How Diet Affects Menopause Symptoms. Are We Eating Too Much Protein? With Professor Sarah Berry.

0:00In the menopause, we have this massive range of symptoms and we have been told so much that what we eat has such a massive effect. I was like, look, as long as you take HRT, then that's it. But actually what we found was people following healthy eating, they reduce their symptoms by that. It's enormous. What are you thinking of an unhealthy to a healthy? What would that look like? So an unhealthy diet, unfortunately, is the typical UK diet. We know they impact cancer risk. We know they impact cardiovascular disease risk. We know they increase our blood pressure. We know they increase our bad cholesterol.

0:35Can I ask you something? If that comes with a cancer risk, I don't really understand how that's even on the shelf still. If we were to start eliminating any food that was bad for us or a carcinogen, then... There'd be nothing left in the supermarket. There'd probably be about 30 % left. It's quite mad. Give me the kind of headline changes that me as a menopausal woman could make to help me. So, headline is...

1:11OK, I've got a favour to ask you. I was just wondering if you could just give us a follow. It costs absolutely nothing, it's completely free and it really helps us to continue to bring you lots more episodes of Begin Again. I'm so pleased you're enjoying it. Thanks. I think what's amazing nowadays is that it's going to have such a massive impact, not just on obviously everybody's weight and well-being. And we know that it's not just about your weight or your size or your health. It's also about your mental health. It's become so apparent that we are what we eat mentally as well. but for me in midlife and in terms of longevity and how best to look after our bodies to live and prosper for as long as we possibly can but for both men and women I mean often women have been just clumped together with men in terms of research and we're all just the same and but I know we're going to talk a little bit later about this amazing new research that you've got that is such a game changer in terms of menopausal women and their symptoms and food.

2:28Yeah. But in all the ways that women differ from men, can you just tell me in terms of like midlife, what big things have you learned that you think are take homes for people in midlife, men and women that are different? How are men and women different? Gosh, this is challenging me now. Yeah, good. um this whole area of menopause is relatively new uh for me i mean you know there's so much similarity between men and women just like there's so much similarity between what kind what foods are good for you and what foods are bad for you for different people well could i ask you then very quickly for but for both sexes what foods would you say because Because protein is so, well, it's quite a tricky area, really, because it's generally said that we should get most of our protein from our diet.

3:27And I do know that a lot of people either are too busy, they're not making the right choices, too much fast food. Lots of people maybe aren't getting quite enough. But if you're young and you eat lots of meat and you can also get enough protein quite easily plant based. but you have got to be making the right decisions. How important is protein as a building block for a midlifer? Because I really struggle getting protein into my diet. I really do. I can't eat a whole chicken breast. It's too much. Yeah, so I think protein has become one of these nutrients that's the hot topic at the moment. You know, I was in the States recently and you go to the kind of lunch restaurants and they say, what protein do you want with that?

4:12I mean, that to me is just crazy. you know we we try and as good nutrition scientists think of food and in terms of food not in terms of nutrients i think there's too much of a focus on protein i don't think it's a big problem the majority of people are getting enough protein now really do you like even if we're eating kind of even if you're eating a plant-based you know exclusively vegan style diet you do need to be more mindful of making sure you are eating protein rich foods and getting kind of the right sort of protein rich foods like pulses etc into your diet the majority of people certainly in the UK and the US are getting enough protein some people aren't and yes at an older ages then we need to be a bit more mindful I think when we think about how men and women differ rather than thinking just because of the sex we need to always think about not just sex but your the phase you are in your life so are you of a childbearing age are you in adolescence are you a child are you a pre or post-menopausal woman um for men obviously those phases are less distinct like they are for women so does their diet not really do they not really need to think about changes or adapting as they get older so as you get older your body composition naturally changes your metabolism naturally changes it's a natural part of the aging process so because of that i think that you need to be more mindful of the types of food that you're eating and i think that you also could but you know need to bear in mind that at any age adapting a healthy diet whether you're 40 50 60 there's really good evidence to show transitioning from an unhealthy diet to a healthy diet whether you're male or female at any age has significant health benefits when you're When you're saying, what are you thinking of an unhealthy to a healthy?

6:02What would that look like? So an unhealthy diet, unfortunately, is the typical UK diet for the average person. So I'm talking about a diet that contains maybe 60 % of heavily processed unhealthy foods, which is the average UK diet, has lots of refined carbohydrates, white bread, white rice, white pasta, has too much red meat in it, doesn't have enough fibre. and then when I think of a healthy diet I think of a healthy diet in one that is kind of a little bit more traditional so a diet where we are cooking from scratch that can have some red meat but limited red meat has a wide diversity of plant-based foods it has plenty of fiber in it being someone who you know I mean I'm in midlife and I'm thinking to myself I grew up on red meat I, you know, I think people generally thought that it was really good for us.

6:55Yeah. Iron, solid, you know, and it is quite hard to wean yourself off that. Why should we only be consuming a bit of red meat? So there's really good evidence to show that if it's processed red meat, so your hams, your salamis, etc. It's like the best. I know. And often this is a problem with processed food. I mean, we can come on to that. But unfortunately, a lot of heavily processed food has that magic mix of the salt, the fat, the carbohydrate to hit those reward centers in the brain. That is why, like you're saying, it's the yummy stuff. But there's really good evidence to show that this heavily processed meats are bad for us.

