Dr Rupy: Today's episode is a deep dive into the evidence-based diet and lifestyle habits to ease the menopause transition. This is based on research that we did for our latest health goal on the Doctor's Kitchen app that has now launched. Due to huge demand from our podcast listeners, our newsletter subscribers and of course our existing app subscribers, our internal and external research team reviewed the nutritional literature to identify beneficial foods and nutrients specifically to help with the menopause. So now you can find a huge selection of recipes and personalised suggestions based on your dietary preferences on the Doctor's Kitchen app specifically for menopause. And this complements our other health goals that we have including heart health, brain health, anti-inflammation and many more. So just click on the link in the show notes to check out the app and all those recipes and make use of the 14-day free trial that we have there as well. For more information about HRT treatment options, navigating early menopause, the physical, emotional and psychological signs and symptoms of menopause, you can check out the podcast that we've done in the past in the show notes down below as well. On this episode, we're going to be going through the foods that you should be centring your diet around that can potentially help with menopause symptoms. We also talk about supplementation and herbal remedies as well and what the evidence is for lifestyle measures that everyone should be doing for healthy ageing regardless of whether it's menopause related or not. And we also talk more practically about how you can introduce these elements into your diet and specific doses of different foods that we suggest as well. I think you're going to find this really useful and pragmatic, but do check out those recipes that we have on the app that will give you an easier idea of how you can incorporate all these different suggestions that we talk about today as well. Remember, you can join the newsletter for free by checking out the link down below in the show notes. We send out weekly newsletters doing deep dives into seasonal ingredients, as well as my eat, listen, read newsletter, which gives you a recipe to eat, something to listen to, something to read, and if you're lucky, something to watch as well as something to brighten up your day at the end of the email too. For now, on to my podcast about menopause and how to ease it with food, lifestyle and supplements.
Dr Rupy: I'm going through evidence-based diet and lifestyle habits to ease the menopause transition, helping stop weight gain, in particular around the belly, so the belly fat, improve hot flushes, night sweats, brain fog, sleep and mood disorders, not to mention lowering the risk of health problems like heart disease and osteoporosis that actually increase after the menopause due to ageing and declining oestrogen levels. For more about HRT treatment options, check the caption below because we've done a whole bunch of other podcasts specifically looking at that topic. So let's get right into it. So here you can see a very simplified overview of what happens during and after the menopause. So the biggest impact is the declining oestrogen and progesterone levels and that leads to changes across a woman's body that increases the risk of cardiometabolic disease and dementia as well. There's a huge catalogue of different issues that could be causing or at least contributing to symptoms of the menopause. And this all coalesces to higher rates of inflammation, higher levels of oxidative stress. Your metabolism is affected, leading to changes in blood sugar regulation, making people more at risk of type two diabetes. There's also significant changes to the gut microbiome that I'm going to talk about later that affects the oestrobolome and all of that is the result of hormone deficiencies. You have increases in blood cholesterol levels that increase the risk of cardiovascular disease. You have a reduction in fat-free mass, i.e. you have a reduction in muscle that is very cardioprotective as well as important for metabolism. So in light of all these changes and the evidence that we have available to us, here are my top five food recommendations for the menopause. Number one is boost your protein. Why am I saying boost your protein? Well, a higher protein intake is linked to a lower risk of fractures and higher bone mineral density in postmenopausal women. It helps minimise weight gain and preserve muscle mass when coupled with exercise, that's an important caveat there, and this is crucial for overall health, particularly metabolic health as well. How much? Well, most people should be aiming for at least 20 grams per meal, but more specifically, I'd be aiming for 1.5 grams of protein per kilogram of body weight. Now, this sounds quite high, that's actually almost double the recommendation that we have in the UK of 0.8 grams of protein per kilogram of body weight, but there's a couple of reasons why I'm suggesting that. Number one, postmenopausally, your protein requirements do increase. And second of all, in an older age group, i.e. above the age of 55 to 60 years old, you are able to absorb less protein from your diet. So it's important to actually have more so you still maintain that protein adequacy. Now, before you think that I'm going to suggest that you should be having more red meat in your diet, more poultry, I actually think that you should be getting the majority