#Menopause: some dietary and lifestyle considerations

What is the menopause?

The Menopause is the name given to the time when a women’s ovaries slowly stop working and the average age when this happens is 51. This leads to a fall in levels of the oestrogen and is thought to be related to a variety of symptoms such as hot flushes, irritability and joint pains. Roughly 80% of women suffer from some menopausal symptoms which last on average for 2 years, but for some women the symptoms can last for over 5 years.

Why is diet and lifestyle important during the menopause?

Due to falling oestrogen levels, during the menopause and after there is a rise in the incidence of osteoporosis as calcium is lost from the bones. Oestrogen is also cardioprotective, so by the age of 65 the risk of heart disease in women reaches the same as that in men. A Healthy diet and lifestyle can offset some of these risks, such as by eating a cardio-protective diet and ensuring adequate calcium and vitamin D is consumed.

Maintaining a healthy weight

During the menopause, joints can become painful and excess weight can exacerbate this problem. Excess weight will also increase the risk of heart disease and certain cancers such as breast and colorectal cancer, during this time. The metabolic rate of women does seem to decline with age and after the menopause there is a tendency for upper lean body tissue mass to reduce (which further reduces metabolic rate) and the fat deposition around the stomach (central adiposity) to increase. This type of fat distribution is itself a risk factor for heart disease, insulin resistance, and possibly breast cancer (Friedenreich CM, 2002)

 Physical Activity

Body fat percentage tends to rise during the perimenopause and menopause. This is because muscle mass tends to fall, especially on the upper body. Just by being present, muscle helps to burn up the calories as it is metabolically active, unlike fat. It is important for menopausal women to therefore try and do some strength /resistance/weight exercised to boost muscle mass. Aerobic and weight exercises both help to also reduce weight gain around the middle. This central adiposity (male pattern fatness) make women more apple shaped rather than the healthier pear shape. Being apple shaped is also associated with increased risk of heart disease and insulin resistance. Weight bearing exercise will also help to offset osteoporosis. A lower BMI is associated with fewer hot flushes and night sweats (Whiteman MK, 2003) and physical activity is associated with fewer menopause symptoms

 Dietary fats

Benefits of reducing fat in the diet:

•improved lipid profile (Davidson MH et al 2002)

•reduced incidence of heart disease

•weight loss •possible reduced incidence of dementia (Moroney JT et al, 1999)

•reduced breast tenderness

Monosaturated fats help to reduce fatty plaques, they can be found in rapeseed oil (canola), olive oil, avocado oil, linseed oil, hempseed oil (these are also good vegetable sources of omega 3 oils).

Trans fats are particularly harmful, causing a rise in LDL and a lowering of HDL cholesterol.  They are found in some pies, pastries, pizzas and biscuits but now removed in most spreads.

Fruit and vegetables

Eating plenty of fruit and veg has been associated with reduced Bone Mineral Density(BMD) loss during the menopause and an increased BMD at the hip after the menopause (Burckhardt P et al, 2001).

Brassicas, such as broccoli and sprouts, may be associated with a decreased risk of breast cancer in post menopausal women. (Fowke JH et al, 2000)

Osteoporosis

From the age of about 25, the rate of bone resorption exceeds that of deposition so that calcium is slowly lost from the bones.  This loss is escalated during the menopause, due to a fall in oestrogen levels, and continues for up to 10 years after the menopause.

It is important to have a diet rich in calcium with vitamin D to help absorb calcium.  Calcium is found in dairy foods, tofu, green vegetables, beans and fish that contain edible bones.

The UK Osteoporosis Society recommend that menopausal women not on HRT have a higher intake of calcium.  Calcium intake in the UK is set at 700mg for adult women, but if there is osteoporosis, then the NOS recommend an extra 500mg calcium, bringing levels up to 1500mg.

Other factors affecting bone health:

Vitamin A:seem to be associated with an increased risk of osteoporosis, so watch supplements and fortified foods. (Feskanich D et al 2002)

Caffeine: Coffee seems to be the main culprit, especially if drunk black.

Phytates: found in dietary fibre which will bind to Calcium and prevent its absorption.  For this reason pure bran should not be advocated for sprinkling on food as a fibre supplement.

Protein consumption: Over consumption of protein should be avoided, in particular meat as this may lead to an increased excretion of calcium, particularly if phosphorous consumption is low.  However low protein intakes are also associated with osteoporosis. (Burckhardt P et al 2001)

Salt: over consumption encourages calcium to be lost through the kidneys and so excess should be avoided. (Burckhardt P et al 2001)

Alcohol: poisonous to the osteoblasts (bone forming cells), although at moderate levels it is associated with increased bone density.

 

Vitamin D

Vitamin D is found in eggs, oily fish, butter and margarine and fortified breakfast cereals.

