Dietary Changes to Make at Menopause
Diet can’t cure the troubling symptoms of menopause, but—for many women—it can make a significant difference. And, if you take menopause as a signal for renewal and preparation for the second half of your life, the changes you make now can yield important benefits for decades to come.
When you’ve gone for a full year without a period, you have officially reached menopause. Nevertheless, a woman’s body begins to change starting about 6 years sooner. During this time, called the perimenopause, the reproductive system prepares to retire and the ovaries gradually produce less estrogen. With perimenopause comes a variety of symptoms.
For many women, hot flashes (hot flushes) are the most noticeable result of the sharp variations in estrogen levels that mark this part of their lives. This sudden burst of heat can occur at any time and spread over your upper body, perhaps causing you to break into a sweat. The good news is that a hot flash will vanish as quickly as it appears. And despite their reputation as a universal sign of menopause, hot flashes trouble some women for only a few months, while as many as a third have none at all.
Over a span of years (often 10 or more), you may also notice changes in your skin, such as increased dryness and wrinkling, and in hair texture. The lining of your vagina may become thinner, drier, and less pliable. Your breasts may lose some of their fullness, and the nipples become less pronounced. Significantly, although some bone loss is a normal part of aging, bone loss speeds up rapidly in women at menopause.
During or following menopause, you may find yourself gaining weight. Although it occurs at a time of dramatic hormonal changes, you can chalk up this gain to advancing age. Unless you exercise regularly, you’ll begin to lose calorie-burning muscle at midlife. In addition, your metabolism will slow down, and your body will no longer need energy to support your reproductive system. To maintain your former body weight, you may need to cut your calorie intake by 10 to 15 percent while increasing your level of activity.
While most menopausal changes are physical, some women also develop such emotional problems as mood swings, irritability, and fatigue. While these feelings have not been directly linked to hormonal changes, they could easily be brought on by hot flashes, sleep deprivation, and other stressful consequences of menopause. Although diet can’t solve these problems, keeping your nutritional status at peak levels is obviously a wise move during this stress-filled period.
Menopause is a highly individual experience. You may recognize many of these changes, or you may hardly notice any. Although you may be tempted to chalk up such problems to menopause, it’s a good idea to report them to your doctor. Some symptoms associated with menopause could be caused by something else, such as a thyroid disorder. Some could be signs of serious disease. Your doctor can determine whether symptoms such as hot flashes really are due to menopause, and can help you decide on a treatment. Whether you seek treatment or not, however, upgrading your lifestyle and your diet can help get you through.
Researchers are just beginning to address the special nutritional needs of menopausal women. Still, nutritional experts generally agree that a well-balanced diet featuring a variety of nutrients is essential to good health at midlife. A diet rich in vegetables, whole grains, and fruits, with moderate servings of protein, is a wise idea at any time of life.
At midlife, it’s also important to increase your calcium intake to maintain healthy bones and reduce your consumption of fat—if you haven’t already—to lower your risk of heart disease, the nation’s Number One killer of women as well as men.
These goals are actually easier to achieve than you might think. In fact, it may take only some relatively minor adjustments. The average American woman gets more than one-third of her calories from fat—a number that needs to be cut back to no more than 30 percent, according to many doctors and nutritionists. Some researchers believe that high-fat diets are particularly harmful to women during perimenopause, since they fuel estrogen production, thereby encouraging the exaggerated hormonal fluctuations that mark the perimenopausal years.
These dramatic variations are thought to lie at the root of many of the annoying symptoms of menopause, such as missed periods and hot flashes. Sticking with a well-balanced, low-fat diet can help smooth out the decline in your body’s production of estrogen. Women are never completely without estrogen, since adrenal glands and body fat continue to produce low levels of estrogen even after menopause.
Menopause At A Glance
|The wide array of problems shown in this diagram may seem daunting; but fortunately, few women experience every one of them. Hot flashes are the most common complaint. However, these annoying sensations pass in due course, while other symptoms may pose a much greater long-term threat. Be particularly alert for lower back pain, which may signal the onset of osteoporosis, the bone-weakening disorder that leaves older women prey to fractures. Remember, too, that menopause robs you of estrogen’s protective effect on the heart, and that heart disease is the Number One killer of women.|
Carbohydrates provide most of the fuel for a healthy body, but it’s important to choose the right ones—especially at midlife, when your body’s metabolism becomes more sluggish. Complex carbohydrates, found in beans, corn, potatoes, and whole wheat, are digested more slowly and are healthier for your body than simple carbohydrates, or sugars, which enter your bloodstream directly from the digestive tract.