of your protein from plant-based proteins. So things like legumes, chickpeas, beans, tofu, tempeh, edamame, nuts and seeds. These are particularly beneficial because they come with fibre and phytochemicals that are going to help with that cascade of issues that causes problems in during the menopause. So the inflammation, the oxidative stress, all these beneficial plant-based proteins are going to be countering that as well as giving you extra protein that you require. And just beyond the benefit of extra protein in the diet for bone mineral density and muscle mass, it can also help with losing weight and the belly fat. A lot of people complain that during or just before the transition, it often leads to weight gain as well as an increased fat mass, particularly around the abdomen or also known as belly fat. This represents something that's that's pretty severe, which is called visceral fat, and that's essentially the most metabolically active type of fat that coats the organs. And that's putting you at more risk of things like type two diabetes as well. Now, why does this happen? So the exact cause is still being debated. There are some researchers that actually suggest that the hormonal changes during the menopause, so the loss of oestrogen, could be causing the body to break down more protein. Now, if that breakdown of protein is not matched with more protein in the diet, what it does is it causes you to crave more energy in your diet. So if you're not having enough protein in your diet, you're going to be overconsuming things like carbohydrates and fats to meet that energy demand of protein, and that signals satiety. So if you're having enough protein in your diet, you're not going to have those craving signals and that's not going to cause you to overeat. This overall is known as the protein leverage effect. And this hypothesis from the research is that increasing protein intake can actually help prevent this weight gain and muscle loss during the menopause. There's also another theory that oestrogen influences where fat is stored in the body. So lower oestrogen levels tend to shift fat storage from the hips and thighs to the abdomen. Coupled with that increase in fat redistribution toward the belly, after the menopause, when the ovaries significantly reduce their production of oestrogen, the body actually has a compensatory mechanism, and it compensates by converting androgens that are produced in the adrenal glands into oestrone in fat tissue. This conversion process is facilitated by an enzyme called aromatase. Now, the production of oestrone in fat cells can actually create a feedback loop. So the oestrone that's actually produced by fat cells has a very weak oestrogenic effect on tissues, but its presence can still promote fat storage, particularly in the abdominal area. So what happens is the body that is starved of oestrogen thinks to itself, okay, I'm getting some more oestrone from fat cells, let's create some more fat cells to produce this weak oestrogenic effect from oestrone. And hence why you have this unusual scenario where fat cells are actually promoted because of that loss of oestrogen that is no longer coming from ovaries. Coupled with all these things that are happening to fat cells, there's also that decrease in muscle mass that occurs. And since muscle tissue burns more calories than fat tissue, this all contributes to a lower or a slower metabolism and increased fat storage. So this is why you find yourself in a bit of a vicious cycle where the belly fat, colloquial term for the visceral fat that's redistributed, just appears to get worse and worse and worse.
Dr Rupy: The third food that I would recommend having in your diet every single day to help with menopause symptoms is soy foods. So edamame, tempeh, tofu. Why am I so such a big fan of these foods? Well, they contain isoflavones that have weak oestrogen-like effects in the body. They have been shown to improve menopausal symptoms in clinical trials of postmenopausal women who eat high amounts of dietary soy protein. They generally have fewer and less intense hot flushes and night sweats than those who eat less soy. Although the evidence is still mixed, I think the mechanism is still strong enough for me to recommend that soy products in the diet are going to be useful. There's also some evidence that it improves heart health as well. Randomised control trials show that soy protein of over 25 grams per day containing isoflavones significantly lowered cholesterol, triglycerides, apolipoprotein B levels in postmenopausal women. So 25 grams per day is not much whatsoever. I would actually say that you should be getting more than that, around 50 to 100 grams per day of soy products because they have that added protein that I was talking about at the start of this. And if that wasn't enough, there's also evidence that the isoflavones that we find in soy products can exert beneficial effects again the against the oestrogen deficient bone loss by modulating these oestrogen receptors. So I mentioned at the start that isoflavones have this weak oestrogenic effect. There are some clinical trials that have found that soy isoflavones had a beneficial effect against bone loss in women in perimenopausal and postmenopausal women as well. Now, there is a clear mechanism behind this. The studies, I will admit, are of short duration and they don't have many people involved in them, but there is enough benefit, I think, of soy products in general, if