Mikki Williden is a Registered Nutritionist and a Senior Lecturer at Unitec.

What happens during menopause and why? Mikki Williden shares some dietary considerations if you experience symptoms.

I’ve been working in the nutrition space for a good 20 years, helping people with their health and nutrition-related goals.

In my job as a nutritionist, I feel really lucky to have information that I can share with people that might help them with their health goals. I equally think it’s almost a terrible job to be in, because inevitably I’m the one who tells you that you need to give up your wine and chips and bread and other things you might enjoy.

Unfortunately, as we head into our menopausal, or let’s go even earlier, perimenopausal years, things do need to change. There are women who sail through menopause – no drama at all. No need to change their exercise, diet or sleep patterns. They are absolutely fine. Other women aren’t so lucky. Many are experiencing weight gain, brain fog, joint pain, hot flashes, sugar cravings and irritability, when nothing else in their lives has changed.

These symptoms occur because of hormones, but it’s not just at menopause. This can happen in your early 40s and can go on for five years before you hit menopause. Twenty percent of women experience these symptoms up to 10-20 years post-menopause.

The transition is gradual if it happens naturally. However, one of the problems is, with oestrogen, you don’t get a gradual decline in levels and then suddenly you’re at a low level. Instead, what happens is you get highs and lows, and you get these fluctuating levels. It’s all about what your brain is signalling to your organs and your ovaries.

 

When your oestrogen levels decline your insulin-sensitivity declines as well, and the less insulin-sensitive you are, the less carb-tolerant you are.

 

Your brain starts getting messages that suddenly your ovaries (the main producer of oestrogen in the body) are no longer producing it. These alarm signals trigger luteinising hormone and our follicle stimulating hormone to go, ‘Whoa, you need to start producing more oestrogen’. This leads to massive surges of oestrogen. However, in mid-balance, you do have a lower oestrogen level. Oestrogen is really insulin, since it helps us be insulin-sensitive. When your oestrogen levels decline your insulin-sensitivity declines as well, and the less insulin-sensitive you are, the less carb-tolerant you are.

You may have got away with having a reasonable amount of carbohydrate in your diet previously, but suddenly you’re recognising that whilst you’re consuming the same amount of carbs, you are starting to store fat around the middle. Researchers don’t know why this happens, but there are some theories. One of the theories is that we also produce oestrogen from our fat tissue. When the body gets these signals that the ovaries are no longer pulling their weight, we start to store more fat around the middle to keep the oestrogen level a little bit higher. The brain doesn’t get the message that you might already have enough fat stores to be able to produce a bit more oestrogen.

Stress affects insulin-sensitivity

You’ve got to think about how life changes as we age. It’s not just what you eat, it’s everything else that’s going on around you. Think about yourself now, if you are in your 40s and 50s, compared to where you were in your 20s. You may have a family. You may be running a household. You may be at the peak of your career. You might have relationship issues, or you may be looking after older parents or relatives. You’ve got all of the stress on top of an already full life. And we know that elevated stress hormones ramp up your body’s glucose production, and therefore ramps up your insulin as well.

 

The oestrogen and its fluctuations are, in part, what create the hot flashes, the mood swings, breast tenderness and vaginal dryness. But progesterone is involved as well.

 

This further compounds that reduction in insulin-sensitivity you already have going on from a reduction in oestrogen over time. That might explain why you’re starting to gain weight. And not only that, it might also explain why you’re beginning to have sugar cravings. Cortisol will ramp up your blood sugar and then it drops down again. Therefore, you suddenly have these fluctuating blood sugars that you might never have had before with your current approach. So, your current approach may have to change. The oestrogen and its fluctuations are, in part, what create the hot flashes, the mood swings, breast tenderness and vaginal dryness. But progesterone is involved as well.

As all this is going on, progesterone is quietly reducing in the background. Progesterone is a super-calming hormone. It supports the GABA (gamma-Aminobutyric acid) pathway. GABA is a calming and sleep-promoting neurotransmitter. As your progesterone is dropping down, suddenly you’re awake at 2am, 3am, 4am, unable to sleep.

 

If you want to reduce these symptoms, you have to make some changes. You can put a Band-Aid on it and take supplements, and they may be useful or not. But the most important thing is lifestyle. And that’s probably not news to you.

 

People talk about oestrogen dominance, but it’s not actually about that. It’s an imbalance between oestrogen and progesterone. As progesterone is declining and oestrogen is going up and down, progesterone is not there to buffer the effects of the fluctuations. A lot of the symptoms of menopause are a result of that imbalance.

If you want to reduce these symptoms, you have to make some changes. You can put a Band-Aid on it and take supplements, and they may be useful or not. But the most important thing is lifestyle. And that’s probably not news to you.

Mikki’s recommendations

  • Go lower carb

My first recommendation is almost always to go lower carb. The reason is, because you are less carb tolerant as you go into perimenopause or menopause – if you are gaining weight, we have to drop back the carbs. So that is the first line of defence. Unsurprisingly, the type of carbs that we cut out are processed carbs, such as bread, cereal, pasta, rice, muesli bars – the things we grab because they’re super-convenient, but they’re actually not doing you any favours.

