Although there has recently been an encouraging increase in media coverage around the topic, many women are still unclear about what to expect from the menopause and the options available to them. There is a lack of easily accessible information about the different treatment options, and even less about the important role that diet and lifestyle can play in supporting women through this hormonal transition. As a nutritionist who specialises in women’s health and the menopause, I find this incredibly frustrating, which is why I wrote my book The Happy Menopause: Smart Nutrition To Help You Flourish.
Our society is very fond of the quick fix, which is why headlines around the latest ‘superfood’ always attract a lot of attention, but there is no one-size-fits-all approach to the menopause. We are highly complex, biochemically unique individuals and an approach that works for one person may not suit another. From a clinical perspective, individual micronutrients, phytonutrients or herbs are more likely to be the icing on the cake in terms of symptom management and, for me, that would be a second phase. First of all, you need to have a really good cake—metaphorically speaking, of course.
My first approach is all about getting back to basics, so that we are giving the body the raw materials it needs to do the job. It may seem dull, but it is extremely important to do this, because it is astonishing how many women don’t really understand the role of macronutrients and how crucial it is to have the right balance, in order to manage menopause symptoms.
Managing macronutrients
Protein
In my clinical experience, most women don’t eat enough protein, whereas men seem to have an instinctive understanding that it is important for them. We are made of protein, and it plays a vital role in the growth and repair of cells, so it is essential for anyone recovering from illness, injury or surgery. Women can lose up to 40% of muscle mass by the time they have gone through the menopause; we need protein to support muscle strength and tone, alongside regular exercise and resistance work. It is also vital for strong bones; and our skin, hair and nails are all made of protein. If there isn’t sufficient protein in the diet, the body will prioritise the vital organs, which is why poor skin and thinning hair are often triggered by a bad diet. The body uses the amino acids found in protein to create key neurotransmitters that govern mood, memory and motivation, all of which can be problematic for women in midlife. A sales pitch for the importance of protein can make all the difference to compliance with a nutrition support programme.
‘We are highly complex, biochemically unique individuals and an approach that works for one person may not suit another’
Fats
Our generation—I say this as a woman of 55—has been heavily influenced by the very strong low-fat message, which has been drummed into us from early adulthood. Although the tide has turned in recent years, there seems to be an ingrained mistrust of dietary fat and my female clients are often reluctant to introduce it into their diet, for fear of weight gain. There is an obvious logic in assuming that eating fat will make you fat. Of course, if you eat too much of anything you will inevitably gain weight after a while, but the body has more immediate jobs for dietary fat than converting it to adipose tissue. One of these key jobs is to produce sex hormones, so if ever there was a time to avoid a very low-fat diet, the menopause is that time. However, not all fat is equal and it is important to focus on poly- and mono-unsaturated fats (the omegas), which play a crucial role in heart health, brain health and supporting the nervous system, and good quality saturated fats, such as products from pasture-fed animals, which support hormone production. This is not the time for large amounts of deep-fried foods, junk food or trans fats.
Carbohydrate
Carbohydrates have been having a pretty bad press in recent years and the ‘low-carb’ diet is increasingly popular for weight management, but it is important to remember that carbohydrate is the body’s primary source of energy, and that the brain is entirely reliant on glucose for energy. When people talk about ‘carbs’, they are generally referring to starchy carbohydrate: bread, pasta, rice and potato, for example. There is a tendency to forget that fruit, vegetables and pulses are all rich sources of carbohydrate too. Excessive levels of sugary food and refined carbohydrate will disrupt the blood sugar balance and encourage the body to lay down fat stores, so it is important to limit these. However, complex carbohydrate, found in wholegrain foods, such as brown rice or wholemeal bread, and in vegetables and pulses, is an excellent source of fibre. Fibre plays a key role in supporting a healthy digestion, regulating cholesterol levels, balancing blood sugar and promoting hormone balance. The body burns through complex carbohydrate slowly, promoting satiety and sustained energy, which is why it can be very helpful as part of a weight-management programme.
Getting the balance right
Having established the importance of each macronutrient, we need to consider how to get the proportions right, in order to maintain optimal blood sugar levels. Blood sugar balance is a key part of the picture in managing the menopause because every time the blood sugar drops, the body releases stress hormones, adrenaline and cortisol, which will directly interfere with sex hormones and exacerbate menopause symptoms.