not for just the protein amount, but also these isoflavones that I think it is worthy of having in your diet as as much as you can, if not over 25 to 50 grams per day. My recommendations for soy products are to go organic. Always look for minimal ingredients, they shouldn't have too many preservatives. You tend to find things like sodium chloride, magnesium or a calcium-based preservative, those are fine. You also may find something that's called nigari, which is what you essentially fix the tofu in in packaged products. But generally, you want to go for minimal ingredients, so without any of the flavours or the sweeteners that can enhance the sort of texture and the and the flavour of these products, and always go for non-GMO as well. The fourth types of foods that I think you should be getting in your diet are calcium-rich foods. Now, the reason why is because the drop in oestrogen levels that occurs during the menopause can lower calcium absorption. And over time, this can lead to less mineralisation of bones and increased risk of fractures. So to help preserve bone health, it's recommended that women over the age of 50 get about 1200 milligrams of calcium each day. You can get this from food, you don't need to always rely on mineral-based supplements to get that amount. And the food sources are things like small fish. So that's actually where you're consuming the bones with the fish as well. So sardines, herring, mackerel, these are all great sources of calcium-rich fish. You can get it from dairy products, so such as yoghurt, milk, kefir and cheese. Tofu and soybeans again are also great sources of calcium, as are sesame. So getting tahini into your diet. And there are certain green vegetables like kale, spinach, broccoli, Chinese cabbage. These are also quite rich in calcium as well. So you're getting a picture now of the types of foods that we should be getting into our diet every single day from a calcium perspective, a protein perspective, and isoflavone or phytochemical perspective. So if you're having greens daily with some soy for protein, you're hitting the first four things that I'm suggesting in this list of five foods for the menopause. A tofu scramble with pak choi or a tempeh-based curry with squash and spinach. These are easy ways to get protein, vegetables, calcium and soy into your diet. So you're hitting four every single day if you can. The fifth types of foods I suggest for menopause are omega-3 rich foods. Now, omega-3 fatty acids are found primarily in oily fish and seafood, so salmon, herring, mackerel, sardines. There are also some plant sources such as flaxseed, chia and walnuts, they can also help, but the conversion of those short-chain omega-3 fatty acids to the long-chain ones that actually have these anti-inflammatory benefits, DHA and EPA, is in a lot of people not that efficient. So I think instead of relying on those plant-based sources, if you are vegan or you don't eat fish for whatever reason, then you may need to rely on an omega-3 supplement and you want to be getting around a gram of EPA and DHA in that supplement as well. You can get it from algae sources as well. The omega-3 fatty acids are fantastic for cardiovascular health. Menopause increases the risk of cardiovascular disease and omega-3 fatty acids are known to support heart health by reducing triglycerides, lowering blood pressure and decreasing the risk of heart disease. They have this unique inflammation-reducing potential. So omega-3s have anti-inflammatory properties that can help reduce the inflammation in the body, which can lead to cardiovascular problems. It's particularly important during the menopause where chronic inflammation is high and can exacerbate symptoms and increase the risk of health conditions more generally. The omega-3 fatty acids, as you can see in this diagram that I'll describe for the folks listening on the podcast here, are converted into something called specialised pro-resolving mediators, abbreviated to SPMs. These are called resolvins and protectins, and these molecules actively resolve inflammation and promote healing. So resolvins, for example, help clear away inflammatory cells and restore tissue function. There's also some suggestion in some studies that omega-3 can enhance calcium absorption and actually promote bone health. And there may be some mood effects as well. So omega-3 fatty acids, particularly DHA or docosahexaenoic acid, are important for brain health. They can improve mood, reduce the risk of depression, support cognitive function, which can be beneficial during the menopause where some women experience mood swings and cognitive changes as well. So overall, you're probably getting a pattern that this is very much a Mediterranean style diet that has some influences from Asia as well. Some people might call it the Mediterrasian style diet. So you're getting soy foods in there, you're getting dark green leafy vegetables, you're getting calcium-rich foods, omega-3 and sufficient levels of protein. Super, super important. Think about these five things, getting into your diet every single day. If you're interested in menopause-friendly recipes, I highly recommend you download the Doctor's Kitchen app, which you can do for free and check out the menopause health goal that we've just recently added for those extra menopause supportive recipes as well as the explanations that I've just given you here about why they are so healthy for the menopause. So, there are