7:39We know they impact cancer risk. We know they impact cardiovascular disease risk. We know they increase our blood pressure. we know they increase our bad cholesterol, our LDL cholesterol. Can I ask you something? If that comes with a cancer risk, I mean, the World Health Organization actually says processed meat is a carcinogen. I don't really understand how that's even on the shelf still. How come we're allowed to eat that? Gosh, you need to get the government in here to answer that. Yes, it feels kind of quite a crazy thing that we are eating. It's the power of the consumer, I think. I mean, this is kind of going outside of, you know, my kind of research area.

8:23But my view on this is the consumer is very powerful. And what the consumer wants is what manufacturers will give to a certain extent. There is a duty of care. I think food manufacturers have, but at the end of the day, they're a business. They have products to sell. our whole food landscape has changed and so if we were to start eliminating any food that was bad for us or carcinogen then there'd be nothing left in the supermarket there would be very little there'd probably be about 30 left it's quite mad but having said that i you know i like to caveat everything it's all about balance so i'm not saying that 70 of the food is going to kill us well what i do i'm half french and um my love for saucisson and ham and mortadella and all the processed meats that are now i know not great for me i don't understand how france italy spain you know the spanish literally you get served tapas and it's like meat and an artichoke why are they well so i think that is a great example of how we need to try and not take what we call a reductionist view of nutrition of food and health because we can't just look at single foods yes we know some single foods aren't the best for us but we have to look at the entire diet and the mediterranean is a great example it's the healthiest diet out there but yes they still have like the french some salami but we need to think what else are they having in addition to that so rather than focusing on kind of what's bad for us i think it's a really good approach to use these kind of countries say okay what's good in their diet the extra virgin olive oil they have loads of that they have loads of healthy fats they still have lots of fiber rich foods but also i think they're they are a great example of how we need to think about food about diet beyond the food so if you take the mediterranean for example they don't snack as much as the uk and the us yes the way the way they eat their food they eat it more slowly and i mean there's fantastic research even that we've been doing about eating rates so the speed at which you eat it and how that impacts your health also the the distribution of how they eat their food so the in most of the mediterranean the main meals the majority of their calories come from their lunchtime meal in the uk the majority of our calories come from our late our kind of evening meal right and actually 35 percent of people in the uk snack after nine in the evening yes and we know that that's not good for you that there's this whole new area called chrononutrition about the time that you eat and so when we look at countries like that it's not a case of oh well they have loads of salami but look they're living these wonderful long healthy lives it's okay what else are they doing how are they eating and this is a real exciting area of research as well as what else is in their diet?

11:26I mean, this is why I found intermittent fasting so interesting for me because the first biggest thing I noticed was in the evening, I was depressed because I'd eat my meal. I'd finish at about seven because I'd know that I'd want to eat after I'd worked out, so I'd want to eat about nine the next morning. So I'd finish about seven, 7.30, and then we'd say, okay, let's watch something on the telly. and then it would be, the boys would be like, oh, okay, let's go and snack cupboard. I mean, we've got a snack cupboard, for the love of God, and it's full of the worst things you've ever seen, you know, wafers and crisps and, you know, and they come with their snacks and they open their crisps and everybody's co-sharing and a toffee bonbon or something.

12:15Oh, that's a bit mean, and you're there. And I'm there sitting on my hands. But after three or four days, again, I didn't want a snack after dinner. I didn't miss it. It didn't take me very long. But it is interesting. It's part of our culture to sit down in front of the telly and have a snack. It is a thing. But it wasn't like 30, 40 years ago. No. It's that the snacking has become very different now to how it was. What was the percentage again that you said that we got our nutrition from snacks? So on average, we get 25 % of our calories in the UK from snacks. That's a quarter of our calories.

12:53But do you know what? I think rather than worrying about it, I think we should see snacking is one of the eating events, as we call it, that's kind of under our self-control. Because typically when you snack, it's something you're snacking on in isolation or you can choose your snacks. A lot of the time your lunch meal or your evening meal is dictated by who else you're eating with or what you're doing at work. and so actually yes 25 of our energy on average comes from snack but it's the simple single strategy that we can do something about and do something about and so what would you change it to so we've actually done some quite a bit of research on snacking ourselves and so we've done some within our Zoe predicts study that shows that actually it's not so much the frequency of eating i.e the snacking in itself that's the problem it's about the timing so avoid snacking after nine o 'clock after dinner ideally after eight o 'clock yeah um we see people snacking even if it's on healthy snacks if they're snacking after nine o 'clock increase risk of cardiovascular disease higher blood cholesterol blood pressure etc also changing the type of snack you're having i mean i know that's obvious but we did a study recently well it is sometimes it is just you want to be doing something so actually it's well do you know what they did a survey and 25 percent of people say they snack purely out of boredom 25 % of people out of habit so 50 % of people are snacking not because they need it but we did a clinical trial where we asked 50 people to eat a 20 % of their energy from typical UK snacks and so basically we made these muffins that had the same profile as let's say a bit of Walker's crisps a bit of a McVitie's digestive but we worked out what's the average kind of snack in the uk and then we had another 50 people who for six weeks were eating almond nuts but the exactly same percent energy was coming so this 20 energy was coming from either nuts or from snacks we said don't change anything else carry on living as you normally would eat everything else you normally would but you must eat this these snack foods that we provide by the end of the six weeks the improvement in health outcomes on those on the almonds was phenomenal when you actually uh calculated what the estimated improvement in cardiovascular risk was from some of the different factors that changed like their cholesterol and their blood vessel function it equated to a 30 reduction in cardiovascular risk and that was from changing nothing else but and i think this is what's so it's so exciting that actually we can make small changes so you know if you want that bit of salami you know with your dinner but if you make an effort to change your snacks I'm not saying everyone should just eat almonds all day well I've I've tried to I've tried to even if I'm not fasting yeah um I've tried to kind of not eat after I've tried to do that not eat after eight o 'clock yeah even if I do have breakfast at 6 30 or because I'm going to work but I try and not snack in the evening and just drink water you You know, not be drinking tea or anything because that messes with my sleep.

