grain bread abundant in fibre and micronutrients for an easy swap. If you enjoy plant sources of protein such as chickpeas and lentils in dishes, those are also bonus sources of fibre. Insoluble fibres are particularly helpful for alleviating constipation symptoms.
#3 Opting for less gassy foods
Gas is a normal part of every day especially with adequate fibre intake from foods. However, if bloating is a significant issue, try specific fibre-containing foods such as chia seeds, pumpkin seeds, strawberries, bananas, berries, baked potatoes with skins which are less gassy.
#4 Stress levels
The gut and brain are closely connected and stress can trigger undesirable gut symptoms. Check in to see if you are experiencing consistent stress and make a plan to navigate this.
By now, you’ll probably recognize that estrogen has multiple influences on the body systems, especially when it starts to fluctuate and drop in the later years of life. Another area it affects is cholesterol and heart health. Earlier on, estrogen has a protective role in maintaining a healthy heart by regulating cholesterol levels. During menopause, the decline in estrogen is associated with higher cholesterol and blood lipids (triglycerides) (16). This puts on a greater risk of heart disease but thankfully we can take an active part in reducing this risk through a heart healthy diet.
Keep in mind some of these best practices for heart healthy eating:
As we age, our body requires more or even less of some nutrients. Here is the quick run down of key nutrient changes for women in perimenopause and menopause.
If you've gotten this far, congratulations! You’re one step closer to supporting a healthy lifestyle in the perimenopausal and menopause years. Remember, nutrition is just one part of holistic health and we need to take care of ourselves physically, spiritually, emotionally, socially and psychologically especially when many changes are happening. Always reach out to a dedicated professional on the topics or consult a doctor regarding additional therapies during this time.
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1. Menopause and Perimenopause, Health Link BC.(2022). www.healthlinkbc.ca/healthy-eating-physical-activity/age-and-stage/menopause-and-perimenopause.
2. Menopausal Symptoms: In Depth. National Center for Complementary and Integrative Health. ( 2017). https://nccih.nih.gov/health/menopause/menopausesymptoms
3. Hormones and Healthy Bones, Washington, D.C.: National Osteoporosis Foundation.(2009).
4. Slowing bone loss with weight-bearing exercise. Harvard Health Publishing. Harvard Medical School. (2021). www.health.harvard.edu/staying-healthy/slowing-bone-loss-with-weight-bearing-exercise#:~:text=Numerous%20studies%20have%20shown%20that,bone%2Dforming%20cells%20into%20action.
5. NIH Osteoporosis and Related Bone Diseases National Resource Center .What People With Diabetes Need To Know About Osteoporosis. www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/diabetes#:~:text=a%20fracture%20occurs.-,The%20diabetes%E2%80%93osteoporosis%20link,have%20the%20highest%20fracture%20risk.
6. Santosa, S., & Jensen, M. D. (2013). Adipocyte fatty acid storage factors enhance subcutaneous fat storage in postmenopausal women. Diabetes, 62(3), 775-782.
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9. Sternfeld, B., Wang, H., Quesenberry Jr, C. P., Abrams, B., Everson-Rose, S. A., Greendale, G. A., ... & Sowers, M. (2004). Physical activity and changes in weight and waist circumference in midlife women: findings from the Study of Women’s Health Across the Nation. American journal of epidemiology, 160(9), 912-922.
10. Sternfeld, B., & Dugan, S. (2011). Physical activity and health during the menopausal transition. Obstetrics and Gynecology Clinics, 38(3), 537-566.
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13. Sleep Foundation. (2022) Menopause and Sleep. www.sleepfoundation.org/women-sleep/menopause-and-sleep
14. Harvard Medical School Division of Sleep Medicine. (2007).Twelve Simple Tips to Improve Your Sleep. https://healthysleep.med.harvard.edu/healthy/getting/overcoming/tips
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16. Harvard Health Publishing (2022). Take control of rising cholesterol at menopause. https://www.health.harvard.edu/womens-health/take-control-of-rising-cholesterol-at-menopause#:~:text=Drops%20in%20the%20female%20hormone,(fat)%20known%20as%20triglyceride.
17. Kjeldby, I. K., Fosnes, G. S., Ligaarden, S. C., & Farup, P. G. (2013). Vitamin B6 deficiency and diseases in elderly people–a study in nursing homes. BMC geriatrics, 13(1), 1-8.