some menopause supportive ingredients that I think are worth a shout-out. So there are citrus fruits, grapefruits, lemons, limes, oranges. These are especially rich in flavonones such as naringin and hesperetin, and these may help protect blood vessels and lower the risk of heart disease through their antioxidant and anti-inflammatory effects as well. There was a recent trial in postmenopausal women that found that grapefruit juice, around 340 mils, providing 210 milligrams of naringin daily for six months, actually lowered arterial stiffness as well. Small study, I'm not a fan of getting fruit in the form of juice, but grapefruit juice is very different because it's quite low in sugar. But there is some benefit of having citrus in your in your meals according to some of those studies and the mechanisms as well. So adding a bit of grapefruit to your diversity bowl or a part of your overnight oats, having an orange in its whole form and just having that as a snack contributes to that combination of the fruits and vegetables that you should be having every single day, and there might be some additional benefits because of those flavonones as well. Another thing are B vitamin-rich foods. They support energy levels, brain function and can help manage stress and mood. There are some observational studies that show that intake of B vitamins is associated with bone mineral density and lower risks of depression. One study in 260 odd women aged 40 to 65 found that vitamin B6 reduced the severity of hot flushes by 8%. That's led to people taking vitamin B6 in isolation. I think you can also get it from food sources as well that can help. Leafy greens, whole grains, beans and nuts are the best sources of B vitamins as well. Magnesium-rich foods. This is really important because it helps the body absorb calcium and is involved in over 300 different processes. And there's some interesting research that suggests increasing magnesium intake may again boost bone density in women after the menopause. And most people do not get enough magnesium from their diet. Greens, greens, greens. When you think magnesium, you're going to think greens. Magnesium is at the centre of that chlorophyll molecule that makes greens that green colour. So if you're thinking asparagus, broccoli, kale, dark leafy greens, these are all magnesium-rich foods. Make sure you're getting these into your diet if if not at every meal, at least daily. You can also get it from pumpkin and chia seeds, nuts, almonds, cashews, legumes, black beans, kidney beans. You're getting a feel for the pattern of foods that are not just rich in singular minerals and vitamins, but actually rich in a whole plethora of different vitamins and minerals that are necessary, not just for menopausal health, but for overall health and well-being as well. Probiotics and the oestrobolome. I want to talk about your gut microbes. So not a lot of people realise, but the your gut microbes have the ability to increase oestrogen levels in circulation. Gut microbes with something called beta-glucuronidase or sulfatase enzymes, termed the oestrobolome, allow oestrogens that are absorbed into the gut via the liver to re-enter circulation and reach other tissues where it can have that desired oestrogenic effect. So I'll describe this diagram for folks listening on the podcast here. You have the liver that does something called conjugation to the oestrogens and that gets absorbed into the gut. Where you have those gut microbes in the large intestine, those do a deconjugation, you don't really need to know what that means, but that essentially changes the structure of those oestrogens so they can be reabsorbed into circulation. So you have this recycling of oestrogen that goes into your body. The diversity of your gut microbiome is reduced after the menopause. You have declining levels of oestradiol and progesterone, as you can see on the other graph here, that changes the diversity of your microbes. And so that that microbe composition actually becomes more similar to men rather than women. And that decline in oestradiol and progesterone can also lead to permeability of that gut barrier, again exacerbating inflammation. So what happens to the oestrobolome is that you don't get this extra the extra oestrogens being reabsorbed into blood circulation where they can have that oestrogenic effect. All this is to say that it can compound what is already a situation where you have crashingly low levels of oestrogen. And there is a suggestion that probiotics may have a benefit. You already know that probiotic foods may have a beneficial effect on the general decline of gut microbes. This could be after antibiotics, after having a long period of low-fibre diet. But specifically looking at menopausal issues, in bone health, there are trials in postmenopausal women that found that probiotic supplements increased bone mineral density, suggesting that it can slow down bone loss. In terms of menopausal symptoms, there was a small trial of 60 menopausal women who were given 100 grams of prebiotic-rich yoghurt daily after lunch and that lowered menopausal symptoms, anxiety and depression as well. You can get these probiotics not necessarily from supplements alone, you can get it from kefir, yoghurts, kraut. In terms of yoghurt, for mental well-being, consuming a probiotic yoghurt improved anxiety, stress and quality of life in postmenopausal women. There's many of these small studies. Now, they're not big enough for