15:58And then try and do nuts and things. I want to show you something. So I bought these and this. And what's interesting because you just mentioned. Oh, I love an almond nut. You just mentioned almonds. Yes. And what I think is interesting is that on the packet, companies would give you the same nutritional value for both of these. But that is not entirely correct. Am I right in saying that? You are totally correct that that is not entirely correct. So can you explain why? So we've got ground almonds here and a whole almond here. Yep. So this is a great example of the importance of what we call the food matrix, so the structure of the food.

16:37And it's a great illustration of why processing food actually changes its health effects. And a great example of why we need to think about the food and not think about the backer pack nutrient labeling. So if you were to pick up these in a supermarket, that would tell you that there is 170 calories per portion which is probably about that maybe a few more so it's about 28 grams wait a minute 170 calories per portion but I think that some people would go what only that number of nuts probably a few more so it's a slightly bigger handful okay I'm going to get some more from down here because I'd quite like to know roughly what that would look like that's better I haven't got my weighing scale that's better add a few more Oh, okay.

17:22Okay. So I would say... I don't even know if I could eat that many arms. Okay, if anyone's looking at this and counting, they might say this is not totally accurate. But let's say roughly. Roughly, yeah, I'd say that's 170 calories. Okay. But I'm just interested because people... But these are good calories because this is good fat. That is like a powerhouse of nutrition. So stop thinking about calories. Fibre, it's got micronutrients, it's got phytochemicals. That is just, well, like I said, that's 30 % reduction in cardiovascular disease if you're swapping your unhealthy snacks with that. And I'm chewing it whole and that is better than this.

18:03Okay, so this is where it gets interesting. So Becker-Pack labelling shows that that's 170 calories. Okay. Now, what actually happened, and the Becker-Pack labelling for this, which is, I assume this is ground almonds. Yes, ground almonds. So the backer pack labelling for both would be exactly the same. 170 calories, 28 grams, whatever amount of fat, protein, fiber, carbohydrate, nutrients. Now, when you eat these, actually, you excrete about 30 % of the calories. So you only actually absorb about 60 to 70 % of those calories. So actually, on average, and I always like to say that on average, you'll actually get about 130 calories from those.

18:45Right. From this, you will get the full 170 calories. The reason it's different is because of the food structure, the matrix. So plant-based foods are made up of thousands and thousands of cells, just like we are. Yes. And these cells have cell walls. And the nutrients are encapsulated within the cell walls. So the fat is encapsulated within those almond cell walls. Now, the cell walls of almonds and lots of plant-based foods are tiny. We're talking about like 20 micrometers, which, I mean, is smaller than a grain of sand. Now, when you chew, you don't chew down to that tiny amount. We actually do what I call mastication studies.

