Menopause & Nutrition

Here’s the thing about Menopause, it can be intimidating, overwhelming even, and a little bit scary. Think back to how you felt when you were anticipating the first big change in your young self….your first period. You may or may not have been exposed to good information, but it was still a big deal, right? There was uncertainty about how it would feel physically & emotionally, the practical applications, and how you would manage this change in general. 

Welcome to the second big significant change your body will go through ( apart from pregnancy & childbirth of course ). It’s happening at the other end of your reproductive life, and you would think that this might bring the wisdom & maturity that age affords us, but often this is not the case, and those feelings of uncertainty or intimidation are back!

The common denominator of course is hormones. How they affect our bodies are complicated & challenging to say the least, and like your first menstrual cycle, very individual, but hopefully this information will break it down for you and allow some ‘non-scary’ understanding of what you will be or are going through, and how to easily transition into the next beautiful stage of your life.

The 4 main concerns for many women are:

• Weight gain
• Hot flushes
• Poor sleep
• Brain fog

I’ll start by clearing up some common misunderstandings about weight gain during menopause, then provide some strategies to improve energy levels, overall health, and relationship with food.

What’s the Deal with Weight Gain During Menopause?

For years, many people assumed that weight gain at midlife was due to a “slowing metabolism.”

However, your metabolic rate — how much energy (i.e., calories) you burn — actually remains relatively stable from about age 20 to age 60, after which it slowly and steadily begins to decline. And yet, many women report weight gain during menopause and midlife. If a sluggish metabolism isn’t behind these changes, what is?
There are five likely culprits:

• More hunger
• More intense cravings
• Less movement
• Redistributed fat
• Poor sleep

#1: MORE HUNGER

As women progress through the menopause transition, oestrogen levels fluctuate downward. This, in turn, influences two other hormones that can trigger hunger. Ghrelin is produced by the stomach, and it stimulates hunger. As oestrogen decreases, ghrelin increases — so women feel hungrier more often.7 Leptin helps regulate our energy intake. When we have more body fat, we tend to have more leptin, which tells the body that we have enough stored energy and don’t need to eat more. But as oestrogen goes down, our cells can’t respond as well to leptin’s signals. This can also make us feel hungrier.8,9,10

#2: MORE INTENSE CRAVINGS

Along with physical hunger (or the need to eat), appetite — the desire to eat — also goes up.That includes cravings for things like sweets or chips, as well as eating due to boredom, stress, procrastination, and pleasure.11 You can thank two more key hormones for these increased desires for food. As estrogen goes down, the hormone neuropeptide Y goes up.12,13,14 This is an appetite-stimulating hormone that you can remember as Neuropeptide Yum. Then, there’s oxytocin. Sometimes called the “love hormone” thanks to its role in bonding, oxytocin suppresses appetite15,16,17 — but it also tends to decrease with age.18Rising neuropeptide Y and falling oxytocin can both lead to more (and more intense) cravings.

#3: LESS MOVEMENT

A sedentary office job coupled with family responsibilities and caring for aging parents? It has a way of interfering with workout time, doesn’t it? And you might have noticed that you (or your midlife clients) don’t seem to tolerate exercise as well, or recover as quickly between sessions. Add on the aching joints associated with menopause, and regular movement can become much more difficult.19 For this and many other reasons, many women get less active as they get older.1 This can change body composition toward less lean mass and more fat mass, especially if their eating habits stay the same.

#4: REDISTRIBUTED FAT

As estradiol and progesterone levels go down, more body fat tends to accumulate around the midsection, or what many people call “belly fat.”2,20 This change in body composition and shape can feel like weight gain — even if the scale doesn’t budge.

#5: POOR SLEEP

During the menopause transition, hot flushes may keep you awake and insomnia may worsen. These sleep disturbances can disrupt the hormones that regulate appetite, which often means food cravings and trouble feeling full.21 So, while menopause itself and its hormonal fluctuations don’t necessarily directly cause weight gain, these multiple overlapping factors can all poten- tially contribute to changes in weight or body shape. And given that old nutrition and exercise strategies often don’t do the trick, it’s easy for women to feel overwhelmed, hopeless, or powerless over their changing bodies.

