Professor Sarah Berry on Nutrition during the Menopause

0:28Hi, Gabby here. Welcome back to The Midpoint. research on the impact nutrition has on menopausal symptoms. So I wanted to get the lowdown on all that they tested and what they discovered. I'm also going to be putting your questions to Sarah later in the show. Now this is still a very young research field and it seems that scientists are learning more all the time as this chapter of women's lives comes into sharper focus. So I'm hoping we'll all be able to take something away from this episode about the relationship between nutrition and the menopause. There's lots to discuss so let's get stuck in.

1:05Professor Sarah Berry thank you so much for coming on The Midpoint. Pleasure thank you for having me. I think the first thing we want to hear is how many women did you speak to for this study and why it was important to you to study the menopause with relation to nutrition? Yes we've done a number of different studies looking at women's health peri and post-menopausally as well as their symptoms ranging from studies with a thousand individuals up to 70 ,000 individuals. So the big body of work that we've done looking at symptoms into relationships with diet and lifestyle is with a group of 70 ,000 peri and postmenopausal women.

1:43And then we did a really deep dive into health outcomes because we know as well as symptoms, there's a huge health burden in terms of increased risk of cardiovascular disease, type 2 diabetes, etc. And we did that in 1 ,000 individuals where we did some quite in-depth clinical testing. And how long did this all take? So we did this very quickly in terms of research. So I've been an academic researcher for 25 years and typically in the kind of academic environment that I work it might take us 10-20 years to collect this kind of data. I was really fortunate that this is part of a big programme of work that we're doing in collaboration with Zoe who are a tech healthcare company and all of the research that we do at ZOE is kind of like research on steroids.

2:25It's very fast paced because we have this incredible team who, you know, leverage all of the kind of modern digital technologies that are available to us, allowing us to do remote clinical testing and also leverage what we call community science, where we ask people in the community to get involved and share their data with us, their experience with us. And so we did this over a period of a couple of years for most of our symptom related work and then also for the clinical work. And I said in your introduction that this is an area that is fast moving and we're finding out more all the time because actually it was largely ignored for many, many years.

3:00And when you're as a researcher looking at previous research, I bet there wasn't that much to go on, was there? No. So I'm actually relatively new in the whole menopause research area. So having worked in the area of diet and health for 25 years, what I've mainly focused on is diet and cardiovascular disease. So how different dietary factors and the food matrix and ultra processed food impacts our health. It's only actually the last two to three years I've taken an interest in menopause. And what I found shocking having started on this new research journey is looking back at all of the studies I've run before.

3:35So I've run about 35 randomized clinical trials. So these are clinical trials where we recruit people, we put them on different diets, we monitor them closely. Only one of those 35 was ever in women. all other 34 trials I've run are in men because it's easy to run these studies in men because you don't have what was considered as a kind of research scientist the annoying irritation of the menstrual cycle or the menopause because you'd have to recruit triple the amount of people to take into account are they pre-perial post-menopause or what stage of their menstrual cycle are they on So just ignore them.

4:13You know, I'm embarrassed to be saying this, but actually I'm glad that I'm in this new area now. And I think that as researchers, we're always struggling for funding. We're struggling for the budget to be able to conduct research. We have to be competitive. And so it's cheaper to study men because you've only got to recruit, you know, a third of the number of individuals. Fortunately, the research landscape is changing. fortunately research funding bodies are now really realizing we have to study women we have to study different life stages and we have to study based on menstrual cycle as well so it is changing yes thankfully and this is a really going to be a really important study and there will be more I'm sure coming because what you found will then you know take people into other areas and the research will get deeper into other areas did you go into this with a premise and an idea that there was something nutritionally that you were going to be specifically looking at and were hoping to find?