19:27So these are chew and spit studies. They're disgusting. And so we get people to chew the almonds. Then at the point at which they swallow, they spit them out. And on average, the particle size at which you swallow is about one to two millimeters. so that means you've got this little particle that's going down your into your stomach and inside it is hundreds and hundreds of cells that haven't been broken so apart from the ones on the surface so you've got all of these almond cells with the cell walls intact with the fat inside it going in your stomach going to your small intestine and it's quite resistant to digestion now it will be digested a little bit but what happens is because it's quite resistant to digestion actually a lot of these intact cells then come out in your poo so this is great because firstly you've got loads of this wonderful food reaching your large intestine your colon which is wonderful food for your microbiome so these trillions of bacteria they're going to be having a party can i tell you something quite funny about my since i've met you guys and other brilliant gut health doctors that I've talked to I've literally I I don't know whether you remember the numbskulls you're probably too young but when I was a little girl there was a tv show called the numbskulls and they were people in your brain and it was a kids tv program and that one person would go okay open the mouth food coming I imagine that my whole gut is like just people oh yeah you know inside out yeah like oh they're having a party when you eat your almonds yeah I'm imagining that they're all going they've literally turned into humans because you keep going your gut microbiome so happy that they've actually turned into like little people anyway that was a side note um so yeah so they are they're happy because you've had these almonds and all of these like bits of leftover that's not absorbed you're excreting 30 of the energy for uh which for many people um might be beneficial i'm not saying you know everyone there's obviously people we want to make sure they're getting adequate intake um of energy and yet if you have the ground almonds all of the cell walls are broken so because they're ground yeah so all of that fat is released so you've got to think of it's like it's all bursted out yeah and so what happens is is you're able to absorb it all so it's not reaching your large intestine so your your microbiome is still having a bit of a party because some of the fibers there but not as big a party it's not like the crazy all-nighter it's a bit more sedate sort of party um and so that's a really good example of how the back of labelling is really misleading and what we also know as well as it infecting your energy levels it infects your hunger levels so we have loads of receptors in our gut that tell us how hungry we are how full we are they're actually more dense lower down in our gut those whole almonds get all the way down there get down there and we'll be saying hey Davina I'm you're actually quite full now actually you don't need anymore and so there's so much more that goes on but I think the most interesting thing about that almond data is that whilst I said and I know I emphasized it on average you'll get about 130 rather than 170 calories when we look in studies where we feed people the whole almonds and you look at how much energy they're actually getting there's huge variability some people are absorbing about only 68 calories from that 170 calories other people are absorbing the full 170 calories right so whilst i told you on average there's huge variability discrepancies yeah huge variability and this is that where we you know are so fascinated now where everyone's different program research comes in do i want to give the same advice to that person who's getting the 170 calories that's the one that's getting 60 if if we were thinking in terms of calories would that mean that some people absorb more calories than others that's what the evidence shows that's it does go a little way to explain why some people really struggle with their weight maybe or would that be right i think that for some foods yes um i think that for the majority of the food that we eat if we're talking about a typical uk diet that's heavily processed all right it is that kind of almond flour where it doesn't make any difference it's not going to make much of a difference okay when we're talking about plant-based foods in its kind of original structure that's where we see more of the variability i think that that's one of many many many factors to do with different levels of obesity different weights amongst different people okay so generally speaking if we're talking about plant-based food eating whole yep you know don't don't mess about there yeah eating whole plant-based foods is always better there's some really old studies that actually we still talk about so when I teach about this to our students I refer back to a study back from 1977 which is the year that I was born don't show off and this was a study where they fed people whole apples yeah they fed people pureed apples so again backpack labeling was the same and then they fed the apple juice so they took away the fiber a bit and they looked at what people's postprandial glucose responses were which is basically the post-meal increase in blood sugar so about 15 to 30 minutes after you have any carbohydrates you have this big increase in circulating blood sugar and they found that firstly people who were eating the apples at those apples at least 100 times or 100 more slowly than if they were having the juice or the puree so that impacted the blood sugar responses but even if they controlled for the speed of eating there were still really big differences in terms of people's fullness and hunger so even though they were having exactly the same calories from the apples or the puree which again remember back up perks the same the puree didn't keep them full for very long the apples kept them full for long as well as the fact that you know you're getting different kind of other sort of benefits with your glucose etc you've you've touched on glucose there and um the spike after having carbs and we've all become quite savvy now that the order of eating food has some relevance the um You know, I've started kind of actively trying, all of my family have in fact, trying to maybe after a lunch take a 10 minute walk to kind of help even out the spike.

26:11And it's all about inflammation. But I do think it's interesting, especially for someone my age to think about why is inflammation something we want to avoid? What is it? so inflammation is a normal physiological response to an injury so cut your finger the reason that you heal is because you have an inflammatory response we have inflammatory responses going on all the time inside our body it's a normal physiological response the problem is is if it's in the wrong place at the wrong time and too much of it we know that it can increase our risk of disease and so what we now are starting to understand is that many chronic diseases cardiovascular disease type 2 diabetes and some cancers are underpinned by inflammation and inflammation that's going on inside your body inflammation for example it's going on at the level of your arteries so we know one of the core underlying kind of physiology that happens in terms of development of cardiovascular disease at the level of the blood vessel inflammation plays a really key role in that so i mean would it be fair to say that just sugary sweets and stuff you know look we need carbs we need fat we need protein you know we need all of those things but actually in terms of just eating sweets in terms of inflammation it's it's like really just in moderation just really try and chill out with the sugar extra sugar it's in moderation look having some sweets here and there having some of these foods i can't do it in moderation and again this is where I think everyone's just got to listen to themselves like I can go and eat a few sweets I'm fine give me a bar of chocolate I need the whole yes yes that's me and so it's about kind of yeah different people different I mean I try and just stay away from chocolate I think it's also very hard at our age we've got kids in the house yeah and just because I'm really trying hard not to do something if they can moderately eat something it seems unfair to not have it in the house if they don't have a problem with it but then it only lasts for 20 minutes because I've eaten it all and they literally have to hide their chocolate it's it's I think if it's not every day or all day long I think everyone I think you know we have such a disparity in people's um view on diet I think in the UK you have the people that just don't recognize the importance of it or can't do something about it or aren't motivated to do something about it and have terrible diets we have quite a lot of people in the middle and then we have a lot of people that you know are doing so well and having incredible diets and I think you know what for these people and maybe these people just don't worry about it having a chocolate bar having that pack of crisps it's okay we need to solve the bigger problem but yeah I've gone off on a tangent now from inflammation yeah sorry about that right I'm going to talk to you about my show sponsor Zoe.

