Menopause

Tuesday, April 10th, 2012

#Menopuse: top ten tips

  1. Eat a variety of foods: This will ensure your body gets a mixture of all the nutrients you need.
  2. Eat the right amount for you. You may not need to eat as much as you did when you were younger unless you are very active
  3. Avoid excessive amounts of animal-based saturated fats; they may encourage weight gain and increase your cholesterol level.
  4. Have a diet rich in calcium and vitamin D (which helps you absorb calcium). Calcium is found in dairy foods, tofu, green vegetables, nuts, seeds, beans and fish with their bones in. As well as from sunlight, Vitamin D is found in oily fish, eggs and some fortified breakfast cereals.
  5. Eat at least 5 portions of fruit and vegetables daily, and preferably 9!  This is to ensure that your body gets enough disease fighting phytochemicals. Along with wholegrain starchy foods, vegetables provide the mood-regulating mineral, magnesium, which is often low in menopausal women.
  6. Eat at least 2 portions of oily fish a week, or take a fish oil supplement. This will provide long chain omega 3 fatty acids that can help protect your heart and other organs.
  7. Have something starchy and rich in fibre with each meal, such as brown rice, brown pasta, wholegrain bread and breakfast cereals. This will help keep your bowels regular and will provide you with a long lasting supply of energy!
  8. Avoid excess alcohol and caffeine. They can be toxic to your body and will drain your energy. Alcohol and coffee may make hot flushes worse and pre-dispose you to osteoporosis, and alcohol may contribute to weight gain. Reducing your caffeine consumption may also help to alleviate any breast tenderness.
  9. Cut down on salt. This can lead to high blood pressure and may cause calcium to be lost from the bones, thus predisposing to osteoporosis. A high salt diet may also exacerbate bloating. To cut down on salt, reduce the amount of processed foods you eat and don’t add salt to your food.

 

10.  And finally, enjoy your food. Eating is more than just getting adequate nutrients- make it a social occasion!

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Tuesday, April 10th, 2012

Eating well during the #menopause

 

 

Menopause is the name given to the time when your ovaries slowly stop working. This leads to a fall in levels of the hormone oestrogen and is thought to be related to a variety of symptoms such as aching joints, and calcium loss from bones. HRT is not suitable or liked by everyone but, whether you use it or not, taking care with your diet may help alleviate some of the symptoms.

ENJOYING A HEALTHY DIET

A good diet will enable you to achieve or maintain a healthy weight and may help protect you from illness. You may want to try: •Eating less fat, especially saturated fat

•Eating less salt and sugar

•Eating more wholegrains and fibre

 How to Eat Less Fat

Fats in general are very high in calories and saturated fat in particular, may raise cholesterol levels.So:

•Cut down on butter, suet, lard and ghee.

•Measure oil using a spoon rather than just pouring it into the pan.

•Instead of frying or roasting with fat, try grilling, microwaving, poaching, baking, boiling or steaming.

•Try spreading butter, spreads as thinly as possible.

• Cut down on pastries, pies, samosas, crisps, olives, croissants, cakes, biscuits and chocolate.

•Cut all visible fat off meat and take the skin off poultry.

•Instead of sausages, burgers, salami, pates and processed meats, try lean cuts of meat and use more poultry and fish or vegetarian options.

•Try skimmed, 1% or semi-skimmed milk and half fat or cottage cheese rather than whole milk and full-fat cheese. Replace cream with low fat yogurt or fromage frais.

Curtting down on sugar

To save calories you may also want to cut down on Sugar. Sugar is not an essential part of your diet, but can add taste to your food and its health implications are that in excess may lead to extra calories.. Cut down on:

• Ordinary fizzy drinks or squashes.

•Sugar, fructose, artificial sweeteners containing sugar

•Jam, marmalade, lemon-curd, honey.

•Sweets, chocolates, biscuits, cakes.

Try instead:

• Sugar free or “no added sugar” drinks and mineral water.

•Sweeteners without sugar.

•Low sugar jam, marmalade or pure fruit spreads.

•Fruit, plain biscuits (e.g. Rich Tea, Digestive)

Eating less Salt

You only need about a teasponn of salt every day, and that includes the salt in bought food such as bread. Indeed 75% of your daily salt comes from food you buy. So choose lower salt varieties (read the label and compare brands) and do not add salt if you can (or just the very minimum) in cooking or at the table

How to Eat More Wholegrains and Fibre

Try to eat starchy wholegrain foods 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. Wholegrain cereals are a good source of magnesium, a nutrient which is essential for a healthy menopause but may be low during this time.   wholegrains also tend to be higher in fibre.  Wholegrain foods include, wholegrain bread, brown rice, brown pasta, and wholegrain breakfast cereal.

Fibre may help to prevent constipation and keep your bowels healthy and help reduce cholesterol levels and the risk of developing some cancers. To eat more fibre:

  •  Choose wholegrain breakfast cereals, wholemeal bread/pasta and brown rice.
  •  •Try using wholemeal flour (or a half/half mixture of wholemeal and white flour) when: baking.
  • •Have larger portions of salad. vegetables and fruit (fresh or tinned in natural juice).
  •  •Try using beans, peas, lentils and sweetcorn in soups, stews and casseroles.