5:07No so the research is part of a really large body of research called the PREDICT programme of research and this is a programme of research funded by Zoe the science and nutrition company and it's a body of research that ultimately aims to disentangle the huge variability that we see between individuals and within an individual and how they respond to food. So we know that dependent on many factors and menopause is just one of these that how we respond to food how we respond to dietary lifestyle all sorts of intervention differs so depending on our age depending on our menopause status depending on how much we've slept the night before depending on the time of day that we're eating you know depending on so many different factors actually shapes how we as individuals so how I will differ Gary to how you will respond to a food and so we were collecting data as part of this research in thousands and thousands of individuals and asking lots of questions collecting lots of biochemical data so we were asking people to wear continuous glucose monitors to monitor glucose we were doing finger prick blood sample tests we were collecting poo samples for the microbiome and collecting lots of other uh data about you know how physically active they are how much sleep they're getting what they're eating and menopause was one feature of this it was one of many features but it's actually where we started to see quite a lot of differences from how they were processing carbohydrates so for example their post-meal blood sugar responses to how they were sleeping to how their blood lipids so their total cholesterol ldr cholesterol hl to so many different factors how they were so different compared to even age matched females so not just thinking about it in terms of oh it's because they're getting older but actually even if we took age-matched individuals seeing these big differences and then we thought well hold on let's also look at symptoms and we started collecting that data as well.

6:57So is it possible to give general results of something that's so entwined in as you pointed out you know the day of the month even that somebody is perimenopausal because those hormonal levels are still shifting aren't they throughout that period? Yeah it's really challenging and I I think something that as nutrition scientists and anyone working in human biology that we're becoming so aware of is that there is huge variability. There's huge variability between individuals, so between you and I. There's huge variability as well in how we'll respond to a food or an intervention, also day to day, depending on all of these kind of lifestyle factors like sleep, time of day, meal ordering, stress, etc.

7:38and so it makes it really challenging sometimes to look at what evidence there out there if you haven't collected a vast amount of data because of this variability as scientists we often think about this as an irritation it's the noise in the data it's something that throws us off from like getting to really understanding what's going on but actually what we now realize is this noise or this irritation in the data, this variability is actually hugely important. And we can start with the data that we're collecting at Zoe, because we've got it now in hundreds of thousands of people, we can start to disentangle what matters for who, and therefore what kind of dietary advice can we give dependent on certain factors.

8:22So can we start then with kind of what you have found, or what you can be quite certain about? Yeah, so I think it's fair to say that the basic healthy eating principles that most of us are aware of, most of us talk about and underpin population-based guidelines are applicable to nearly everyone. We know that fibre is good for us. We know that we don't get enough fibre. 90 % of us aren't eating enough fibre. We know we should increase our intake. 90 % of us aren't eating enough fibre. Yes, it's shocking. and do you know what fiber is the one individual nutrient that there is indisputable evidence about how just increasing even by five grams a day can lower your risk of so many different chronic diseases.

9:03Is that because people have become averse to carbohydrates or because they think of fiber as being in you know high carb products or they're not eating the pulses and beans that fiber is in? Yeah I think it differs again it's dependent or you know it differs for every individual. Because I can't was that always thus I mean as a general kind of population have we always been undernourished with fibre? No, so our fibre intake has significantly reduced over the last 30, 40 years. Our intake of what we call these ultra-processed foods are heavily processed, you know, artificially kind of manufactured foods has increased massively.

9:35They tend to be low in fibre, they tend to be higher in fine carbohydrates, salt, sugar, etc. So it's a perfect storm? It's a perfect storm and we're not eating enough of these unprocessed or minimally processed plant-based foods beans pulses fruits vegetables and whole grains i don't think a reduction in carbohydrate is responsible for the reduction in fiber i think it's more what we're eating on top rather than as well as what we're not including so i interrupted you on fiber so you're about to start listening so we're not eating enough fiber absolutely not and fiber for women as well in menopause and perimenopause when the hormonal changes can point towards cardiovascular issues that is vital absolutely we know that in your perimenopausal postmenopausal phase of your life we know that your insulin sensitivity reduces so for example you'll have higher blood sugar responses to a carbohydrate rich meal we know that you can we just break that down for people so that they really understand that so what that means is that the way you consume or the way your body processes carbohydrates and they can be really good carbohydrates by the way not just white bread but your insulin levels are going to spike more as a perimenopausal and menopausal woman?