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30:02As a Zoe member, you'll get an at-home test kit and a personalised nutrition programme, which is so good with lots of recipes and stuff that are good for you to make, specifically for you. So you can make smarter food choices that support your gut. Go to Zoe.com, the code is DAVINA10. I've got a little challenge for you. Think of one creative project you've always wanted to start. Okay, now let me tell you how you can bring that idea to life with our sponsor Adobe Express. So it's a really quick and easy create anything app by Adobe. So this tool is designed to give you the confidence to turn those dreams, your dreams, into reality.

30:47I've even tried it myself. We've used it to brand this show, so I can actually genuinely say that it makes creating gorgeous graphics and social posts and professional presentations just so straightforward with smart templates I can get things done like in a few clicks and there's an AI feature which is like having a little creative genie with you so whatever you're dreaming about honestly it's never too late to begin so I dare you sign up for Adobe Express for free and take that first step the most transformative chapter of your life is waiting for you the thing you mentioned earlier which I do want to touch on which is something again I think from a childhood my granny was always like eat up and I eat really quickly and I think it is also something I may have passed on to my children I thought it was a good thing so why isn't it?

31:42So it's not a good thing and sadly I think we're all brought up to eat more quickly whether it's survival of the fittest whether you come from a big family like my own. Everybody's eating your food before you finish it or you know whether it's at school i mean it's shocking how they're given such short periods of time in the canteen before the next class it's a real problem at school eat up eat up quick quick quick evidence shows that if you eat your food fast and we call this having a high eating rate that you have higher levels of obesity you have higher risk of cardiovascular disease higher blood pressure higher insulin resistance so kind of impacts your your glucose metabolism now there's a number of reasons for this we know that the kinds of food that encourage you to eat fast typically aren't the best foods for you but what we also know is if you actually look at some of the trials out there and there's some trials that have been conducted where they'll get people to eat more slowly and they will have then another group that are eating exactly the same food so we're talking the same food but eat at a faster rate you see differences in energy intake so if If you increase the time in which you're eating your food by just 20%, so you go from like a 10-minute breakfast to a 12-minute breakfast, you subconsciously, so without even thinking about it, will reduce the amount of calories you're consuming by about 15%.

33:05Now, for people who are wanting to reduce their energy intake in this kind of obesogenic environment we live in, I think that that's quite a valuable added tool in our toolbox. I think one of the great things again about Mediterranean, and we were talking about the fact that, you know, it's not just about the fact that they eat lots of salami and ham. It's like, what else do they eat as well? And at school, they have frisee lettuce. They have iceberg lettuce. They have rocket. They are given a different type of cheese every day. The mayor of the village will oversee the school's weekly recipes or making sure that they're getting a full varied...

33:54I mean, it is unbelievable what French school kids are exposed to in terms of variety of food, all home-cooked, all incredibly healthy. But it's this idea that you have cheese every day and it's a different type of sometimes uber smelly, sometimes really kind of quite simple, or a goat's cheese or something like that. I mean, amazing. So I agree with you what you're saying about that. But also the thing that I love about the French, being half French, spending kind of half my life there, is that mealtimes are a time of family. And it goes on for hours. And I mean, here, I know that everybody's running everywhere all the time.

34:38we we've forgotten I mean I'm saying this really kind of about myself that hearing you talking about eating slower I think gosh we must kind of try and remember to properly sit down all phones under table you know let's talk and take our time over this you know I think the way that we used to eat has been lost for many many people and so that whole kind of social connection that we used to have over food has been lost and you know people eating while looking at their phone people eating while on zoom calls people eating while they're working I do that nearly every lunchtime I know I shouldn't do it unfortunately I do we know that if you're eating food while on your phone or whilst watching tv that you tend to eat more of that food and you tend to eat it more quickly because you're distracted you're not listening to your fullness hunger signals you're not kind of you know you're kind of wolfing it in maybe and i think it's one of the many many examples of how if we could go back a little bit to how we used to eat as well as how we used to live but the reality is now in the last 20 years 30 more women are in the workplace so 30 more women who were the ones traditionally doing the home-cooked meals sitting with their children having the longer meals maybe when the husband was still at work it's all changed and we have to we have to find a way to move with with the times I mean I think that and I think this is this is a brilliant thing and a problem yes you know it's great that 30 % more of us are in the workplace I love working I really enjoy it but often the last thing I want to do when I come in is cook but what I have found and I mean I guess I'm saying this in case anybody listening you know um this might be an idea for them is that actually if we say we're going to cook together it then becomes quite a fun thing what should we make and you know I do one bit Michael do another and it's a thing that we can do together as part of our debrief um for the day and that's quite nice you know yeah make together they clean up together, kind of it becomes sort of a pleasure rather than a chore, one person doing it for someone else.

37:03You know, you're alone in the kitchen, they're watching telly, it's not as much fun. I know that's not possible for everybody because not everybody has a set-up like that. But I think finding ways that work with your set-up, your family is important. So I would like to move on to this amazing bit of research that you've done recently because obviously in the menopause um we have this massive range of symptoms and we have been told so much recently that um the gut brain um access is so important and what we eat has such a massive effect but you've actually found some solid really good research evidence evidential research what would you say evidence evidence research evidence you found some great research evidence we've got some good evidence we've got some good evidence um around um symptoms and the menopause can you just talk us through that yep so we've done a big program of research where we've looked at the number of symptoms that women have who are peri or post-menopausal i mean there are a lot it's huge up to 60 i think now we've got to um so yeah we're we're monitoring 20 symptoms um but yeah there's like 50 60 symptoms that people are reporting but we've been monitoring the core 20 symptoms and so we've been looking at how many symptoms they have and the severity of the symptoms and i mean it's it's the prevalence is huge so we see and the prevalence for symptoms that people don't typically think of as being traditional menopause symptoms.