Nevertheless, some foods that are promoted as complex carbohydrates—including so-called “healthy” cold cereals made from whole-grain sources—actually break down very quickly in your system and don’t provide long-lasting energy. Even whole wheat responds more like a simple carbohydrate when it’s processed into flour and made into pasta or bread. The same is true of white rice. Remember, too, that you need to switch to complex carbohydrates—not simply add them to what you already eat. Your body converts excess carbohydrate calories into fat, which—if not balanced with additional exercise—causes weight gain.
You can add complex carbohydrates to your diet in a variety of ways. Purchase whole-grain bread instead of the usual white bread (but check the label to be sure white flour or sugar has not been added). Try brown rice instead of white, rolled oats instead of instant, rye crackers instead of saltines. Add fresh or frozen beans and peas to your diet. Look for whole-wheat pasta in the specialty section of your grocery store.
At the same time, avoid sources of simple carbohydrates such as white bread, cakes, donuts, and cookies. For a snack or dessert, substitute fresh fruit. Although fruits also are high in a simple sugar called fructose, their fiber content helps stabilize their impact on blood sugar levels.
One of the most highly publicized “natural” remedies for menopausal symptoms is a class of compounds called phytoestrogens. A group of plant-based chemicals with weak estrogen-like effects, these substances are also said to reduce cardiovascular risk. One type, called isoflavones, is especially abundant in soy products, sparking a plethora of media reports about the benefits that soy confers on women during and after menopause.
The evidence for soy products’ heart healthiness is strong enough that the Food and Drug Administration now allows manufacturers to claim that 25 grams per day of soy protein may lower the risk of heart disease—provided it’s part of a diet low in cholesterol and saturated fat. Scientific studies confirm that daily soy protein lowers total cholesterol and ” bad” LDL cholesterol, though purified isoflavone supplements seem to have less impact than soy-based foods and soy protein. It’s also well known that women in Asian countries are much less likely to die from heart disease than American women, a fact that is thought to be related to the soy products in their diets.
Menopausal women in Asian countries are also much less likely to experience hot flashes and sleep disturbances, but evidence that this is due to their intake of soy products remains mixed. Likewise, a recent consensus statement published by the North American Menopause Society finds that the data is mixed and sparse about whether isoflavones improve bone health.
Asian women also experience lower rates of hormone-related cancers (cancer of the breast, ovary, or uterine lining), and some experts have attributed this to their high consumption of soy. However, there’s also some concern that excessive intake of soy isoflavones could actually stimulate tumor growth in women with estrogen-related cancers. Some experts advise women with such tumors to avoid soy supplements. Others go even further, and recommend avoiding soy-based foods.
In any case, moderate consumption of soy foods is considered safer than taking refined soy extracts in pill or powder form. Examples of soy-based products include tofu, soy nuts, soy milk, and soybeans. Other forms of phytoestrogens are found in cereals, nuts, berries, peas, beans, sunflower seeds, red clover, and bean sprouts.
As the bone-maintaining levels of estrogen subside at menopause, a boost in calcium intake, along with moderate exercise, becomes absolutely essential. Without these measures, your chances of developing osteoporosis (brittle bones) rise dramatically. This debilitating disease, affects 10 million Americans. Another 18 million have thinning bones, placing them at risk of full-fledged osteoporosis. Among those most prone to the disease—postmenopausal Caucasian women—it causes a fracture in one out of three.
To forestall osteoporosis, the National Institutes of Health recommend increasing your intake of calcium to 1,500 milligrams daily at age 50. (Women taking estrogen replacement therapy can stay with an intake of 1,000 milligrams daily until age 65, boosting it to 1,500 milligrams thereafter.)