10:50Yeah so what we could do is actually take a step back and I could talk you through what happens when you eat a meal. So when you eat any kind of meal typically it contains a mix of protein, fat, carbohydrate and hopefully, fingers crossed, a bit of fibre. What we know is that there are short-term changes in your blood when you eat the meal and we know that these short-term changes underpin many of the long-term effects that food has on your health. So as nutrition scientists, we're spending a lot of time looking at these short-term changes. So the carbohydrate in the meal causes a short, sharp rise in circulating blood glucose, which we sometimes refer to as blood sugar.

11:27That peaks around 30 minutes after eating the carbohydrate, returns to baseline around two hours. And some people actually have a dip below baseline around two to four hours. The fat that's in the meal causes an increase in circulating triglycerides, which sometimes we refer to as blood fat. And that peaks around four hours after consuming a fat containing meal returns to baseline around eight hours. So given that we eat on average two to three main meals a day, and given that we eat on average two to three snacks a day, that means you're in this state of what we call metabolic flux throughout the day.

12:05And given that the fat only returns to baseline around eight hours after your last meal, depending on when you have your dinner, it means for most people, apart from the first four hours before you wake up, your bloods are going up and down and up and down in terms of your glucose and your fat and etc. So you're in this state of metabolic flux. And we know that if these levels of both the fat and the glucose are elevated, excessive and repeated over a very prolonged period of times that increases your risk of chronic diseases, increases your risk of cardiovascular disease, of type 2 diabetes. So in short the aim is to get those levels back to baseline as quick as possible.

12:46It is. Now it is a normal physiological response and it's really important to say that because I know that there's quite a lot of influencers out there that talk about flatlining your glucose. We never want to flatline our glucose but it's about not having excessive peaks, excessive dips and what we know from one of our pieces of research that we did is that we know that if you're peri or post-menopausal you have a higher blood glucose so blood sugar response to a carbohydrate rich meal compared to if you're pre-menopausal and so that's an immediate short-term effect of just eating that carbohydrate that's different for myself who i'm a perimenopausal Do we know why?

13:27So it's obviously because of oestrogen. And this is why, you know, so much happens in that peri and postmenopausal phase because every cell in our body nearly has oestrogen receptors. So oestrogen impacts so many different areas of our physiology. So, for example, how we process fat, how we process carbohydrate. We also know that it impacts areas in our brain, hence why, you know, you have fatigue, brain fogs, you know, sleep issues, etc. so why it impacts both symptoms but also health outcomes as well. So that is one of the absolute certainties, that perimenopause and menopausal women will have different responses to carbohydrate meals, but they have to still consume carbohydrates.

14:11Yes. Now, Gaby, I do always caveat everything. I'm sorry, I'm one of those cautious scientists that... We like that. You know, I'm talking about on average, an average peri or post-menopause woman on average compared to someone of a similar age who hasn't gone through the menopause will have a higher blood sugar response. So what do they need to be aware of when they're consuming those complex carbohydrates? So I think there's different things that we can do. I don't think that we should avoid carbohydrates and particularly not the complex carbohydrates. So the carbohydrates that have fibre, given what we talked about a minute ago, given that your risk of type 2 diabetes, cardiovascular disease goes up post-menopausally, it's really important to get that fiber in.

14:53Now, ideally, you're getting that fiber in with pulses, with other plant-based foods, but whole grains is also a great source. So what you could do is avoid the refined carbohydrates. So avoid the white rice, the white pasta, the white bread. But there's also lots of other tools in our toolbox that we can use as well, because we know now that how we eat can also impact our blood sugar responses so by how we eat we mean the time of day that you eat we mean how much sleep you've had we mean uh your meal ordering um how fast you eat when you say meal ordering you don't mean how you respond to the waitress you mean um the other food groups that you're putting with that yeah i mean if you're getting cross that you're not being served.

15:39Then your cortisol levels are going to... Exactly. But yeah, you know, we know, we've done some research in all of these areas. And so, you know, for example, we know that if you have a poor night's sleep, you have a higher blood sugar response to a standard carbohydrate meal than if you've had a good night's sleep. The problem is as well, if you've had a poor night's sleep, you have these reward centers in your brain that will say, hey, Gabby, you've had a shit night's sleep. Go have some refined carbohydrates. You need a quick fix. So they're driving you to that. Plus when you have it, you have this higher blood.