me to say in full confidence that this is going to improve symptoms, but they are suggestive enough and low risk enough for me to suggest that it's worth a shot having these kind of foods into your diet. So it might not be one of the mainstays of things that I suggest, but certainly as an additional add-on, having probiotic foods into your diet is is likely to be a good strategy considering that decline in oestradiol and progesterone that can reduce the diversity of your microbes. If you're interested in some additional add-ons that I think won't form the mainstay of a diet, but I think are worth it. Number one, anti-inflammatory spices. I'll check out the full episode that I've done on anti-inflammatory spices. Anything that reduces oxidative stress and inflammation is going to be beneficial for postmenopausal symptoms. So, turmeric, cumin, cinnamon, clove, these are all great spices to have in your diet, whether it's in the form of a tea, whether it's in the form of something that you add to a recipe. These are all fantastic and I highly recommend you use anti-inflammatory spices. Check out the full episode that I've done on that, just type in anti-inflammatory spices, Doctor's Kitchen and it'll come up, or you can check the captions below as well. Pomegranate. Now, in some studies, pomegranate improved the severity of hot flushes and menopausal symptoms, but these studies are very limited. They often involve a small number of people, they aren't always set up in the best way, so it can't, I can't be completely sure about all these benefits. It's promising, but we need more solid research with bigger groups to really understand the effect. And why might pomegranate have this effect? It's likely going to be due to the antioxidant and the anti-inflammatory effects of pomegranate and those different phytochemicals that you find in what is quite a tart, bitter fruit. Prunes. Now, there was a 12-month randomised control trial known as the PRUNE study. 50 grams daily were given to postmenopausal women and they were shown to preserve bone mineral density compared to the controls. Now, prunes are wonderful, 50 grams of prunes every single day seems like quite a lot, and I think there are probably other ways to preserve bone mineral density, but I thought that was an interesting one because it was literally called the PRUNE study. Anti-inflammatory effects of spices, like I've just mentioned, but the number one I would say is turmeric. There was actually small trials that found that oral intake of curcumin and vitamin E significantly reduced hot flushes in postmenopausal women. The problem with curcumin and turmeric studies is that a lot of them are actually funded by the manufacturers of them, so you just need to be careful of that. But turmeric as an anti-inflammatory spice, I think is a no-brainer really. Any foods that lower cholesterol and blood pressure are things that you should definitely be thinking about as well. I'll check out our full episode on cholesterol-lowering foods. We've got that in the captions down below as well. I'm going to talk about five lifestyle habits now to improve menopausal symptoms. Number one, drinking enough water. Now, adequate fluid intake is important at any stage of life, but it's also got an important role in regulating heat balance, detoxification, maintaining proper functioning of your GI tract and the moisture of mucous membranes as well as the turgor of your skin. But there is some interesting research suggesting that drinking enough water can help maintain a healthy weight by regulating appetite. This improves metabolism and makes exercise a lot more efficient as well. So the simple act of hydrating enough can be useful when it comes to weight regulation. I'd always drink before you're thirsty, don't wait until you feel the impetus to to drink. I'd keep sipping water regularly throughout the day, keep a water bottle handy. I'd also think about infusing your water with slices of fruit, like the citrus fruit that we mentioned earlier that are beneficial for menopausal symptoms, or even certain spices like clove or rosemary. These again add to the antioxidant levels that you're going to find could potentially benefit menopausal symptoms as well. I'd drink herbal teas that are decaffeinated and don't have that diuretic effect. I'd also keep an eye on the colour of your urine to see if you're drinking enough as well. So you want your your colour of your urine to be straw-coloured. The second lifestyle tip is exercise. Why? Well, it can help lower vasomotor symptoms, it can improve sleep and mood. Several studies show that assigning menopausal women to strength exercises, so that's working on the biggest muscle groups, your glutes, your hamstrings, your hinge movements, these increase bone density and hormonal metabolic responses. So things like heart, blood pressure, hot flushes, these are all improved compared to inactive control groups and other interventions. Exercise is probably one of the best interventions that anyone can do for healthy ageing, regardless of whether you're postmenopausal or not. And strength exercises are super, super important. When it comes to the best type of exercise, the research isn't entirely clear since different exercises can offer different benefits. For example, yoga might be beneficial for vasomotor and psychological symptoms, while strength and resistance training can help maintain that muscle mass and bone mineral density. But if you combine