Perhaps your client’s are being woken by leg cramps at night?
Maybe they are regular exercisers and don’t understand why they aren’t recovering the way they used to?
Maybe your clients assume that muscular aches and pains are a normal part of menopause? Or maybe they are taking supplements such as turmeric and glucosamine targeted towards women in middle age and older, hoping for the relief that they deserve – but these no longer work for them?Â
The interview I did with a journalist last year was interesting. She had watched my Masterclass on Menopause, and had picked up on a statement I had made, about women backing off high-intensity exercise.
“Why don’t you promote high intensity exercise like everyone else does for women in menopause?” she queried.
I’m assuming she hadn’t talked to women who had sore knees, plantar fasciitis, aching joints and who weren’t sleeping.
Women on my own doctoral studies were the same … as I was too.Â
“Menopause has been so heavily medicalised” I mentioned, “and only viewed through the lens of hot flushes, anxiety and depression. But there’s so much more to it than these concerns.Â
Our muscles are ageing and for women who exercise, this means that the uptake of calcium into their muscle fibres is slower, and this affects the organelles that produce energy too – the mitochondria.
As such, this affects the muscle contraction speed and many women who come on my programmes complain about aching muscles and restless legs that trouble them at night, keeping them awake. I hear about it all the time as a generation of Personal Trainers and women who have exercised all their lives, go into their 50s” I replied.Â
The Muscle-Nerve-Calcium Connection in Menopause:
1200mg a day. Every day.
Thatâs the amount of calcium women need from their 50âs onwards. But whilst weâve all been told that itâs to do with our bone health, I beg to differ.
If you are coaching midlife women who exercise regularly, (especially high intensity or endurance exercise), or they are in a physically demanding job, then calcium intake is not only about bone-health, itâs about muscle and nerve contraction too.Â
This includes cardiac muscle and the tiny smooth muscles that make up blood vessels. They require adequate calcium too. Several studies reveal that low calcium intake is related to high prevalence of cardiovascular diseases such as hypertension [Mi-Hyun Kim et al., 2012], so we must keep this in mind with our clients as well.Â
An important aspect of calcium metabolism is plasma calcium homeostasis (balance). This refers to the regulation of calcium ions in the blood plasma, which are kept within narrow limits. You can see this narrow range in blood markers for calcium.Â
The level of the calcium in plasma is regulated by the hormones parathyroid hormone (PTH) and calcitonin, which is influenced by Vitamin D levels. Parathyroid hormone is released by the parathyroid glands when the plasma calcium level falls below the normal range in order to raise it.Â
If women aren’t sleeping, or they are doing too much exercise and not having enough calcium, or they have gut health concerns, then this can be the slippery slope towards calcium being drawn out of bones and teeth in order to balance up plasma calcium needs.Â
I talk about this in my video below and give you some suggestions to share with clients.Â
A woman’s circulatory system, extracellular fluid, muscle, and other tissues need calcium.
Calcium as a nutrient, is most commonly associated with the formation and metabolism of bone. With over 99 percent of total body calcium found as calcium hydroxyapatite in bones and teeth, it provides hard tissue with its strength.
But whilst the emphasis for women in menopause and post-menopause has primarily been about calcium for bone health, there’s another reason that it’s important.Â
Calcium is critical for controlling the contraction and dilation of blood vessels.
It’s also crucial for muscle contraction because of its role in helping the nerve electrical current to ‘jump’ across the gap (synapse) between the nerve and the muscle.Â
Bone tissue serves as a reservoir for and source of calcium for these critical metabolic needs through the process of bone remodeling. You can guess what happens to bones if calcium levels are low.
Yes, that’s right. The bones deplete calcium to help to balance up the plasma levels. This is why, I tell my clients, that if they aren’t sleeping (altered HPA-Thyroid Axis) and if they haven’t got their nutritional intake of both calcium and magnesium sorted, or if they have gut health concerns, then high-intensity exercise or endurance exercise can deplete calcium stores even more.Â
It’s not ‘just’ about calcium in food either. Optimal Vitamin D levels are crucial to maintain during the menopause transition too.Â
In the MyMT⹠Education Courses, especially the Practitioner course, I talk a lot about Vitamin D levels and have specific information for Practitioners who join me.