38:43So tell us a few of those. So we see that about 80 % of women have sleep disturbances. I think that's reasonably well known. Similar percentage, so 80 % of people have brain fog, have anxiety, have memory loss, have all of these other kind of neurological, you know, the irritability, etc, that goes with it. We have loss of libido. I know that's talked about a lot in about i think it's about 70 the traditional symptoms like the night sweats uh or the hot flashes we see in about 50 so it's really interesting it's these kind of non-traditional ones but they're the ones that are really impactful 10 of women actually leave their jobs yes because of the symptoms and what i was really shocked by and i did have to double check the analysis i'm such a skeptic i'm always like wait we need to check that i don't believe it we found that 99 % of people had at least one symptom.

39:37This is in our perian postmenopausal group. That's interesting because we're sort of led to believe that 25 % of women sail through it, but actually what they might not realise is that they're sailing through it, but they have got a few symptoms. It's not enough to bother them, but they are symptomatic. And I think it's a case of recognising nearly everyone will have some kind of symptom. Some people, the 10%, it's so severe they leave their job. 50 % of people will say it's actually really bothersome and 25 % of people say it's severe enough to actually impact their quality of life. And so as well as looking at how many symptoms people had and the severity of the symptoms and how it impacted their quality of life, we also looked at, OK, how does it differ depending on whether you're on HRT?

