As we talked about in our June post, “Are you “very peri”? ….and did you know that it’s linked to your heart, bone and mental health?”, we looked at body composition and cardio-metabolic changes related to the menopause transition. In this post we explore what are some of the ways you can nourish your body’s health during perimenopause.
But first, a recap - what is the “perimenopause”?
Perimenopause is the transitional time around menopause. Menopause is when a woman, trans or non-binary person's periods stop. It's marked by changes in the menstrual cycle, along with other physical and emotional symptoms. This time can last 2 to 10 years before when someone reach menopause (at around 51 years of age).
What might I experience in perimenopause?
We often just think of oestrogen as being involved in fertility and reproduction. However, oestrogen is a great multi-tasker! It influences our heart and blood vessels, our brain, as well as adipose tissues (the way our body stores fat). Oestrogen has an anti-inflammatory effect, as well as cardio-protective one which keeps our HDL (high density lipoprotein or “good” cholesterol”) high and blood vessels elastic.
Collectively, studies suggest that loss of oestrogen promotes abdominal fat accumulation and a drop in energy expenditure. It is well known that body fat distribution rather than weight status alone is a good indicator of cardiometabolic risk during the menopausal transition. Bone mineral density decreases most rapidly in the year (to three years) before the final menstrual period and declines but does not cease to three to four years following this.
Is there really anything I can do to change my health risks at this time?
Time for some good news – the answer is YES. There have been many good studies that have shown starting lifestyle modification programs that incorporate dietary changes and being more physically active during perimenopause are extremely beneficial.
‘Food first’ is our mantra.
Eating a variety of food in the perimenopause is important. The main nutrients to focus on are: calcium and vitamin D, iron, fibre, omega-3 fatty acids, and low glycemic index carbs.
While it can be appealing quick fix to pop a multivitamin or other nutritional supplement*, we never truly get the same benefits as we do when we eat a minimally processed, varied diet. Above providing nutrients, food gives us pleasure through its preparation, sharing as part of celebrations, and savouring its tastes and textures. There are also hundreds of plant chemicals (phytonutrients) that can’t be replicated in a pill (*in most cases, supplements are ‘expensive wee’ unless you have a diagnosed deficiency).
Below, we’ve listed the six important nutritional decisions to prioritise to keep you feeling strong, healthy and happy for many years to come (For those who love numbers, we’ve provided the EAR and RDI for each nutrient)**.
1. Concentrate on calcium. This bone-strengthening nutrient is found in dairy foods, fortified soy and other fortified nut milks, green leafy vegetables, nuts, seeds, canned fish with bones. Your calcium requirements increase from the age of 51 to 1100 (EAR)-1300mg/d (RDI).
2. Don’t overlook Vitamin D. Vitamin D helps calcium keep your bones and teeth healthy and strong. A blood test will tell you if you do not have enough Vitamin D in your blood. Vitamin D comes from the sun, supplements and a small amount from food. Most of the Vitamin D your body needs comes from the action of sun on your skin. Do not get sunburnt as this will increase your risk of skin cancer. If you are low in Vitamin D you will require an additional Vitamin D supplement of at least 1000IU.
3. Include iron rich foods. If you are or have been experiencing heavy periods it’s likely your iron is low. Iron deficiency anaemia is also the most widespread deficiency worldwide, so you’re not alone. Need to check? Ask your GP to make sure to include ‘serum ferritin’ in the test (this is your ‘storage’ indicator). Iron is important in many vital body functions, including carrying oxygen around your body, general energy and focus, your immune system, and the regulation of body temperature. Good food sources are red meat, fortified cereals, egg yolks, green leafy vegetables, legumes, nuts. Women’s iron requirements are 5 (EAR) - 8 (RDI)mg/day.
4. Fill up on fibre. Fibre-containing foods are our best friends in perimenopause. We are all familiar with the health benefits of soluble and insoluble fibres for helping keep us regular, but they also help reduce our cholesterol levels and regulate our blood glucose levels. Very important in helping lower our cardiometabolic risk. In addition, resistant starch (technically NOT a fibre, but close enough) acts as a prebiotic.
Prebiotics are a source of food for your gut's healthy bacteria. They're carbs your body can't digest. So they go to your lower digestive tract, where they act like food to help the healthy bacteria grow. These bacteria influence our body’s immunity, inflammation, and regulate how we process and store the kilojoules we consume. Women need 25g of fibre each day; this can come from wholemeal and wholegrain breads and high fibre cereals, oats, vegetables and fruit with the skin on, as well as legumes, nuts and seeds.
5. Omega-3 fatty acids. Omega-3 fatty acids are found in both plant and marine foods, although it is the omega-3 fatty acids from marine sources that have the strongest evidence for health benefits (including reducing the risk of heart disease). Fish and seafood should be an important part of your diet in perimenopause. It is an excellent source of protein, is low in saturated fat, and has high amounts of omega 3.
The Heart Foundation recommends that all Australians should aim to eat 2–3 serves of fish, including oily fish, per week such as Atlantic salmon, mackerel, Southern blue fin tuna, trevally and sardines. This provides about 250–500 mg/d of marine-sourced omega-3s. Plant food sources include – canola and soy oils, canola-based margarine and seeds.
6. Love your low glycemic index carbs. You may have heard of the glycemic index (or the GI) – this describes how different carbohydrate foods raise blood glucose levels. Carbohydrate foods are ranked from 0 to 100. This measure tells us whether a food will raise blood glucose levels slowly, moderately or quickly. In response to increasing blood glucose levels, the hormone, insulin is secreted to remove this glucose into your muscles where it is used for energy.
Low GI carbohydrate foods raise blood glucose levels more slowly over a longer time, and in turn, insulin requirements are more uniform. This can help people who have impaired glucose tolerance. In addition, low GI foods help reduce appetite as they keep you fuller for longer and may assist people who are above their most comfortable or healthy weight. Some “low GI” food swaps include: Multigrain or rye bread rather than white or wholemeal; Crackers based on whole grains or seeds rather than highly processed biscuits; Pasta, noodles, or Basmati or Doongara rice over white or brown rice; or Sweet potato rather than white potato. It is important to remember when making your “swaps” that you should keep these to normal serves sizes and not increase the amounts.
A personally prescribed eating plan or advice is much more likely to be sustainable than following a radical generic diet that is very different from a person's usual or previous habitual eating.
This is where working with an Accredited Practising Dietitian can be extremely helpful. Dietitians understand the influences and basis of how you usually eat and help you tweak this into a healthier eating pattern. Dietitians consider your food preferences, your social and cultural influences and practicalities such as budget or the need to feed a family as well as time constraints.
**EAR – estimated average requirement; a daily nutrient level estimated to meet the requirements of half the healthy individuals in a particular life stage and gender group. An intake above this means it’s unlikely your intake is inadequate; RDI - recommended dietary intake; This is set at the average daily dietary intake level that is sufficient to meet the nutrient requirements of nearly all (97–98%) healthy individuals in a particular life stage and gender group, so if you’re meeting this it’s highly unlikely your intake is inadequate.
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