NUTRITION STRATEGY #1: RECOGNISE THE DIFFERENCE BETWEEN HUNGER AND APPETITE

Hormonal changes at menopause can leave women feeling torn between needing to eat — in other words, physical hunger — and wanting to eat — in other words, appetite. Learning to distinguish between hunger and appetite can be a helpful skill for women who want to get to know their bodies better and eat more intuitively. Learning to recognise the physiological cues — and more importantly, to start trusting them — can also be a relief for women who might have relied on external strategies like calorie counting or macro counting in the past. Notice what body cues, thoughts, and feelings are coming up. Ask yourself, “Am I physically hungry? Or do I just want to eat?” All answers are OK, but this simple pause can help you practice learning your own signals. If the feeling is more like a craving, and you’re  not really hungry, you might choose to mindfully satisfy the craving. Or, this might be a good moment to do something else, like go for a walk, check something off your to-do list, or do a stress-relieving meditation.No matter what, the simple act of pausing to check in and get curious puts you in the driver’s seat.

NUTRITION STRATEGY #2: EAT SLOWLY AND MINDFULLY

Though I recommend this powerful nutrition skill for women of all ages, it becomes even more important during the menopause transition. With everything midlife women juggle — work, caregiving, relationships, travel, and so on — you might not even remember the last time you sat down to slowly and mindfully enjoy a meal.But slow, mindful eating can help you:

• Eat less while feeling more satisfied. This is especially important given those hormonal changes that make women feel hungrier.
• Make each bite more enjoyable by amplifying the sensory input from your taste and smell receptors. This can weaken some cravings.
• Activate the calming parasympathetic nervous system (PNS). Since the PNS is the “rest and digest” system, this helps with satiation — and in turn, eating the right amount of energy for your needs.
• Calm the gastrointestinal tract, which can help prevent or decrease symptoms like heartburn and bloating — which might help you feel far more comfortable in your body and clothes.

Slowing down my eating has allowed me to enjoy my food more because I can actually taste and savor, and it’s allowed me to tune in to my fullness cues and feel more satisfied.

NUTRITION STRATEGY #3: EAT ENOUGH PROTEIN

Protein is one of the three macronutrients the body needs to function well — and it’s essential for healthy fat loss. Your body burns more calories digesting protein than carbs or fat. It also helps boost satiation and satiety, meaning you’re satisfied with how much food you’ve eaten sooner (so you’re less likely to overeat at a given meal) and you stay satisfied for longer after the meal — both of which can help you eat the right amount of energy for your needs. And remember what I mentioned earlier about women moving less as they get older? Well, protein provides the nutritional building blocks the muscle fibres need to repair, so eating more of it will help you build more lean muscle, recover better between workouts, and maintain physical function.22 And as a bonus, having more muscle increases the number of calories your body burns while exercising and at rest. All this said, many women struggle to eat enough protein in the first place. And during midlife, this becomes a much bigger potential issue, as the body becomes less efficient at synthesizing, digesting, and absorbing protein.23 Eating more protein can help you feel and perform much better.

Check out the resources page for a portion size guide and list of high-protein options.

NUTRITION STRATEGY #4: CONSUME MORE MINIMALLY PROCESSED FOODS

Here’s a totally underrated weight loss secret: Focus on what you’re adding, not on what you’re taking away. So, just like we recommend adding more protein, we also recommend adding more minimally processed foods!These foods are rich in nutrients, such as vitamins, minerals, healthy fats, and fiber (and, in the case of fruits and vegetables, water). These nutrients can help you to fill up more effectively on fewer calories, which can be super helpful for balancing your energy needs.Various minerals, like magnesium, iron, and zinc, can support many key processes that we need at midlife, like good sleep, cognitive health & immune support. And on top of it, when you’re eating more minimally processed foods, you likely aren’t eating as many highly processed foods, which tend to be high in calories, easy to over-consume, and more likely to contribute to weight gain. Luckily, including more minimally processed foods doesn’t need to be hard. You can help your client build out a great nutrient-rich, satisfying menu with some simple changes. 

You can get some ideas for minimally processed foods in the Healthy Eating Cheat Sheet, available in the resource page.

Phytoestrogens

Women’s oestrogen & progesterone levels decrease with age, causing the changes in the body most commonly known as peri/menopause. Studies show that phytoestrogens, which are oestrogen derived from plant sources, can help relieve some of menopause’s physical symptoms. Improved Bone Health – Oestrogen’s help maintain healthy bone density, reducing the risk of osteoporosis in both men and women. Studies show that phytoestrogens from food may support this effect, improving long-term bone health. They can also Lower the Risk of Heart Disease, reduce inflammation in the body.