all these different exercises, you're giving yourself a smorgasbord of all the different benefits that high-impact exercises like jumping, skipping and jogging can have versus the strength training and weight training exercises and and the like. So you you want to really be spreading your bets across all those different types of exercises. If I was to offer a routine, it would be two strength days in the week and two cardiovascular days in the week as well. Just doing that every single week is is going to essentially guarantee that you're going to benefit from those the the impact of of exercise. There was actually a new study led by UCL researchers for menopausal women who regularly swam in cold water and they reported significant improvements to their physical and mental health symptoms. Now, it really depends on whether you're someone who enjoys the stress of being in cold water. I personally don't like that stress and I don't find that the euphoric effects after cold water exposure outweigh the pain of being in cold water. But it might be an interesting exercise to experiment with. You're getting the cardiovascular benefits of swimming and you're getting some benefits of the cold water exposure that can potentially mitigate against mental health issues. So it's something to experiment with, but not something that I I personally would like to do. And finally, we get asked about herbs and supplements quite a bit. And these are the ones that I think probably have the most value looking at the evidence that we have available. Vitamin D, it's essential for slowing down bone loss and aiding the absorption of calcium. And research shows that osteoporosis treatments only achieve their effectiveness with adequate vitamin D supplementation. So that's around 1,000 international units per day. Increased intake from dietary sources is also tied to a 17% lower risk of early menopause, but I think it's actually quite hard to get your intake of vitamin D that's required from food alone. The food sources are fatty fish, trout, salmon, tuna, mackerel, and UV-exposed mushrooms and egg yolks, but it's very hard to get to the levels of supplementation doses that I recommend. So getting at least 1,000 international units per day is recommended. Some people need more, like myself, I need 3,000, and I titrate that according to my vitamin D blood levels as well. So get your vitamin D blood levels checked and ensure that you're supplementing the correct amount to push yourself into the optimum range of vitamin D. Herbs like black cohosh, ginger, red clover, sage, they are associated with reduced hot flushes and night sweats. Red clover tea is actually a plant in the Fabaceae family, the legume family, and that may lower hot flushes. There was actually a meta-analysis of eight trials that found that red clover supplementation taken for three months resulted in an average of 1.7 fewer hot flushes daily compared to placebo, particularly in postmenopausal women experiencing at least five hot flushes daily. The dosage is over 80 milligrams per day. So if you're going to be trying this, you want to make sure you're getting a total isoflavone content of over 80 milligrams per day. That is the dose that showed the most effect as well. More research is needed. There aren't many longer-term trials and a lot of these trials are funded as well, so there's a big confounder there, just to be honest about it, but it may be worth a shot. Sage tea. So this has also been shown in a meta-analysis of four clinical trials that found that daily sage extract of 100 milligrams, that was the dose, 100 milligrams of sage extract, lowered the frequency of hot flushes in postmenopausal women. Beyond hot flushes, there was actually one trial in 66 women that found that sage extract improved night sweats, heart palpitations, muscle and joint pain, depression, anxiety, sleep disorders compared to the control. So that was quite an interesting trial. Again, that was using 100 milligrams of daily sage extract. There's also some small trials looking at sage extract to improve memory and cognitive performance of older adults in general as well. So there may be some benefits of sage extract that you might want to trial with. Why is it having this effect? Well, it's a source of polyphenols. These phenolic acids such as caffeic acid and flavonoids are considered phytoestrogens, so it might be having that weak oestrogenic effect. But honestly, even though there was a meta-analysis, those four clinical trials were of quite poor quality in terms of the number of people involved in the studies themselves and the fact that some of them were funded too. So this is a very murky field, but if you are going to try some of these, those are the ones that I would suggest have the most value. And that is pretty much it. In terms of the amount of things that you can do from a dietary perspective, lifestyle perspective, and herbs and supplement perspective, these are the ones that hold the most value. Everything else really fits into the category of whether hormone replacement therapy is for me, if it's appropriate for me given my background, my medical history, and how you get access to that as well. And I always discuss that with your personal physician and and exploring the different treatment options. But there is a lot that we can do with diet, lifestyle, supplements and herbal remedies as well. If I've missed anything, let me know in the comments and I'd love to hear from you.