The ideal way to obtain calcium is through foods such as milk, yogurt, cheese, and other dairy products; canned salmon or sardines with bones; and dark-green leafy vegetables such as spinach and broccoli. For example, an eight-ounce glass of milk contains about 300 milligrams of calcium. If you are lactose-intolerant, try acidophilus milk or lactose-reduced milk which are easier to digest.
Calcium in pill form is absorbed best when taken with food, in 250 or 500 milligram doses throughout the day. (Do not combine it with fiber or iron supplements.) You also need a daily intake of 400 to 800 IU of vitamin D to help your body absorb calcium and build bone. Tuna, liver and fortified milk are good sources. Fifteen minutes in the sun each day helps the body make its own supply. Be careful when taking a purified supplement; high doses (25,000 IU or more) can be toxic.
To ward off osteoporosis, some nutritionists also suggest that you limit your intake of red meat to 3 or fewer servings per week. They also advise you to avoid carbonated soft drinks which contain high levels of phosphorus. While your body needs this mineral to make proper use of calcium, too much of it can actually lead to loss of bone. For more information on preventing osteoporosis, see the “Sure-Fire Way to Prevent Brittle Bones.”
Estrogen has a protective effect on the heart, raising levels of “good” HDL cholesterol and lowering “bad” LDL cholesterol. It’s no wonder then, that your risk of heart disease begins rising at menopause. To compensate, it’s more important than ever to adopt a diet that is low in total and saturated fats and cholesterol and high in complex carbohydrates.
Breast, colon, and lung cancer are other significant risks for women at menopause and beyond. Most scientific studies that have examined the role of nutrition on cancer suggest that a diet high in fruits and vegetables—particularly those rich in vitamin A or beta-carotene—may provide some protective effect. These foods include citrus fruits and juices, cantaloupe, carrots, winter squash, tomatoes, broccoli, cauliflower, and leafy green vegetables. In addition to providing essential vitamins and minerals, these foods also are major sources of dietary fiber, which helps prevent constipation.
Our ability to absorb vitamins and minerals from food becomes less efficient as we age, so it’s even more important to make the right food choices—those low in calories and high in essential nutrients.
Most women can get all the nutrients they require by eating a sensible, well-rounded diet. You may need supplements, however, if you have certain chronic health conditions or have developed deficiencies during an unsupervised diet or during pregnancy. Your body may also need a temporary boost during some of the major life stresses that so often coincide with menopause: career changes, children leaving home, or caring for elderly parents.
A multivitamin pill can supply the daily requirements that may be missing in your diet. Be cautious, however, about taking high doses of individual supplements; large doses of some vitamins can do more harm than good. For example, too much vitamin B6 can cause nerve damage.
Some women find that vitamins (and herbal remedies) serve as natural therapy for such symptoms of menopause as hot flashes. While many of these remedies may indeed be effective, few have been formally validated by scientific clinical tests. Many take 2 to 6 weeks to produce any benefits. Try them if you wish, but check with your doctor before taking massive doses of any supplement or herb.
Vitamin E is one agent that does have a proven track record:In daily doses of 400 IU or more, it may help some women with hot flashes. It sometimes relieves vaginal dryness as well, and some women claim that it gives them more energy and an improved sense of well-being. Most nutritionists believe that a diet containing whole grains, green vegetables, beans, and nuts can provide menopausal women with an adequate intake of vitamin E, but the supplement is certainly a big seller. An antioxidant, vitamin E also protects red blood cells and has other health benefits. It may not be suitable, however, if you have certain health conditions such as high blood pressure or diabetes. To ease digestion, take it with meals.
Other vitamins, including B-complex and C, are also reported to relieve menopausal symptoms, including hot flashes. While the B-complex vitamins certainly promote digestion and healthy skin and vitamin C aids in wound healing and resistance to infection, any additional effect on menopausal symptoms is unproven.
Vitamins, used properly, can enhance the absorption of essential minerals in your diet. For example, vitamin D is important for calcium absorption and bone formation. Other essential minerals are zinc and magnesium. Zinc helps maintain pliancy in your genital tract, while magnesium helps prevent mood swings and insomnia. Found naturally in leafy green vegetables, nuts, and seeds, magnesium also boosts the calcium levels in your blood.
