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Eating ‘like a 25-year-old’ poses risks during the menopause transition

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PHILADELPHIA — The “perfect storm” of inadequate dietary intake, physiology and low physical activity can put midlife women at risk for several cardiometabolic conditions, but changes made both before and during the menopause transition can dramatically improve outcomes, according to a speaker here.

“I was asked by a journalist recently, ‘When is the right time to start preparing for menopause?’ I said, ‘20,’” Jennifer Blake, MD, MSC, FRCSC, chief executive officer of the Society of Obstetricians and Gynecologists of Canada in Ottawa, said during a presentation at the North American Menopause Society Annual Meeting. “That was not the answer that they wanted. But really, it makes sense for us to begin thinking about this [at that age].”

At midlife, Blake said, women often experience a combination of changes, including children moving out of the home and related changes in their social situation, as well as changes in activity levels, stress levels, hormone influences and metabolism. These changes, she said, affect eating behavior at a time when women are already primed for increased risks for conditions such as overweight and obesity.

“We can blame our hormones for this, and it’s nice to say this is because of what my estrogens are doing to my tissue lipoprotein lipase activity, but the fact of the matter is that it’s changing,” Blake said. “And we’re also having changes in insulin resistance, leading to increased risks of hyperglycemia, dyslipidemia and hypertension. If we go into menopause with those things, we are much more likely to get into worse trouble with menopause.”

Eating ‘errors’ and physical activity

Women must be careful of several eating “errors” that can lead to increased calorie intake, Blake said, including mistaking fatigue or thirst for hunger or eating too quickly. Eating foods that don’t produce satiety, late-night snacking and alcohol consumption also affect eating behavior, Blake said.

“Alcohol changes many of our habits, including the one that says, ‘No, you’ve had enough,’” Blake said.

Additionally, she said, women are less active than men and become less active with time, and they often experience barriers to physical activity that men don’t, such as safety and security when going out for walks in the evening.

Weight control consistently emerges as a major concern among women at menopause, and weight gain is typical at this time, Blake said. In the observational SWAN study, healthy women gained, on average, 4.5 lbs. through the menopausal transition, Blake said.

Addressing any weight gain well before menopause is key, Blake said, adding that there are risks that come with weight loss after menopause.

“The real risk is if we try to lose [weight] after menopause that we will lose muscle mass rather than fat mass, so its’s really important to maintain your lean body mass,” Blake said. “Unless adequate protein and activity are maintained, what we see is weight loss as we get older that is dangerous to our health.”

The right diet

Blake made several recommendations for a healthy diet for women before, during and after menopause:

• Protein — Research now shows women need more, not less, protein as they age, Blake said. “That may be counterintuitive — we think protein is for the guys lifting weights in the gym,” Blake said. “But increasingly it’s looking like about a gram of protein per kilo of body weight. That means for a woman, 20 g to 30 g at each meal, because we don’t absorb it well. Think about getting protein at every meal.”
• Carbohydrates — “There are no essential carbohydrates, as it turns out,” Blake said, cautioning that low glycemic index foods are ideal, as glucose resistance increases with age. An appropriate contribution of carbohydrates to diet varies with age and between individuals, she added.
• Dietary fat — The Canada Food Guide advises 30 mL to 45 mL of unsaturated fats daily, including oil used for cooking, and recommends limiting the intake of butter, hard margarine, lard and shortening. The 2015 Dietary Guidelines for Americans, however, does not specify an upper limit on dietary fat. “Reducing dietary cholesterol has not been found to reduce serum cholesterol,” Blake said. “In the WHI, a low-fat diet did not impact CV risk, and low-fat diets may result in decreased healthy fats, such as fish, vegetables and nut oils. Furthermore, “low fat foods are often high-sugar foods, and fats contribute to satiety, and that’s an important regulator of consumption,” Blake said. “So healthy fat is prudent advice.”
• Calcium and vitamin D — Women who choose to take a calcium supplement should take careful note of what they are eating and take calcium in small quantities, best absorbed over three meals, Blake said, adding that calcium is not absorbed well in a bolus dose. All adults over age 50 years should take a daily vitamin D supplement of 400 IU, according to Health Canada recommendations, which also recommends a routine vitamin D supplement for postmenopausal women of 800 IU to 1,000 IU daily.
• Iron — Menstrual iron losses stop with menopause, but women who have had menorrhagia may have persistent iron deficiencies, particularly if they have a diet low in meat, Blake said. Iron is important for neurocognitive function, and deficiencies should be corrected, she said. “Any iron deficiencies — a women who has had very heavy periods coming into menopause — needs to have those iron deficiencies corrected,” Blake said.

Blake said that menopause clinicians must convey to women the importance of a healthy, balanced diet combined with the right amount of physical activity.

“It’s time for us to say that there are lots of things we could be doing that make a real difference, and give people a new lease on life,” Blake said. “It comes down to dietary habits and physical activity, and if we do those things right, the specific nutrients will follow.” – by Regina Schaffer

Reference:

Blake J. Menopause: What, why, where and how to eat. Presented at: Annual Meeting of the North American Menopause Society; Oct. 11-14, 2017; Philadephia.

HerNutrition Canada. Available at: www.hernutrition.ca.

Disclosure: Blake reports no relevant financial disclosures.