 

NB It is important to drink plenty of fluid (at least 6 – 8 cups/day) to allow the fibre to work properly.

 

 How to Eat More Vitamins and Minerals

You should be able to get all the vitamins and minerals that you need by eating a wide variety of foods:

•Try to have five portions of fruit/vegetables daily (not including potatoes).  A portion of fruit is:

  •  A piece of fruit e.g. an apple, an orange, a banana.
  •  A small bowl of tinned or stewed fruit.
  •  A small glass of fruit juice.
  • A handful of smaller fruits, e.g. strawberries, cherries, and grapes.
  • A portion of vegetables is: 2 tablespoons cooked vegetables. A small side-salad.
  • Beans and pulses also count as a portion even if canned

 

Fruit and vegetables are good sources of many vitamins and minerals and are believed to reduce the risk of developing certain cancers and heart disease. They are also a rich source of magnesium, which may help to relieve some menopausal symptoms.

•Try to eat fresh fruit and vegetables within one to two days of purchase, as the vitamin and mineral content decreases over time. Remember frozen can be just as nutritious as fresh.

• Cook vegetables in a small amount of water for as little time at possible to preserve the nutrient content.

Reducing your Alcohol Intake

Drinking too much alcohol is bad for everyone. The recommended guideline for sensible drinking in women is no more than 14 units/week, spread throughout the week with two drink-free days. You may find that during the menopuse you cannot drink as much alcohol as you used to before it starts to have an effect on your judgement etc

1 unit of alcohol is:

•1 pint of standard strength beer/larger.

•1 glass wine or sherry.

•1 measure spirits.

MAINTAINING A HEALTHY WEIGHT

It is important to maintain a healthy weight, as it will reduce your risk of developing certain diseases such as diabetes and may help to reduce hot flushes. . However, take care not to lose too much as, this will lower oestrogen production, put you at greater risk of osteoporosis and may make your symptoms worse.

SPECIFIC DIETARY ADVICE

 Osteoporosis

This is the name given to the condition where bones lose calcium and so become fragile and prone to breaking easily. From the age of about 25, there is a slow loss of bone in both men and women. However, during the menopause, oestrogen levels drop, causing an increased loss of calcium from bones. This is more common in menopausal women, who are not on HRT, as HRT replaces oestrogen. In order to get sufficient calcium in your diet you need to have at at least 3 helpings of calcium rich foods in your diet everyday. Four helpings are advisable if you are at risk or have osteoporosis or do not take HRT. These include:

• 1/3 pint of milk or milky drink/milkshake

•1/3 pint fortified soya milk •Small pot of yogurt

•25g (1oz) of hard/medium hard cheese (about the size of a small matchbox

•A pudding made with milk such as rice pudding, custard

•Ice cream

•A portion of pizza containing cheese

•A portion of quiche containing cheese •A sauce made with milk or cheese

•A portion of fish with edible bones e.g. sardines (eat the bones)

•A portion of tofu (soya bean curd)

Other foods also contain some calcium and can help to boost your daily intake:

• Bread

•Shellfish

•Oranges

•Green leafy vegetables especially spinach, cabbage and broccolli

•Nuts, especially peanuts, almonds and Brazils

•Beans, for example baked beans, butter beans

•Dried fruit, especially figs, apricots and dates

If you are still concerned about your calcium intake then see the doctor and/or seek referral to a state registered dietitian. Drinking too much alcoholic may increase you risk of osteoporosis and make hot flushes worse, as may eating too much salt. Vitamin D is essential for bone health too, as it allows the calcium to be absorbed from your diet. It is found in eggs, oily fish, margarine, butter and some breakfast cereals are fortified with it. The body manufactures most of our vitamin D when sunshine falls on the skin. If you avoid the sun, or are over 65 years of age, it is advisable for you to take a cod liver oil supplement that contains vitamin D.

Breast Tenderness

Reducing your caffeine intake may help with this and other symptoms such as hot flushes, anxiety and mood swings. To reduce your intake:-

• Cut down on coffee, tea, cocoa and caffeinated fizzy drinks (e.g. cola).

•Try mineral water, herbal tea, decaffeinated tea and coffee.

Following a low fat diet (see earlier) may also help breast tenderness. You could also try evening primrose oil (2-4 capsules twice daily). It can take up to 4 months for it to have an effect. If you have not noticed any improvement after this time, then it should be discontinued.

Fluid Retention

Many women experience this during the menopause. Try the following suggestions:

•Drink at least 6-7 glasses or mugs of liquid daily. This helps your kidneys to work efficiently.

•Reducing your salt intake may help to relieve bloating and may also help to offset the rise in blood pressure which can happen during and after the menopause.

 Plant Oestrogens (Phytoestrogens)

Some foods from plant sources contain natural oestrogen which scientists now believe could help boost a diminished oestrogen production and hence help reduce menopause symptoms and maintain bone health without the use of HRT.    Good sources include Soya beans and Soya mil. Rice, barley, potatoes, carrots and other vegetables and grains also contain some. Supplements containing plant oestrogens can also be purchased. Plant oestrogens seem to work for some women but not others.

 

Last of all , remeber to still enjoy your life and take pleasure in eating!

 

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Monday, April 9th, 2012

#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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