Several herbal remedies have recently gained popularity for relief of menopausal symptoms. Black cohosh, also known as Cimicifuga racemosa and contained in the over-the-counter product Remifemin, is thought to function as a substitute for estrogen. One review of studies found that black cohosh is a safe and effective alternative to estrogen replacement therapy. Another report indicated that black cohosh can cause occasional stomach pain or intestinal discomfort. As black cohosh has not been tested in long-term trials, some authorities advise using it for no more than 6 months.
Evening primrose oil, which has anti-inflammatory properties, is considered a remedy for premenstrual syndrome and, for some women, seems to relieve hot flashes.
Other herbs taken for relief of menopausal symptoms include borage, Chinese cinnamon, golden ragwort, greater burnet, lady’s mantle, valerian, and vitex. With the exception of vitex, however, none has been definitively proven effective for menopausal symptoms. Additionally, it’s worth remembering that most herbal products are not tested to ensure that each batch has the same quality, or even that two products with the same name actually have the same ingredients.
Take These Steps For Best Health at Menopause . . . and After
|•||Follow a low-fat diet that includes generous servings of green, leafy vegetables, beans, and whole grains.||•||Cut back on fat by reducing the use of heavy creams and sauces, gravy, butter, and vegetable shortening.||•||Prevent high blood cholesterol levels by limiting the animal fat in your diet to three servings weekly and restricting your use of eggs.||•||Take in 1,000 to 1,500 milligrams of calcium daily through low-fat, high-calcium dietary sources such as skim milk, plain low-fat yogurt, and broccoli.||•||Substitute fresh or dried fruit for sugar- and fat-laden sweets.||•||Get enough vitamin D to enhance calcium absorption—either through regular exposure to sunlight or via a vitamin D supplement.||•||Keep caffeine and alcohol to a minimum, and try to quit smoking.|
|•||Follow a low-fat diet that includes generous servings of green, leafy vegetables, beans, and whole grains.|
|•||Cut back on fat by reducing the use of heavy creams and sauces, gravy, butter, and vegetable shortening.|
|•||Prevent high blood cholesterol levels by limiting the animal fat in your diet to three servings weekly and restricting your use of eggs.|
|•||Take in 1,000 to 1,500 milligrams of calcium daily through low-fat, high-calcium dietary sources such as skim milk, plain low-fat yogurt, and broccoli.|
|•||Substitute fresh or dried fruit for sugar- and fat-laden sweets.|
|•||Get enough vitamin D to enhance calcium absorption—either through regular exposure to sunlight or via a vitamin D supplement.|
|•||Keep caffeine and alcohol to a minimum, and try to quit smoking.|
Overdoing a number of our favorite foods at this point in your life can not only aggravate some menopausal symptoms, but increase your risk of post-menopausal disease. And because of the complex way foods interact, certain substances can undo some of the benefits of any healthy additions you make to your diet.
Sodium plays an essential role in our bodies. It regulates blood pressure and transmits nerve impulses. But most of us get more than enough from dietary sources, so using a lot of salt is unnecessary and can be harmful. There is an as yet unconfirmed belief that excessive salt contributes to high blood pressure—which is a health risk as you age. And there is definitely a link between salt and osteoporosis. In fact, excess sodium leeches calcium from your digestive tract before it can be used by your bones, literally pulling it into the kidneys, where it’s eliminated from the body.
Unless you prepare meals carefully, using only fresh ingredients, you probably get plenty of sodium from a variety of sources. These include baking soda, baking powder, canned and cured foods, prepackaged and convenience foods, potato chips, condiments, and flavor enhancers such as MSG. The easiest way to avoid eating too much salt is to remove the salt shaker from the kitchen table and stop cooking with salt. In addition, cut back on salt-cured and smoked foods, such as sausages, smoked fish, ham, bacon, bologna, and hot dogs.
Americans are conditioned to use salt. Your family might protest for a week or so, but they’ll be surprised how quickly they adjust to the real taste of food.
If you’re a heavy coffee drinker—and most American women are—now’s the time to cut back on caffeinated coffee or eliminate it from your diet altogether.
A stimulant also found in soft drinks, chocolate, and tea, caffeine is used by most people to overcome fatigue and work harder or faster—thus, the traditional “coffee break” mentality in American business. At menopause, however, coffee and other caffeinated beverages can increase the number or intensity of hot flashes. Caffeine also has been implicated in breast changes such as fibrocystic disease, in osteoporosis, and in a rise in serum cholesterol associated with heart disease. Despite our affection for coffee, it’s difficult to make a case for caffeine use at menopause.