16:09When what you actually need is some eggs and some salmon. Exactly. Or have that white bread if that's what you really want, but add in more fibre, add in more protein, add in more fat. So adding in the egg or the salmon.

16:37fat you know it was kind of historically for women kind of from the 50s a dirty word you know and actually a lot of people who are interested in nutrition now understand yes the good fats are essential what have you learned about fat with the perimenopausal menopausal woman? So before I dived into the world of menopause in the previous 20 years of my research has actually all been about fat and fat structure. So I'm just really opening your big jewellery toolbox here this is full of diamonds and gold that you've been unearthing go on. So there's a lot going on with fat in terms of our health we know that actually the amount of fat as you've said is not what we should worry about it's the type of fat we should worry about and we typically think about fat in terms of saturated mono and polyunsaturated fat but we actually know even more than that now we know that actually even that's too simplistic and that we need to think of the food source of the fat so i would encourage everyone to always take a food based approach whether it's to your carbohydrates whether it's to your fat whether it's to your protein and think about the food that it's delivered in what we do know is that peri and postmenopausal women have a higher blood fat response in that immediate four to eight hours after having a meal that contains fat.

17:53We know that again, like with glucose, if you have a very high blood fat response, it triggers like a cascade of downstream effects like inflammation and an increase in clotting factors, et cetera. And so it's a case of thinking how you can, like with glucose, keep that down a little bit. And so it's the same principles that you would have with blood sugar or blood glucose so making sure you have fiber in the meal which delays the rate at which your stomach empties if you can go for a walk after you've eaten we know that that also why is that so i kind of know it to be true because when you actually manage to do it if something happens and you feel better afterwards and you seem to digest your food better but why so there's lots of different reasons um so for blood glucose we know it's related to the uptake of glucose by your muscles for blood fat.

18:44We believe it's related to the activity of particular enzymes that are involved in removing the fat from your bloodstream so that the fat and the glucose essentially is coming out of the bloodstream and being kind of packaged away more quickly. So the fats that we're talking about, you know, because people like takeaway advice, what are the kind of fats that women in this period of life should be looking at? So I would really reinforce the message that you said, that we need to avoid low-fat foods. So we need to really think about having a good intake of fat because it will keep us full for longer.

19:18And we know that healthy fats like the monopolyunsaturated can reduce the risk of cardiovascular disease. So we've got extra virgin olive oil. It's like the king of healthy fats. fats that are in plant-based foods nuts seeds avocado etc the other misconception if i could also kind of bust a myth here is that we must avoid all dairy fat and i think that's something people get very focused on as they get older and they might be aware that their cholesterol's increasing particularly if you're perian postmenopause and your ldl your bad cholesterol's gone up what we now know is that actually we can't think of all dairy as the same and if it's what we call fermented dairy which is like cheese and yogurt so greek yogurt natural yogurt kefir on greek yogurt i instinctively go for zero percent greek yogurt should i just go for the two percent or the five percent does it make any difference and if i should be getting good fats from my greek yogurt so your greek yogurt will still contain saturated fat even at zero percent yes uh well at two percent five percent not at zero percent but what we know is if it's fermented which is what Greek yogurt is, which is what yogurt is, that actually something kind of magical happens with the food matrix that prevents it having a cholesterol raising effect.

20:35So based on that, unless you wanted to be mindful of the amount of energy that you're getting, I would go for the 2%, the 5 % if you prefer the taste. I haven't noticed a difference, to be honest. Yeah. So if you don't notice a difference, I would say it's kind of neither here nor there. The 2 % or 5 % is going to be more energy dense. It's going to have more calories per spoonful. But in terms of people worrying about it because of the saturated fat, current evidence shows that the saturated fat that's in the cheese and the yogurt, for example, doesn't elevate. So which cheeses are we talking about here?

21:11Feta cheese? Yeah, most cheeses. Because most cheeses have gone through some sort of fermentation. Best cheese? King of the cheeses? Oh, gosh. I can't answer that one. I don't know. What I do know, not the kind of cheeses that my kids like, which are those. Daryly, you don't serve those. Daryly. Oh, do you know what? They love the cheese strings. I shouldn't admit to that, but they do love a cheese string. We were talking about those the other day. The kids were kind of reminiscing about what was in their lunchboxes. The little baby bells. Oh, yeah. They're okay. They're okay? They're okay, yeah.

