Can nutritional changes throughout the menopause transition help manage menopause symptoms amidst a growing reliance on medicalised solutions and supplement?
It’s an interesting question isn’t it? And one that I asked myself, especially when menopause symptoms, including sore joints, insomnia, palpitations, hot flushes and weight gain, weren’t resolved with HRT.
That’s why, drawing from my background in exercise physiology, nutrition and women’s healthy ageing research, I want to highlight how and why the Mediterranean Dietary approach is now recognised as one of the most important ways of eating for midlife and older women.
Why the Mediterranean Diet?
Positioning the menopause transition in ageing research opened the door to several symptom management alternatives not only for myself, but for thousands of women around the world, utilizing food as medicine.
While each woman’s experience of menopause is different, it was placing this normal life-stage transition into the context of women’s ageing and inflammatory research, that offered a departure from the conventional idea that menopause is a sickness that has to be “cured.”
Menopause can be normalized by acknowledging that this stage of life is a natural process that is a stepping stone towards our post-menopause years, and as such, incorporating aspects of the Mediterranean nutritional approach, which is well evidenced in women’s health, longevity and nutrition studies, made so much sense!
I know myself, that whilst seeking the quick-fix menopause supplements and HRT solutions, I didn’t understand that nutritional lifestyle solutions were becoming well evidenced for symptom management in midlife women.
Today, Scientists have discovered thousands of substances in foods that go way beyond relying on ‘just’ supplements or hormone therapies.
‘Among the various aspects of health promotion and lifestyle adaptation to the menopause and postmenopausal period, nutritional habits are essential because they concern all women, can be modified, and impact both longevity and quality of life.’ (Silva, Opperman et al, 2021).
This is where dietary changes come into our lifestyle decisions.
The menopause transition is increasingly seen as a systemic inflammatory phase that facilitates subsequent neurogenerative (nerve degeneration) and cardiovascular disease, as well as bone and muscle changes.
Taking inflammatory changes into account and the fact that cardiovascular disease has the highest prevalence in health risk for older women, a large body of evidence now demonstrates that there is an inverse association between adherence to the Mediterranean Diet and a lower risk of death from cardiovascular disease (CVD), Type 2 diabetes (T2D), cognitive disorders, osteoporosis and many other inflammatory conditions. [Mazzocchi et al., 2019; Schwingshackl et al., 2019].
Definition of the Mediterranean Diet
The traditional Mediterranean Diet is defined as the diet that emerged in the 1950s and 1960s in certain regions of the Mediterranean basin, especially in Greece (Crete) and parts of Southern Italy. While differences existed back then in the interpretation of this diet, it became clear to researchers that olive oil, especially extra virgin olive oil, was a commonly consumed food.
Today, most scientists agree that the hallmarks of the Mediterranean diet include:
- An abundance of plant foods, including a range of fruits and vegetables and wholegrains – rice, cereals, bread, pasta
- Raw vegetables in salads and cooked vegetables
- Legumes such as chickpeas, lentils and beans
- Nuts such as pistachios, hazelnuts, almonds, walnuts, pine nuts and seeds.
- Herbs and spices, including rosemary
- Olive oil as the main source of fat
- Small consumption of animal products, including eggs, fish and seafood (2-3 times a week)
- Low consumption of red meat
- Small amounts of fermented dairy products – cheese, yoghurt, goats cheese, kefir.
- Small to moderate consumption of red wine, taken at mealtimes only.
The value of the Mediterranean diet for midlife and older women, lies in the specific nutrients obtained. This includes folate for managing hot flushes and improving brain fog; melatonin-rich foods (pistachio nuts and olive oil) and a range of vegetables that offer improvements in fibre content and therefore, gut health.
When women get the variety of foods on offer through the Mediterranean diet, then this provides an optimal number of macronutrients (15-20% protein/ 40-50% of healthy carbohydrates/ 30% of healthy fats rather than saturated fats from animal products).
Most importantly, the Mediterranean diet has a high content of vitamins and minerals (micronutrients) and it’s the combination of these, that helps to restore hormonal balance in the body as we transition through menopause and into post-menopause.
The discovery of phyto-nutrients has changed everything we know about foods.
The term ‘phyto-nutrients’ refers to the compounds in foods that contain an abundance of microscopic healing substances. Some scientists call them the ‘vitamins of tomorrow‘ such is their power to heal.
Many pharmaceutical companies are using these phyto-chemicals in plant-derived hormone therapies for women and as I examine many of the ingredients of menopause supplements, then they too have a variety of phyto-nutrients in them, especially B-vitamins which are known to reduce hot flushes, anxiety and mood swings in women. (Bani et al., 2013; Barnard et al., 2022; Young et al., 2019]
Another example is apples. How many of you were told to eat apples when you were younger? Not only to improve chewing, which helps to reduce dizziness and improve balance in women, because it helps to clear the ear canal), but also to improve your lung health.