Foods With Oestrogen

Many types of food-based phytoestrogens are studied for their potential health benefits. These include:

• Lignans – These are fibre-associated compounds found in many plant families and common foods, including grains, nuts, seeds, vegetables, and drinks such as tea, coffee or wine, which possess a steroid-like chemical structure and are defined as phytoestrogens, are of particular interest to researchers. Traditionally, health benefits attributed to lignans have included a lowered risk of heart disease, menopausal symptoms, osteoporosis and breast cancer.
• Isoflavones – Many different legumes contain isoflavones, but soybeans and other soy foods like tofu, miso, and tempeh are particularly rich sources, and possess antioxidant, anti-inflammatory, anti-microbial, and anti-cancer properties.Recent studies have shown that daily isoflavone intake can improve sleep quality. In humans, isoflavones mimic the estradiol compound in the body, a precursor to the oestrogen hormone, and can raise over-all serum oestrogen in the body.
• Flavonoids like Quercetin – Flavonoids might reduce your risk for heart disease. Their antioxidant activity could help lower inflammation and blood pressure. Diabetes prevention. Flavonoids may reduce your risk for type 2 diabetes because they improve how your body uses glucose (sugar) and digests carbohydrates. They can increase oestrogen activity because they function as selective oestrogen receptor modulators.

Each of these phytoestrogens has antioxidant properties. This means that in addition to the nutrients’ potential health benefits, they fight cell damage in our bodies linked to a wide range of chronic diseases. 

The best dietary sources of phytoestrogens include:

Flaxseeds

Flaxseeds are the richest dietary source of lignans (polyphenols found in plants). Researchers believe they lower breast cancer risk. You can sprinkle flaxseeds on many dishes, bake them into bread and cookies, or blend them into smoothies and spreads. 

Soy

Soy contains high levels of isoflavones, phytoestrogens that may mimic oestrogen’s effects and reduce the risk of both breast and prostate cancer. Soy is also rich in a range of essential vitamins and minerals. It can support heart health as an alternative to red and processed meats. It’s also extremely versatile — you can include soy in your diet with foods like tofu, tempeh, edamame, and soy milk.  

Peaches 

Because of their high lignan content, studies show that eating two servings of peaches or nectarines a week reduces a woman’s breast cancer risk. Researchers find similar effects from consuming blueberries and strawberries. 

Garlic

Regular garlic consumption can help lower cholesterol, reduce blood pressure, and prevent clots — all heart disease risk factors. Research shows garlic can influence oestrogen levels in the body, perhaps helping reduce age-related bone loss. But more research is needed to study this effect. 

Red Wine

Red wine is rich in resveratrol, a phytoestrogen researchers believe reduces heart disease risk by regulating cholesterol levels. Another study found that phytoestrogens in red wine may stop cancer cell growth, particularly among postmenopausal women. 

Sesame Seeds

Sesame seeds are easy to add to almost any meal — and they may help improve your cholesterol levels. Studies show they affect oestrogen levels, with potent antioxidant activity fighting chronic disease risk factors. 

Cruciferous Vegetables

Vegetables like broccoli, Brussel sprouts, and kale contain phytoestrogens with anti-cancer and anti-inflammatory properties. Diets rich in cruciferous vegetables are also associated with lower risk of many chronic diseases, including heart problems. 

 Nuts

Nuts like cashews, almonds, peanuts, and pistachios are a great source of heart-healthy phytoestrogens. They’re easy to add to your diet. But because most nuts are high in calories and fat, be sure to limit your portions to the recommended serving size.

Flavanone’s

Flavanone’s are known for their anti-inflammatory properties. They may also help you manage your weight and cholesterol. Flavanone’s are found in lemons, limes, oranges, grapefruit.