Warning: If you’re used to drinking five or six cups of coffee or caffeinated soft drinks daily, eliminating caffeine too quickly can trigger withdrawal symptoms. These range from headaches and nervousness to drowsiness, nausea, and constipation. To avoid caffeine withdrawal, switch gradually to decaffeinated drinks over a period of several weeks.
Fluctuating hormones affect blood sugar levels and can cause cravings for sugar. Refined sugars—those found in your sugar bowl and in candy, cakes, pastries, cold cereals, syrups, and a nearly endless variety of processed and prepackaged foods—are packed with calories and little else. They make it easy to gain weight, but contribute nothing of value to your nutritional status. Sugar also suppresses the body’s use of calcium and phosphorus. And too much sugar can cause a vaginal discharge that can contribute to recurring vaginal and urinary-tract infections.
In general, you can suppress a craving for sweets by keeping your protein levels steady. Also, be sure to stock your pantry with healthy alternatives. Fresh and dried fruits contain the natural sugar fructose along with fiber. A small serving can quench a sugar craving and serve as a natural laxative to aid your digestive system. Scientists believe that fruit may also help protect against stomach and colon cancers. Today’s grocery stores carry nearly every variety of fruit year-round—from the mundane to the sublime. Indulge your taste buds while treating your body to good nutrition.
Prior to menopause, estrogen helps suppress the buildup of fat along arterial walls that often results from intake of too much saturated (animal) fat and cholesterol. But as menopause drives down your estrogen levels, this extra protection vanishes, leaving you prey to the arterial buildup that often ends in cardiac disease, heart attack and stroke.
Some experts have suggested that high rates of breast cancer may also be due to the excessive amounts of dietary fat, though some evidence casts doubt on this assertion.
Although a modest amount of fat is a recommended part of our diet, it is easily obtained from meager amounts of lean meats, nuts, fish, and poultry. Fats can be used sparingly to add taste to a menu—for example, a dab of avocado to garnish a salad or a spoonful of peanut butter on whole-grain toast. But otherwise, spare your heart by reducing or eliminating your intake of butter, rich sauces and gravies, fatty meats, and whole milk and ice cream. Bake, steam, or broil your food instead of frying it in fat. And serve eggs and organ meats sparingly. Though they add iron and protein to your diet, they have extremely high concentrations of cholesterol. For more information, see “What to Do About Fat.”
Numerous studies have confirmed the negative effects of alcohol and smoking on a woman’s health at midlife. It may be confusing to hear that moderate amounts of alcohol can reduce the risk of coronary disease in women by raising “good” HDL cholesterol levels and improving other lipid levels. At some point, however, too much alcohol can increase the risk of high blood pressure, while limiting its use can bring blood pressure down. Heavy drinking is a risk factor for osteoporosis, and may aggravate hot flashes. Due to its high sugar content, alcohol even promotes weight gain. Most experts agree that minimizing or eliminating your alcohol consumption, including beer and wine, boosts your overall health at midlife and beyond.
As for tobacco, lung cancer now causes more deaths in American women than breast cancer. Heavy smokers also tend to have an earlier menopause, which has been linked to higher rates of heart disease and osteoporosis.
Several new studies have confirmed that cutting out smoking even in midlife or old age—cuts your chances of developing heart disease and cancer of the lung, mouth, esophagus, kidney, stomach, and colon. It also helps the heart, lung, and circulatory systems and reduces the impact of emphysema or chronic lung disease. By giving up cigarettes, you’ll unquestionably improve the health of your heart and lungs and decrease your risk of developing osteoporosis. (For more, see “What Smokers Need to Know About Diet.”)
Remember that variety and moderation are the keys to good nutrition during this exciting, though occasionally turbulent, period. At midlife—as in your younger years—you are what you eat.
Embrace a healthy diet for its boost to a robust heart, strong bones, and radiant skin. Maximizing your intake of nutritious foods and minimizing your reliance on empty calories will prepare you to appreciate the joys of menopause without suffering its sorrows.