The skin of apples (red skin) contain quercetin. This is known to reduce the inflammatory changes in lungs as women age and to reduce the risk of heart disease as you age.
Most importantly, apples, tomatoes and cruciferous vegetables (all foods of the Mediterranean diet) are evidenced to help women detoxify their liver – an important part of weight management as they move through menopause and into post-menopause.
Does the Mediterranean Diet help with menopause weight loss and cardiovascular health?
It is well known in metabolic and cardiac research that the menopause transition and subsequent endocrine or hormonal changes, are associated with increased prevalence of metabolic syndrome, cardiovascular disease, obesity, osteoporosis and immune dysfunction.
Looking at these clinical end-points was important to me, especially with both weight increase and cardiovascular changes, that I was struggling to manage. Thousands of women have a similar experience and it’s no surprise to me that over 80% of women who undertake the MyMT™ Symptoms Quiz mention that they are overweight.
For example, when exploring the nutritional research on menopause and post-menopause weight gain, there is clear evidence that dietary plant carbohydrates, a hallmark of the Mediterranean diet, offer a low rating on the Glycemic Index rating system (below 55), and whole grains (instead of refined grains), have positive effects on our resting metabolic rate (Silva et al, 2021).
Wholegrains are also an important component of the traditional Mediterranean Diet.
Cardiac health research also reports that wholegrains help to steady blood glucose response and give lasting energy as well as reducing harmful LDL-cholesterol.
Whole-grains are also important for reducing palpitations and protecting the cardiovascular system as women age. [NZHF Wholegrains and the Heart Evidence Paper, 2018]
From our early-50’s onwards, as menopause progresses, cardiac muscle changes in structure and function, as do our skeletal muscles. And it doesn’t matter if women are regular exercisers or not, their ageing heart and muscles need the nutrients that matter to them to help their cardiac health as they age. Some of these nutrients come from wholegrains, which are an essential part of the Mediterranean Diet.
There is a lot of confusion about nutrition for the menopause transition these days, and numerous women entering menopause may be following a diet high in protein, which is promoted in the fitness industry.
If much of this protein is from animal fats, then don’t forget that all animal protein is also high in saturated fats, which, for women with fatty liver disease, or who don’t have a gallbladder, may be problematic.
I can’t reinforce this enough and have written about the detrimental effects of diets high in both fats and animal protein and the load that these are known to place on ageing kidneys. This is known as PRAL, or Potential Renal Acid Load.
How do you get started on the Mediterranean Diet? A video for you!
When it comes to looking ahead to a potentially healthy ageing, then I’m a great advocate of using the menopause transition to begin to try new approaches.
The lifestyle and disease-prevention science specific to women allows a framework from which to make these adjustments and I tell you about the best 5 nutritional changes you can make to get started on your new way of eating for menopause and post-menopause, in the video below.
Food is at the heart of your health as you move through menopause and I have all of your dietary and other lifestyle solutions in the world-class My Menopause Transformation programmes.
Wendy Sweet (PhD)/ My Menopause Transformation/ Member: Australasian Society of Lifestyle Medicine.
References:
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Barnard ND, Kahleova H, Holtz DN, Znayenko-Miller T, Sutton M, Holubkov R, Zhao X, Galandi S, Setchell KDR. A dietary intervention for vasomotor symptoms of menopause: a randomized, controlled trial. Menopause. 2023 Jan 1;30(1):80-87. doi: 10.1097/GME.0000000000002080.
Feskens EJM, Bailey R, Bhutta Z, Biesalski HK, Eicher-Miller H, Krämer K, Pan WH, Griffiths JC. Women’s health: optimal nutrition throughout the lifecycle. Eur J Nutr. 2022 Jun;61(Suppl 1):1-23.
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Schwingshackl L, Morze J, Hoffmann G. (2020). Mediterranean diet and health status: Active ingredients and pharmacological mechanisms. Br J Pharmacol. Mar;177(6):1241-1257.
Silva, T., Oppermann, K, Reis, F. & Spritzer, P. (2021). Nutrition in Menopausal Women: A Narrative Review, Nutrients, 13, 2149, 1-14.
Yoshany, N., Mazloomy Mahmoodabad, S., Bahri, N., Moori, MK., & Hanna, F. (2020). Association between lifestyle and severity of menopausal symptoms in postmenopausal women. Electron J. Gen Med. 17(5): em22, 1-6.
Young LM, Pipingas A, White DJ, Gauci S, Scholey A. A Systematic Review and Meta-Analysis of B Vitamin Supplementation on Depressive Symptoms, Anxiety, and Stress: Effects on Healthy and ‘At-Risk’ Individuals. Nutrients. 2019 Sep 16;11(9):2232. doi: 10.3390/nu11092232.