The best way to balance blood sugar is to ensure a combination of protein and complex carbohydrate with each meal and snack (Table 1).
Table 1. Foods to support blood sugar
| Food type | Examples |
|---|---|
| Fibre | Whole grains, eg brown rice, whole-wheat pasta, wholemeal bread, quinoa, buckwheat; oat-based products, eg porridge, oatcakes; lentils and pulses; vegetables; fruits with an edible skin |
| Protein | Chicken; turkey; lean meat; oily fish (eg tuna, salmon, sardines, mackerel), white fish; eggs; hummus; cottage cheese; nuts and seeds; tofu; soya beans; nut butter; quinoa; lentils; beans |
| Fluids | Water; diluted fruit juices; vegetable juices; herbal teas |
It is also important to limit foods that spike blood sugar and activate the insulin response. Hidden sugars can be a particular challenge, as many apparently healthy foods, such as fruit yoghurt, breakfast cereals and fruit juices, can contain anything from 4 to 8 teaspoons of sugar per standard serving, so it is essential to read labels carefully. Note that 4 g of sugar is the equivalent of a teaspoon. Avoiding sugar, caffeine and alcohol has the added advantage of significantly reducing common menopause symptoms such as hot flushes and insomnia, and may also help to relieve low mood and anxiety (Table 2).
Table 2. Foods that disrupt blood sugar
| Food type | Examples |
|---|---|
| Refined carbohydrates | Sugar, white bread and white bread products, white rice, white pasta, white noodles, cakes, biscuits, baked goods |
| Sugary foods | Fruit yoghurts; prepared sauces; high-sugar fruit eg mango, grapes; chocolate; sweets; squashes; undiluted fruit juice; carbonated soft drinks |
| Stimulants | Alcohol; tea; coffee; caffeinated drinks eg Diet Coke, Red Bull; nicotine; some painkillers and cold and flu remedies |
In a clinical setting, I use the visual reference of fist-sized portions for each of the food groups that feature and a graphic of a plate to help with portion management at lunch and dinner (Figure 1).
Each quarter of the meal should feature a fist-sized portion of the recommended food group and will play an important role in supporting women to have a healthy transition through the menopause:
- Foods that contain protein also contain fat, so that this quarter very neatly covers two essential macronutrients. They are also rich in iron, which can help during the perimenopause for women experiencing heavy periods or flooding
- A fist-sized protion of starchy complex carbohydrates provides good levels of fibre and an energy boost. Most of us have a pretty sedentary lifestyle and do not require more than this and indeed may even comfortably skip this at either lunch or dinner and increase the vegetable portion to 75% of the meal, which can help to support weight management. However, if you have a very physically active job—a nurse could be a good example of this—or play competitive sport at an elite level, it would be wise to ensure sufficient starch at both lunch and dinner to support energy levels
- Half of the plate is dedicated to vegetables, which have the dual advantage of supporting fibre levels and providing a whole range of menopause-friendly vitamins and minerals that activate the various chain reactions required for a whole host of systems in the body to support physical and mental health. Leafy green vegetables, such as spinach, cabbage or watercress, are a one-stop-shop for bone health, because they contain twice as much calcium per 100 g as milk and are also an excellent source of magnesium, which we need to support calcium absorption. Magnesium’s other roles include supporting muscle function; calming an over-anxious nervous system and promoting energy. Leafy greens also contain vitamin K for bone strength and vitamin C, which the body uses to make collagen, a key component of our bones, keeping them flexible, so that we are less likely to break them if we fall. The all-important element of vitamin D, which is essential for calcium absorption, is best acquired via a supplement, because the amount found in some food sources is negligible and the stores acquired through exposure to sunlight may be compromised by the use of sunblock.
By following this simple guide to portion size and nutrients, there is no need to worry about weighing food or counting calories, which can be time consuming, stressful and unsustainable as an approach to weight management in the long term. It also ensures that the individual has the right balance of macro- and micronutrients to support them through the hormonal transition of the menopause without having to think too hard. After all, a midlife woman is a very busy woman and it is important to make it as straightforward as possible when it comes to meal planning, shopping and cooking.