10-15 mins sun on face and forearms during summer months is also recommended to keep the body topped up with vitamin D throughout the year, although the manufacture of vitamin D by the action of sunlight is less efficient as the body ages. In the UK, people over 60 are recommended to take a 10 mcg supplement daily (DoH, 1998)

Vitamin D is also believed to help reduce heart disease in women

Starch and Fibre

Dietary advice for maximum health benefits include the recommendation to eat around 40-50% of calories as carbohydrate, with as much as possible coming from unrefined sources

Women during the menopause should be encouraged to  eat starchy food at each meal as they provide a steady release of energy and are less likely to cause weight gain or heart disease compared to fats.  An Atkins type diet shpould be avoided.

Fibre helps to keep the bowels healthy and help reduce cholesterol levels and the risk of developing some cancers.  Fibre intake is also associated with increased bone density at the spine.

Alcohol

Excess alcohol is associated with:. •hot flushes •osteoporosis •weight gain. •Cancer, especially of the breast

Excess alcohol can give rise to weight gain as well as potentially more serious conditions such as liver disease and encourage certain cancers and it is also damaging to osteoblasts (the bone forming cells)

However moderate drinking (an average of two units a day) need not be discouraged as the flavonoids such as resveratrol  in alcohol may protect against heart disease.

Alcohol can also lead to increases in healthy HDL levels.

Alcohol drinking after the menopause has been found to be particularly beneficial after the menopause as a way of offsetting heart disease (Baer DJ et al, 2002).

Salt

Consuming more than 6g salt a day can lead to high blood pressure. It may also cause calcium to be lost from the bones, thus predisposing to osteoporosis. A high salt diet may also exacerbate bloating and fluid retention.

To cut down: reduce the amount of processed foods you eat or choose lower salt varieties and don’t add salt to your food (use more herbs and spices). 75% of salt in our diet in the UK comes from processed food. Therefore read the label and aim to have no more than 6g a day (UK SACN guidelines 2002)

Phytoestrogens

Possible Benefit of including these plant oestrogens in the diet are:

•May help reduce some menopausal symptoms e.g. hot flushes (North American Menopause Society, 2000), but absolute proof is still missing

•May help reduce incidence of Cardiovascular disease (Washburn S, et al 1999), including post-menopause

•May help with Cholesterol lowering (still debated)

•May benefit Bone health

•May help reduce Blood pressure

Due to a very similar structure, phytoestrogens can bind to some of the same receptors as oestrogen (mostly the beta oestrogen receptors), but has a weaker effect than oestrogen.

Phytoestrogens have anti-oxidant properties too which may explain some of their functions.

How much soya is enough?

A total of around 50mg isoflavone is believed to be required to help relieve some of the symptoms of the menopause including hot flushes. It may take up to 12 weeks to start to see the beneficial effects of the phytoestrogens on symptoms.

Isofalvones seem to work best when they come from the diet and there is some evidence that omega 3 oils enhance the effect.

There are still some concerns over their safety, even so, many women are being recommended to try them as a safer alternative to HRT

Food sources of phytoestrogens

•Soya and soya products such as soya milk, tofu, soya yogurts

•Vegetables and fruit •Seeds especially flax seeds (linseed).

•Nuts

•Peas, beans and lentils

References

•Friedenreich CM. Weight gain, waist-hip ratio identified as risk factor for breast cancer. Int J Cancer 2002; 99:445-452 •Whiteman MK. Smoking and Obesity Increase risks of severe Hot Flashes. Obstet Gynecol 2003; 101:264-272 •Davidson MH, Maki KC, Karp SK, Ingram KA. Management of hypercholesterolaemia in postmenopausal women. Drugs Aging 2002; 19(3): 169-78 •Moroney JT, Tang MX, Berglund L. Low–density lipoprotein cholesterol and the risk of dementia with stroke. JAMA 1999; 282:254-260 •Fowke JH, Longcope C, Hebert JR.  Brassica vegetable consumption shifts estrogen metabolism in healthy postmenopausal women. Cancer Epidemiol Biomarkers Prev 2000; 9(8): 773-9 •Burckhardt P, Dawson-Hughes B, Heaney RP. Nutritional Aspects of Osteoporosis. 2001; London: Academic Press •Feskanich D, Singh V, Willett WC, Colditz GA. Vitamin A intake and hip fractures among postmenopausal women. JAMA 2002; 287(1):487-54 •Department of Health: Report on Health and Social Subjects (49): Nutrition and Bone Health. London: The Stationary Office; 1998 •Baer DJ, Judd JT, Clevidence BA, Muesing RA, Campbell WS et al. Moderate alcohol consumption lowers risk factors for cardiovascular disease in postmenopausal women fed a controlled diet. Am J Clin Nutr 2002; 75(3):593-9 •Scientific Advisory Committee on Nutrition (SACN) Draft report on salt. [cited 2002 November 4]. Available from: URL: http://www.sacn.gov.uk • Washburn S, Burke GL, Morgan T, Anthony M. Effect of soy protein supplementation on serum lipoproteins, blood pressure and menopausal symptoms in perimenopausal women. Menopause 1999; 6:7-13 • North American Menopause Society. The role of isoflavones in menopausal health. Menopause 2000 Jul-Aug;7 (4):215-229

 

 

 

 

 

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