40:21How does it differ depending on what kind of diet you have? and I think that you know we're all as you know better than everyone very focused on the benefits of HRT and we know I think there's you know incredible evidence to show the benefits of HRT in reducing our symptoms as well as reducing some of the health effects and I think it's important we recognize that with menopause and our research has shown this as well it's not just the symptoms of the problem it's the health effects the increase in blood pressure you get the increase in bad cholesterol the increased inflammation and so forth um so yes we see a significant reduction in symptoms we still see lots of people are still having symptoms despite the hrte now that could be a whole other topic of conversation about how well controlled they are on whatever regime they're on but what's most surprising from this body of research that we did is the power of diet now this is where i was a real skeptic so having been in nutrition research for 25 years obviously i think diet's quite important but i was like look as long as you take hrt then that's it but actually what we found was people following the zoe program which is basically healthy eating yes uh dietary yes we found that if you looked at them at the beginning and then at the end and then looked at how large their change was in diet there was a relationship between their change in diet and reduction symptoms that they're reporting so that on average as people improve their diet they reduce their symptoms by about 35 percent every time you say it i've heard you say this before and i can't 35 percent is enormous but you know what to be in as well which i think is fabulous is when we looked at those taking hrt or not taking hrt we saw a similar percent reduction although those taking hrt are coming from a lower threshold we still saw about yeah it was around 35 I think it's 34 something but similar so I think the message everybody will benefit everyone will benefit from following an overall healthy diet now obviously being the boring scientist I do have to caveat this there's no silver bullet no this is the problem can you give me the kind of headline changes that me as a menopausal woman could make that to help me yeah so I can give you the headline and then i can give you a few kind of great extra pointers so headline is back to basics there's no silver bullet i'm afraid it's the simple boring message of less of the heavily processed foods more of the plant whole foods so the whole almonds for example um more of a diversity of foods so making sure like you're talking about in the french schools they have a real mix getting a real diversity of foods so you're getting a diversity of different kinds of micronutrients and phytochemicals making sure you're getting plenty of fiber making sure you're minimizing that kind of processed meat that the refined carbohydrates in particular as well adding some fermented food to your diet so for example cheese yogurt doesn't have to be anything kind of posh that's yeah i mean because people i know people go kimchi oh god you know kefir like all of that kind of stuff yeah well tim made me tim he's not converted me tim specter made me change to kefir oh no i don't mind kefir i like it no i quite like that a tiny bit of honey or mix it with your piece yogurt yes i had it this morning on my uh on my grat um sauerkraut i'm not there yet i'm not there with sauerkraut i don't know if i ever will be yeah i'm not sure if i ever will be but a really mega mega change that I've made and I'm and I would like to implore all places where you can buy soft drinks any venues where you can buy soft drinks please will you give me as a non-alcoholic drinker you know I'm a teetotaler and I have no choice but to go with either a diet soda or a soda of any of the famous brands yeah they never put anything else on unless it is a non-alcoholic cocktail and we know that that is made with syrups after syrups i don't want to have that's the point and kombucha can't be that hard to have on a on a menu now i think and i love kombucha there's more places serving it but i think it's but not once you go outside london as well i think it's less well i think outside of london almost nowhere yeah so i'm that's a that's a plea that i'm making but anyway so yes so it's going back to those basic healthy fermented so plenty of fiber plenty of plant-based foods a variety of different foods minimizing odd processed high sugar refined carbohydrates I mean refined carbohydrates is is a is a big one as well because I think that that is just something where you've just got to get used to it and um can I ask you whole wheat toast is that better than sourdough sourdough is such a buzz bread at the moment and I just want to know is it as good as we think it is so I think it depends what you're having it for yeah so I always go back to what you enjoy the most sourdough okay so then have sourdough I think when you're talking about two kinds of food that there's probably only marginal differences in their health outcomes that's where you've got to just choose what you prefer the most there have there has been no studies comparing that i'm aware of whole wheat and sourdough okay we do know that sourdough because it it has you know is a kind of probiotic so we know that okay it might be better for your gut microbiome but in terms of other health outcomes i don't know okay good yay um and what are the other you said okay that's the broad brush stroke but what are the other kind of little tips that you can get so there's other tips that relate a little bit to how we eat um because like i said earlier you know i think we've got to stop just thinking about what we we need to think about how we so we've got some amazing research that's just coming out actually where we looked at the time of day effect in pre versus postmenopausal women so by this i mean that we know that if you eat your carbohydrates in the morning on average you have a lower blood sugar response than if you eat them in the afternoon on average oh my god that's really interesting and but then what we did is we did some analysis of ours so we predict data and we looked at people who were pre-menopausal and post-menopausal and what we found was if you were a post-menopausal perimenopausal woman the time of day effect was more pronounced so what that meant was is that you had an even bigger impact from eating your carbohydrates later in the day than in the morning so the take-home message from that could be if you want to have your cake yeah fine if you want a cup of tea and cake 11 o 'clock have it 11 rather than 4 o 'clock amazing but that is amazing it's little things like that it's not saying don't have your cake that's so interesting the other piece of research again this is related uh to to blood glucose responses is when you have a carbohydrate rich meal what we know is lots of people have a dip in their blood glucose so about two to four hours after you have if it's a very refined carbohydrate we know about 30 % of people have a dip in quite a big dip in their glucose so you might find that some people talk about being hangry or getting a bit of brain fog sometimes yeah about and for many people for me it's when I'm walking home from school with the kids and so it'll be about two or three hours after I've had my lunch right oh I'm very hangry it's not just because they're being naughty on the way home it's because and I know now having worn a glucose monitors because I am a dipper as we call them and what we know is if you're a dipper not only do you feel a bit rubbish like hungry but also people who are dippers have as well as less energy less alertness they have a bigger drive for hunger during that time because of different hormone responses and they will go on to eat about 100 calories more at their next meal and about 300 calories more over the day now where menopause comes into this is we know from our own analysis is that postmenopausal and perimenopausal women have a slightly bigger dip than premenopausal women so therefore they might be a bit more susceptible so it's again another kind of reminder of try and reduce i'm not saying eliminate try and reduce that refined carbohydrate or try and make sure you're adding healthy protein and healthy fat into your carbohydrate meal so that you're minimizing the chances of having those dips how big a difference is it between a refined carbohydrate and an unrefined carbohydrate because we're talking about white pasta white bread like when I go out to a restaurant I don't think I've ever been to a restaurant that serves whole wheat pasta ever so I think that it does make some difference not a huge difference I think where you get the biggest difference is what else you're adding into the meal right and this is why I love taking the approach and we do this at Zoe it's about okay what can you add in to make it healthier rather than oh my god I can't eat this and I can't eat that so if you were to have let's say some white rice how what can you add in to make it healthy you can add in healthy oils healthy proteins more fiber and then that will have a big impact something that i do want to say though davino is if ever i talk about blood sugar responses it's so important to say they're normal physiological responses yes it's normal i don't want people to get over focused with this obsession it's a normal physiological response it's just if it's excessive and repeated you can feel a bit rubbish you might eat more and there is some evidence that it's if it's you know very excessive repeated over long periods of time linked to later cardiovascular disease one final thing I'd really like to talk to you about um because I love it when you say the word nutribollocks so I'm going to get you to say that today but is um about something that we in the kind of menopause world have started calling menowashing which um actually makes me so angry yep um so can we just discuss what what is menno washing so menno washing from my interpretation is putting the word menno in front of something and then charging double the price yes i mean i'm surprised we haven't got menno t-shirts menno watches well there's menno face cream there's menno face cream there's menno hair like that makes no difference impacts impacts our skin we know menopause impacts our hair but unless no michael says there is absolutely nothing that you can do to your hair um that will change it um you could put a bit of conditioner on it but it's not a special yeah i do not understand the link between and like this whole idea of a meno cream face cream yes your skin's going to change so have if it's drier than have a more richer moisturizer but do you need men in front of it and paying three times same with supplements the supplement industry yeah is like men are washing or neutrabollics everywhere it it's like crazy you go into health stores and it's just like men know this men know that and i'm not often the thing i think that's upsetting is that it's often more expensive oh It's always more expensive.

51:35And look, sure, you might. What I don't like is when someone sort of tries to set up a problem for a menopausal woman and then solve it with some meno thing. That upsets me because we're vulnerable and we're often a bit lost and we feel invisible. And then sometimes we feel that these companies are talking to us and looking after us and loving us in some way. I would quite like to run three things past you that I do take. Yep. vitamin d in the winter good or bad good okay um and that's quite good for bones and um i'm not quite sure but i i've read up on it and i can't remember because i'm menopausal but um d3 yes so we know that in the summer we don't usually get enough you get enough from the sunlight this summer yeah still getting enough but but in the uk in the winter your stores so it's a fat vitamins it's stored in your liver but by a certain period of time by october november i think it's beneficial to have a supplement magnesium i personally wouldn't take a separate magnesium supplement personally if i was going to take a Try and get it from food?