This is because Calcium metabolism is regulated in large part by the parathyroid hormone (PTH)-Vitamin D endocrine (hormone) system.
A series of feedback loops help in maintaining blood calcium levels depending on Vitamin D absorption. This is why, during vitamin D deficiency, bone metabolism is significantly affected as a result of reduced active calcium absorption into bones, muscles and in our nervous system.
If your clients aren’t getting enough Vitamin D (and I’ve written how our skin is changing in menopause and Vitamin D absorption is affected too), and they are experiencing weak muscles, poor recovery after exercise or they have restless legs and muscles cramps at night, then have a serious look at their calcium intake, as well as asking about their gut health, if this is in your Scope of Practice.Â
The colon is the main site of calcium absorption into your body.
This means that poor gut health might affect your client’s ability to absorb calcium from food. If this is the case, then their priority is to sort out their gut health. [If you need to learn more, then have I have a gut-health module that can be purchased separately from the 12 week programme as part of my Restoration Series).Â
Sources of Calcium:Â
Whilst I have a focus on the traditional Mediterranean Diet on the MyMTâą Education programmes, typically this diet is lower in dairy products, especially milk.
That’s why other sources such as oily fish, wild salmon (which differs in Vitamin D content from farmed salmon), small fish, nuts, legumes, cereals (which are fortified with Vitamin D in some countries) and certain vegetables are important sources of dietary calcium too.
Georgia and I have just produced my new MyMTâą Food Guides for the women on the 12 week online programmes, and I share some of the calcium foods with you below.
There are numerous symptoms that women experience in menopause, including restless legs and sore, aching muscles.
But as I always say, the ‘problem’ isn’t menopause – this is a natural event that all women go through. The ‘problem’ is that women don’t understand how to change their lifestyle to accommodate this incredible stage of life.
That’s what the online MyMTâą Practitioner Course teaches you and I have some of this information in the MyMTâą Menopause Weight Loss Coach Course too. I hope you can join me sometime if you are struggling to help your clients make sense of their symptoms, especially musculo-skeletal symptoms, during their menopause transition. Â
Dr Wendy Sweet (PhD)/ Member: Australasian Society of Lifestyle Medicine.Â
References:Â
Astrup, A. (2014). Yoghurt and dairy product consumption to prevent cardiometabolic diseases: epidemiologic and expereimental studies. Am. J. Clin. Nutr., 99; 1235S-42S
Bronner, F. & Pansu, D. (1999). Nutritional Aspects of Calcium Absorption, The Journal of Nutrition, 129 (1), 9â12.Â
Kim MH, Bu SY, Choi MK. Daily calcium intake and its relation to blood pressure, blood lipids, and oxidative stress biomarkers in hypertensive and normotensive subjects. Nutr Res Pract. 2012 Oct;6(5):421-8. doi: 10.4162/nrp.2012.6.5.421.Â
Kim YS, Hong KW, Han K, Park YC, Park JM, Kim K, Kim BT. (2020). Longitudinal Observation of Muscle Mass over 10 Years According to Serum Calcium Levels and Calcium Intake among Korean Adults Aged 50 and Older: The Korean Genome and Epidemiology Study. Nutrients. Sep 18;12(9):2856.
Preedy, V. & Watson, R. (2020). The Mediterranean Diet: an evidence-based approach. Elselvier Academic Press: London, UK.
Romero-Parra N, Maestre-Cascales C, MarĂn-JimĂ©nez N, Rael B, Alfaro-Magallanes VM, Cupeiro R, Peinado AB. Exercise-Induced Muscle Damage in Postmenopausal Well-Trained Women. Sports Health. 2021 Nov-Dec;13(6):613-621.
Seo DY, Lee SR, Kim N, Ko KS, Rhee BD, Han J. Age-related changes in skeletal muscle mitochondria: the role of exercise. Integr Med Res. 2016 Sep;5(3):182-186. doi: 10.1016/j.imr.2016.07.003.
