It’s taken a while for the research to be undertaken exploring the link between our nutrition in menopause and our hot flushes, or as they are better known in medical parlance, ‘vasomotor symptoms’. That’s why I love this new research, conducted as part of new women’s studies in America.
The Women’s Study for the Alleviation of VAsomotor Symptoms (WAVS), consolidates much of what I’ve been studying about the incredible link between heat production in the brain, which is where hot flushes start, temperature dysregulation in menopause and our diet.
Whilst high-fat, high protein diets have become popular in peri-menopause and menopause for weight loss, primarily due to the marketing of the Keto diet, this type of dietary approach doesn’t sit with the women’s cardiovascular health and menopause symptom management research for women in their menopause and early post-menopause years. Convincing women of this is challenging, which is why this new research sheds some light on the type of diet we need to help reduce our hot flushes (Barnard, Kahleova et al., 2021).
I first came across Dr Neal Barnard MD, when he presented on a Diabetes Symposium at an Australasian Lifestyle Medicine conference. As a leading authority on nutrition and hormonal health, he researches and applies his findings to a broad range of health conditions – whether it be infertility and endometriosis or in the case of this very new research, hot flushes (vasomotor symptoms) in menopause.
A number of multi-ethnic women were selected for the study based on the number of hot flushes they were having day and night and then were classified into a control group, versus a dietary intervention group.
The dietary intervention group was asked to follow a low-fat, vegan diet, based on fruits, vegetables, whole grains and legumes, minimise fatty foods and to have ½ cup (86 grams) of cooked soybeans daily.
The control group participants were asked to maintain their customary diets. And whilst it is well known that women on a plant-based diet generally don’t get Vitamin B12 (Cobalamin) which is an intrinsic factor present in animal protein foods, both groups were provided with a daily Vitamin B12 supplement.
This is one of the strategies that I get women to consider on the MyMT™ programmes too (and get blood tests done), if they are shifting to a mainly plant-based diet and/or they are exercising heavily and still menstruating. It is well known in the sport and exercise science literature that female athletes can be low in B vitamins, including Vitamin B12.
With women who are in menopause or post-menopause however, the need for B-vitamins and folate increases if women have developed higher homocysteine levels. Homocysteine is an amino acid or protein.
Vitamins B12, B6 and folate break down homocysteine to create other chemicals the body needs for energy. This helps to reduce increasing risk for cardiovascular disease. High homocysteine levels may mean you have a vitamin deficiency and without treatment, elevated homocysteine increases your risks for dementia, heart disease and stroke. Hence, if you are having lots of hot flushes and you have a family history of heart disease then I encourage you to get your homocysteine levels checked with your Doctor.
But back to our plant-based, low fat, hot-flush prevention diet from Dr Barnard and his team.
What I loved about this research was the emphasis on low glycemic index carbohydrates – yes, to all of you ‘low carbohydrate, no grain’ devotees, this dietary research included whole-grains. It also included low glycemic index carbohydrates, which, if you’ve been following my posts for a while, you will know that I favour these types of carbohydrates on the MyMT™ programmes too.
What also fascinated me about this study was the discussion on cultural differences in hot flush prevalence over our lifetime. The researchers noted that in the 1980s, over 1000 women living in Japan were surveyed for reporting of hot flushes. For the Japanese participants 13% of peri-menopausal women and 15% of post-menopausal women reported positively for vasomotor symptoms. Compare this to Western countries where vasomotor symptoms (hot flushes) impact 80% of menopausal and post-menopausal women and you have the curiosity that in Japan, compared with North America, cultural and biological variables may be acting in concert to produce this variation. (Lock, 1998; Barnard, Kahleova et al, 2021).
Furthermore, with the change of diet to higher meat and protein consumption in Japan, a 2005 study reported that compared with the 1980s study, the prevalence of hot flushes in Japanese women had increased, but still hadn’t reached the prevalence data found in women living in western countries. The difference, according to Barnard et al study, was that soy intake continues to remain higher in Japan compared with the United States and Canada.
The Power of Plants for Menopause Hot Flushes
Many of you have heard me talk about the inflammatory changes that arrive in peri-menopause. With the decline of oestrogen in menopause impacting the loss of elasticity in blood vessels and nerves, as well as the known contribution of menopause insomnia on inflammation in the body, a plant based diet helps to alleviate many of these inflammatory changes.
With the right type of vegetables and fruits and plant-based proteins and fats, a variety of nutrients are provided as well as certain bioactive constituents which help to modulate immune and inflammatory processes.
When we also choose carbohydrates that have a lower glycemic index and glycemic load, our pancreas doesn’t have to work as hard to produce insulin. I often refer to the glycemic index of carbohydrate foods in my Hot Flush Module in my programmes.
In the early 1980’s researchers noted that the body digests carbohydrate-rich foods at different rates and its insulin response to each food varied. Insulin is a hormone that is often forgotten about during menopause, but when blood glucose levels are high our ageing pancreas has to produce more insulin.