1  Pontzer H, Yamada Y, Sagayama H, Ainslie PN, Andersen LF, Anderson LJ, et al. Daily en- ergy expenditure through the human life course. Science. 2021 Aug 13;373(6556):808–12. 
2  Davis SR, Castelo-Branco C, Chedraui P, Lumsden MA, Nappi RE, Shah D, et al. Under- standing weight gain at menopause. Climacteric. 2012 Oct;15(5):419–29. 
3  Greendale GA, Sternfeld B, Huang M, Han W, Karvonen-Gutierrez C, Ruppert K, et al. Changes in body composition and weight during the menopause transition. JCI Insight [Internet]. 2019 Mar 7;4(5). Available from: http://dx.doi.org/10.1172/jci.insight.124865 
4  Al-Safi ZA, Polotsky AJ. Obesity and menopause. Best Pract Res Clin Obstet Gynaecol. 2015 May;29(4):548–53. 
5  Razmjou S, Abdulnour J, Bastard JP, Fellahi S, Doucet É, Brochu M, et al. Body compo- sition, cardiometabolic risk factors, physical activity, and inflammatory markers in premenopausal women after a 10-year follow-up: a MONET study. Menopause. 2018 Jan;25(1):89–97. 
6  Geraghty P. Menopause Hormone Therapy [Internet]. Each Woman’s Menopause: An Evidence Based Resource. 2022. p. 121–43. Available from: http://dx.doi.org/10.1007/978- 3-030-85484-3_6 
7  Abdalla MMI, Jegasothy R. Role of ghrelin in postmenopausal obesity. Int J Womens Health Reprod Sci. 2020;8:119–24. 
8  Saranya GM, Pathy MR. Insights into the putative role of leptin in various traversing stages of women: A narrative review. J Basic Appl Pharm Sci [Internet]. 2018; Available from: http://japsonline.com/abstract.php?article_id=2688 
9  Hestiantoro A, Astuti BPK, Muharam R, Pratama G, Witjaksono F, Wiweko B. Dysregu- lation of kisspeptin and leptin, as anorexigenic agents, plays role in the development of obesity in postmenopausal women. Int J Endocrinol. 2019 Dec 1;2019:1347208. 
10  Farhadi Z, Azizian H, Haji-Seyed-Javadi R, Khaksari M. A review: Effects of estrogen and estrogen receptor modulators on leptin resistance: Mechanisms and pathway. Obesity Medicine. 2022 Sep 1;34:100446. 
11  Springer AM, Foster-Schubert K, Morton GJ, Schur EA. Is there evidence that estrogen therapy promotes weight maintenance via effects on leptin? Menopause. 2014 Apr;21(4):424–32. 
12  Ainslie DA, Morris MJ, Wittert G, Turnbull H, Proietto J, Thorburn AW. Estrogen deficiency causes central leptin insensitivity and increased hypothalamic neuropeptide Y. Int J Obes Relat Metab Disord. 2001 Nov;25(11):1680–8. 
13  Mann E, Kluess HA, Neidert LE, La Mantia AM, Sandage M, Plexico L. Neuropeptide Y and Dipeptidyl Peptidase IV in Pre‐ and Post‐Menopausal Women [Internet]. Vol. 32, The FASEB Journal. 2018. Available from: http://dx.doi.org/10.1096/fasebj.2018.32.1_sup- plement.882.4 
14  Zhu J, Ji M, Xing L, Yu Z, Guo X, Chen X, et al. Ovarian hormonal change-related energy metabolism and obesity in menopausal women. Horm Ther Replace Cancer Aging-Relat Dis [Internet]. 2020; Available from: https://books.google.com/books?hl=en&lr=&id=VX- L8DwAAQBAJ&oi=fnd&pg=PA97&dq=neuropeptide+y+menopause+review&ots=kW7_ fMlUPF&sig=8CMbTpvrbvPR5aDnyarqOIlG_ps 
15  Olszewski PK, Klockars A, Levine AS. Oxytocin: a conditional anorexigen whose effects on appetite depend on the physiological, behavioural and social contexts. J Neuroendo- crinol [Internet]. 2016 Apr;28(4). Available from: http://dx.doi.org/10.1111/jne.12376 
16  Giel K, Zipfel S, Hallschmid M. Oxytocin and Eating Disorders: A Narrative Review on Emerging Findings and Perspectives. Curr Neuropharmacol. 2018;16(8):1111–21. 
17  Kerem L, Lawson EA. The effects of oxytocin on appetite regulation, food intake and metabolism in humans. Int J Mol Sci [Internet]. 2021 Jul 20;22(14). Available from: http:// dx.doi.org/10.3390/ijms22147737 
18  Maestrini S, Mele C, Mai S, Vietti R, Di Blasio A, Castello L, et al. Plasma Oxytocin Con- centration in Pre- and Postmenopausal Women: Its Relationship with Obesity, Body Composition and Metabolic Variables. Obes Facts. 2018 Oct 30;11(5):429–39. 
19  Watt FE. Musculoskeletal pain and menopause. Post Reprod Health. 2018 Mar;24(1):34–43. 
20  Kapoor E, Collazo-Clavell ML, Faubion SS. Weight Gain in Women at Midlife: A Concise Review of the Pathophysiology and Strategies for Management. Mayo Clin Proc. 2017 Oct;92(10):1552–8. 
21  Spiegel K, Tasali E, Penev P, Van Cauter E. Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med. 2004 Dec 7;141(11):846–50. 
22  Gregorio L, Brindisi J, Kleppinger A, Sullivan R, Mangano KM, Bihuniak JD, et al. Adequate dietary protein is associated with better physical performance among post- menopausal women 60-90 years. J Nutr Health Aging. 2014;18(2):155–60. 
23  Burd NA, Gorissen SH, van Loon LJC. Anabolic resistance of muscle protein synthesis with aging. Exerc Sport Sci Rev. 2013 Jul;41(3):169–73.