 

Optimising your protein intake as you head into your 40s and 50s and beyond is one of the best things you can do for your health.

 

The opportunity that this provides us is you have to replace the energy that was once coming from carbs with another nutrient. Enter protein. Protein is one of the best things that you can have, hands down. Optimising your protein intake as you head into your 40s and 50s and beyond is one of the best things you can do for your health.

Protein is more satisfying. Protein takes the longest of all macronutrients (carbohydrate, protein, fat, and alcohol) for our body to digest. And therefore it stabilises our blood sugar a lot better than what carbs do. In my experience, women fare better on a high protein, lower carb, moderate fat diet. Fat is satisfying, but not nearly as satisfying if it’s by itself without the addition of protein. From the hundreds of women that I have dealt with in my years as a nutritionist, I’ve known that to be true. So we lower the carb intake and replace it with protein. We want at least 1.5 grams protein per kilogram body weight per day, according to the most latest research.

 

You need to anchor your meals around protein to help stabilise your blood sugar.

 

Let’s think about food. You will have three eggs, not two. You will have 150 grams of cooked meat, not 80 grams. Don’t just get a salad from a restaurant or café and think that the protein in it will suffice. It won’t. That salad will fill you up for about half an hour. Don’t put yourself in that position. 

  • Dairy

The A1 casein protein in milk and in all dairy can be inflammatory. From a practitioner perspective, if you eliminate the casein, you will eliminate a lot of the inflammatory aspects that occur monthly with your symptoms around perimenopause – for example breast tenderness, abdominal bloating, cramps, irritability, brain fog. If you eliminate dairy and you drop your carbs and eat much more nutritious carbs, you will fare far better.

However, If you have no symptoms, then you don’t necessarily need to change anything. 

  • Alcohol

Our tolerance for alcohol as we head into perimenopause and menopause is compromised. Sleep is much more impaired from a couple of glasses of wine than it ever was. It’s up to your liver to detoxify alcohol and because it’s preferentially metabolised, that will delay your liver’s ability to get rid of oestrogen, and to get rid of other toxins. It can exacerbate the symptoms too.

If you think that alcohol is affecting your sleep, it is best to minimise or avoid it and start working on the foundation of getting your lifestyle habits back to where they should be. Sleep is the best recovery tool we have, and we’re already up against it, because progesterone is starting to decline. So if you experience issues with sleep, getting rid of alcohol can certainly help.

  • Caffeine

If you are someone who uses caffeine as a way to prop yourself up during the day, it can impact on blood sugar and it can increase cortisol production, which can then result in increased fat storage, amongst a whole host of other things. You need to step back and be really honest about some of these things. And it’s hard. People are fine to change their diet in terms of food. But when it comes to stress and sleep habits, you switch the focus and you have to think about how you interact with the rest of the world and how that might have to change in your environment.

But if you do experience symptoms and they are impacting on your health and wellbeing, then it’s definitely worth exploring.

  • Resistance training

One of the best things that you can do is start lifting weights. The first benefit is you’re going to increase your muscle mass. We are losing this from the age of about 30. You are not able to hold onto your muscle, and your muscle is the key to your metabolic health. When we’ve got additional muscle, you’ve got somewhere for those carbs to go. It’s not just about being ‘skinny’. It is about being fit, being strong, being healthy. You don’t just lose muscle, you also lose bone. We lose the lean mass that is going to help keep us healthy into our older years.

A lot of women shy away from doing weights. Women think that they’re going to get bulky. But is that a bad thing? Often, it’s not even possible to get bulky in the way that I think they fear. There’s just too much focus on the scales and not enough focus on being fit and strong. We need the muscle and we need our bone density if we want to have a long and healthy life. It’s not about swimming or aqua aerobics or non-weightbearing activities. It’s actually lifting weights. A really good resource for this is Mark’s Daily Apple. Check out this page for some useful information on functional training. It does not require a gym. Though, I do recommend, if you have the means, to contact a Personal Trainer and get going. It’s never too late, but you do need to start now, because that is what is going to keep you healthy and well. It is going to maintain your metabolic rate. It’s going to allow you to eat more carbs, basically. It’s going to prevent you from falling as you age.

 

People are so ready and focused to change their diet, but so unwilling to change sleep hygiene behaviours, digital device behaviours at night, or their connection to nature.

 

  • Green and blue space

If you experience mood swings, or low mood, make sure that you think of things outside of diet. I think that’s really important. People are so ready and focused to change their diet, but so unwilling to change sleep hygiene behaviours, digital device behaviours at night, or their connection to nature. These are things which really help with our low mood. Try to get into some green space or blue space. If you live near an ocean or a river, spending some time in nature is critical for our mood, especially in winter. But equally important, the sun is responsible for helping us synthesise vitamin D on our skin.

 

Recommended reading

 

Visit Mikki’s website here.

Watch Mikki’s Facebook Live on menopause and weight loss here.