But not only is it foods that contain large amounts of refined carbohydrates that are the problem, but also high fat diets too. Fats convert in the body to 3 fatty acids and one glycerol (glucose) molecule. The more fats you eat, the more glycerol your liver is converting, the more insulin you are producing. It’s a vicious cycle.
Carbohydrates that have a high glycemic index rating induce a rapid flow of glucose into the blood-stream, raising blood glucose and insulin relatively sharply. But when higher fibre carbohydrates are eaten such as plants and fruits, blood sugar levels don’t rise so quickly. This observation led researchers to the development of of the dietary concepts of glycemic index and glycemic load. Both of these systems classify foods by comparing the rise in blood glucose depending on the amount of carbohydrate eaten. If you are experiencing hot flushes and night sweats, especially following a hysterectomy, this is important information to understand!
Carbohydrates aren’t all bad!
When I hear that women have cut out carbohydrates in the form of grains or certain starch vegetables from their diet, I despair! There is so much mis-information about the role of carbohydrates in the body, but for busy women experiencing hot flushes, it’s important to have the right type of carbohydrates in your diet.
Carbohydrates are an important source of energy for the body and none more so, than for busy women going through menopause. Glucose is the primary end-product of carbohydrate and is an important fuel for muscles and other cells, our nervous system and red blood cells. If you don’t have enough glucose, especially if you are an exerciser, then you have very little energy.
This is why plants are an important component of our diet. They give your body carbohydrates – which in turn helps our energy levels, reduces inflammation and subsequently, help to reduce our core temperature. Afterall, a hot flush or night sweats is a sign that your body is over-heating and trying to get rid of heat. New research and improved brain scan technology also indicates that our hot flushes start in our hypothalamus region of our brain and occur when the nerve endings thicken due to declining oestrogen. The nerve endings become inflamed. (Zhang, deVittorrio et al, 2021)
That’s why scientists, including the WAVS study (Barnard et al, 2021) have increased their interest in the intake of Soybeans. The isoflavones in soybeans may help to reduce hot flushes.
If you can tolerate whole soybeans (organic preferably) then you might also like to add these to your diet. This is because of the conversion of soybeans to isoflavones. The WHAS study recommended ½ cup per day of well soaked and cooked soybeans. This delivers around 55-60 grams of isoflavones. The popularity of soybeans is that the soy isoflavones have greater affinity to oestrogen receptor-B, hence they are used to help re-balance oestrogen in the body.
When soybeans are eaten, gut bacteria change very quickly and in some women, this can cause bloating and discomfort at first, hence, some women tolerate soybeans and others don’t until they sort out their gut health as they transition menopause. If women also are on treatment for breast cancer, then some of these oestrogen-mimicking foods are also not recommended. Once again, ‘one-size doesn’t fit all’!
The greatest success of women in the MyMT™ programmes is that they become the main characters in their own lives. Like me, they now better understand that our menopause transition is a time of life, whereby we need to take back control of our health. One of these strategies is to do with our nutrition – and in this respect women in their menopause transition and in post-menopause don’t need to follow popular dietary fads of the day, but instead, follow the research.
The purpose of these articles is to help you make the right decisions and if you find it all a bit confusing, then please do consider coming onto my 12 week self-paced, online coaching programme. You won’t be alone. MyMT™ is more than a programme. We are an active community of thousands of women around the world bound together by a common goal of getting our energy, sleep and sanity back!
Achieving a reduction in our hot flushes, losing weight and restoring our health as we age, requires shifting to a primarily plant-based diet and for women, the Mediterranean Diet offers an approach that meets the scientific evidence for women’s health as we age. Whilst our symptom management isn’t ‘just’ about diet however, (sleeping all night is the main health issue to resolve), the information in MyMT™ is built on the science of health ageing specific to women and follows by 7 Pillars of Women’s Health.
I hope you can join me and my fabulous community of like-minded women sometime soon. Or at least, commence with my 2 hr Masterclass on Menopause and yes, you can ‘pause’ me anytime. There is a small fee for this of only NZ$15/ £10 as I host this in my private member area. The video telling you about the Masterclass is below.
Dr Wendy Sweet (PhD), Founder: MyMT™/ Member: Australasian Society of Lifestyle Medicine.
Barnard, N. D., Kahleova, H., Holtz, D. N., Del Aguila, F., Neola, M., Crosby, L. M., & Holubkov, R. (2021). The Women’s Study for the Alleviation of Vasomotor Symptoms (WAVS): a randomized, controlled trial of a plant-based diet and whole soybeans for postmenopausal women. Menopause (New York, N.Y.), 28(10), 1150–1156.
Lock M. Menopause: lessons from anthropology. (1998). Psychosom Med. Jul-Aug;60(4):410-9. doi: 10.1097/00006842-199807000-00005.
Watzl B. (2008). Anti-inflammatory effects of plant-based foods and of their constituents. Int J Vitam Nutr Res. 78(6):293-8. doi: 10.1024/0300-98188.8.131.523.
Zhang, Z., DiVittorio, J. et al (2021). The effects of estrogens on neural circuits that control temperature. Endocrinology, 162 (8), 1–12