21:44We've got to digress with cheese chat. It was going to happen. So the fats, we know, they're very important still. Yes. And not to avoid fats. Yes. That would be a very bad thing to avoid fat. Absolutely. The fibre is really important and the glucose levels. What else were your key findings? So we've talked about nutrients there, but I think that we really need to be thinking about foods when we're thinking about the type of best diet for people at a peri and postmenopause. And what we found was that when we asked people to follow what was the Zoe programme, but basically it's putting people on a healthy eating program.

22:22It's personalized to them, but ultimately it's improving the overall quality of their diet. It's improving the fiber, the quality of the fat, reducing refined carbohydrates, but taking a very food-focused approach. So increasing whole foods, reducing ultra-processed foods. We found that there was about a 35 % reduction in symptoms. So this is in menopause symptoms. so in everything from sleep disturbances to anxiety to irritability to brain fog etc which actually really really really surprised me yeah so that that's the clip right there isn't it you know knowing that you can make those changes and that it's going to have that impact on your symptoms yeah is where i think most women in this period their ears prick up because it's the motivation you need yeah and you know that kind of diet is going to improve those health outcomes that we talked about so the fact that when you are peri and post-menopausal suddenly that kind of protection that estrogen has given to you that means that typically compared to a typical age match man you've got lower blood cholesterol lower blood glucose lower blood pressure lower abdominal obesity so so fat around your tummy and then suddenly you hit the menopause whoa you you catch up with men on some of these and on some of these you overtake them so following that kind of diet so very kind of mediterranean style diet very unprocessed diet will help you in terms of all of those health symptoms but also will help you with the symptoms that i think are the most troublesome for people because they're what you're feeling right here right now and you mentioned there the belly fat the kind of and that's the classic midlife woman's kind of the body shape changing and it becoming harder and harder for them to and we'll when we dig into our questions that crops up time and time again, actually, that people feel like they're doing the right thing, but not having an impact.

24:16Yeah. I mean, it's really tough because, again, it's all down to our little friend estrogen or lack of. Estrogen plays a really critical role in simple terms in directing where fat is deposited. So when you have adequate estrogen, then it directs fat to your hip and bottom area. So we talk about women being pear-shaped. and when you lose your oestrogen, then the fat actually moves up, and you have a fat distribution that's more similar to men, so it's in that abdominal area. Gosh, I mean, it just kind of makes sense, doesn't it, when you think about what's happening to the woman's reproductive system and why the fat was there in the first place.

25:01Yeah, and then it moving. And we know that fat behaves very differently where your belly is, so we know that it's metabolically more active and metabolically more harmful, and that's one of the reasons that we see many of these unfavorable effects in terms of some of the cardiovascular disease risk factors and we know from our research and also other research that once you're post-menopausal you're about two to four times more likely to put on weight here and on average you'll dispose about 20 percent more fat around the belly and it's difficult because this is the fault of the lack of estrogen you're also generally we see in our results 80 percent of people are tired because they're not sleeping enough.

25:41They might have low mood, depression, anxiety, so they might not want to be as physically active. Your metabolic rate reduces a swell. So it's really like stacked against you.

25:55I hope you're enjoying this episode of The Midpoint. If you are, it would be amazing if you could give us a review and subscribe. It really helps. I'll be back in a moment.

26:08Shall we get going on the questions? Yeah. Let's have a look. Georgina says, is it advisable to fast a current trend of between 12 and 72 hours, she says, exclamation mark, exclamation mark, during the menopause? Is fasting good for women in this period? Gosh, well, I'd say to anyone that fasts for 72 hours and doesn't feel really hangry, fair play to you. I can fast about three hours and that's it. again and i know that i've said this a few times it really depends on you as an individual and we actually conducted this really big study called the big if study we had 150 000 people practicing intermittent fasting but the kind of intermittent fasting where we asked them to fast for a period overnight of 12 to 14 hours so they were eating in a smaller window we call that time restricted eating.