52:49Well, obviously. What is it in? Gosh, all of these micronutrients are in so many foods. So, I mean, walnuts is a great source, for example. I love walnuts. Different nuts. All plant-based foods are rich in this. And, you know, things like eggs as well. I never talk about eggs, actually. Eggs are a superfood. Eggs, nuts, superfood. Yeah. I mean, obviously, you don't want to be having 10 eggs a day because it will reach a point in which it affects your cholesterol. But this myth that eggs affect your cholesterol because it's cholesterol-rich, is again another neutral body as long as you're having you know eggs not to excess but magnesium is found in so many different foods same with zinc same with like so many of these other micronutrients i think taking box standard supermarket multivitamin and mineral is all most people need to do i think that going for these and you do think that might be a good idea so i think that in an ideal world no it's fine in an ideal world we want everyone to get everything from their diet and everyone should be able to get everything from their diet i think that i would not say to everyone yes you must go out and buy multivitamins i think as an insurance policy there is potentially a benefit and there's certainly no harm if it's one of these bog standard where i worry is people doing these mega doses i know which is like a thousand times or spending lots of money we shop at standard retailers you know high street retailers i have in my cupboard a standard multivitamin and mineral when i remember i take it when i remember i might give the kids one here and there it's my little insurance policy because i live a busy life i know i don't have the diet that i should have there's actually very little uh nutrient deficiency in the uk right and so i think for most people they don't need to worry about it when it comes to you need to tell me your third one actually you told me to magnesium two is that something that goes with it they said it goes with magnesium i don't know okay i've never heard of that so i'm I mean, this is something, this is a problem, right?

54:59We get served this stuff like it is a problem and we're deficient in it. And then we end up looking at it and we think, oh, it does really good things for me, but I'm probably getting enough of it already. I think most people are. I think that's why if you want to take one, just take the standard supermarket ones that have your, just have a low level amount. Because if you're getting too much of it. You just need to boost, not. Yes. And if you're getting enough of it from your diet, then you don't want to megadose. And sometimes it's bad for you to megadose. It actually can be dangerous for your health.

55:33Yeah. So, you know, if you take one of these megadose vitamin C ones, I don't know if you've noticed in your Wii, it probably looks bright yellow or orange. Have you ever seen that after? I don't really take vitamin C because I feel like I eat a lot of fruit. I feel like I get loads. But sometimes if I haven't drunk enough the day before, when I wake up in the morning, I think, oh, my God, I definitely need to get some water. But if you take, vitamin C is a great example that you actually will see a few hours later, you'll see, you'll wee it out. Now, to wee it out, your kidneys have had to process that.

56:08So you're just putting extra burden on your body. I think when it comes to the whole men are washing of nutritional supplements I think this is where we have a big problem that there isn't enough evidence yet there are actually lots and lots of small trials that show that oh there might be a benefit here or there might be a benefit there but actually as many trials show that there is a benefit for a particular supplement the same numbers show that there isn't a benefit and there's only one supplement that I would suggest that people might want to try that there is reasonable evidence for and this is soy isoflavones so isoflavones are what we call a phytochemical so they're not strictly speaking a nutrient so they're a chemical found in lots of plant-based foods but in very high concentration in soy products and they can also be bought as a supplement and isoflavones are a chemical that has the same structure as estrogen and so they actually bind to your estrogen receptors in your body and your body thinks well that's some estrogen binding to my receptors stimulates the receptor and it does whatever the normal job that that cell was meant to do if there was estrogen there and so what we know is if you supplement women with estrogen that there is evidence to show you there's reduction in some of the symptoms now i'm sorry supplement did i say estrogen okay so what we know is if you supplement women with isoflavones oh right yeah there is a reduction in some symptoms we know though that the bulk of the evidence shows there's a particularly active part of the isoflavone and so if people are wanting to go and get isoflavone supplements what they should be trying to do is look at the backup pack labeling and looking to check it's got a chemical called genistein and that it's got about 15 milligrams per day in the capsule and i think i know we've discussed this before but i think it's really important because there's lots of isoflavone supplements that are below that threshold and i don't think they don't the evidence doesn't support them having enough but if it's got more than 50 milligrams of genistein then i think there's good evidence to show for the majority of people it will have an impact it will be different between people and this again is where it's that whole fascinating area of variability so some people have particular microbes in their gut that digest or process um the isoflavones so that they become like super active and some people don't have these or have very low levels of these so they don't become very active and so if we know that if you supplement people who've got these bugs they have a 75 percent greater reduction symptoms and supplementing people who don't have these bugs so it's an example of go try it make sure it's got 50 milligrams but be mindful that depending on your gut microbiome so you you know your friend might buy and say wow this is great you might only see a small effect we're all different exactly i mean we could make everybody literally stay here all night and uh carry on i think i've waffled long enough i've learned so much again i i can't believe every time i see you i learn something you might love it thank you um but it's been lovely getting to know you a bit better so thank you very much sarah love having such a a nice chat about all my favorite things thank you pleasure

59:54Thank you.