26:59There's very little published at the moment about any benefits of that in terms of symptoms for peri and postmenopausal women. But when we did some quick analysis of our data, and I do need to point out this hasn't been published yet, what we found was that peri and postmenopausal women did report some benefit of fasting for that 14 hour period overnight. So what that means in practical terms is like having your last meal of the day maybe at seven. Which is not a bad idea anyway, is it? No, and then having your first meal at nine. And actually, do you know, we've done a lot of analysis in our whole group of people, whether they're pre-peri or post-menopausal, showing that actually if you can avoid eating after eight o 'clock at night, it hugely benefits your metabolic health.

27:43So it benefits your levels of inflammation, your LDL cholesterol, your blood cholesterol, and that weight around your tummy. So I would say in answer to that, that, you know, trying to have a period of 12 to 14 hours overnight where you're not eating, trying not to eat late at night. I think the evidence really points to a benefit for everyone. And the benefit might be even better in peri or postmenopausal women. Fasting for a 72-hour period, I'm not aware of anyone that's looked at this specifically in peri and postmenopausal women. And personally, I would caution a little bit against those kind of dietary behaviours.

28:20You just don't feel hunger in the same way as you get older generally. I mean, you know, when I look at my teenage kids, and the idea of actually not eating from 8 o 'clock doesn't seem such a hardship, does it? If you've had your evening meal at 7, it really probably is boredom, isn't it? That you're snacking your way through the evening. I'm a proper night time snacker. Gosh, Sarah, you're doing all this wrong. The thing is, I know what I'm doing wrong, so I beat myself up about it. Every night I go to bed, and you should hear what goes in my head, I must do this, this and this tomorrow. Well, I think our listeners will love that.

28:54This is a common refrain, I think, from a lot of people generally, not just women in this period of life and men listening to this, if there are, if they haven't been turned off by the idea that this is about perimenopause and menopause. How do you overcome sugar addiction and therefore the fatigue that comes from it? This person says perifatigue, but obviously sugar addiction is a problem. Yeah, I mean, I don't think sugar is the only reason that people are fatigued. during menopause. We know that there's all of these other factors related to estrogen impacting lots of other areas of our health that are impacting fatigue.

29:28We do know that sugar contributes to that. And we know that from our own research that we know that about 30 % of people have dips two to four hours after they have sugar or carbohydrate-rich meal. And this actually drives more of that addiction. And we've seen that this is more pronounced as well in peri and post-menopausal women. So we see that the size of the dip, which relates to the amount of sugar or carbohydrates you then want to have after, is higher in pairing postmenopausal women. You know, there isn't a silver bullet. I don't have a magic answer to this. I think that what we need to be doing is slowly trying to reduce our intake.

30:07There is some evidence emerging around food addiction. It's kind of quite a controversial area in nutrition and that certain nutrients and particularly high sugar foods stimulate certain areas of the brain that has this kind of dopamine like response and so because we're starting to understand that there might be this addiction my first thing is would be to say you know be gentle on yourself that it's really hard in the food landscape that's out there you know given there's all of these refined carbohydrates high sugar foods it's actually quite difficult and so i would say kind of come off it slowly but once you start to come off it your body really reaps the benefit of not having these big like roller coasters in your blood sugar levels that would drive more hunger and more desire to eat these kind of foods i think also if you've had a period of high sugar and then you've managed to wean yourself off and have a better balanced diet sugary foods just taste awful afterwards you know and the idea that i can't believe my younger self put sugar in hot drinks and things you know because now they tastes disgusting so I think it's that knowing that it is possible and that you can change the way your taste buds respond to those things which doesn't sound because I've had this conversation with a very close family member recently and it doesn't sound very easy because it's not but actually when you get there you'll be amazed yeah how food tastes different and I think you know what everyone likes to do things different ways some people just want to go cold turkey you know if that works for you fine or doing it gradually but your sweet taste receptors that you have in your mouth that feed back to your brain this desire for more sugar do adjust they go to sleep yes so in exactly the same way that you've said okay you've answered the next question actually very well in your first half of the chat about blood spikes depending on cycle and hormones and how we respond differently and i think that is a personal journey isn't it people will work out where you know can almost keep a diary about how you feel about you know your blood sugar levels going up and down through the month or wear some kind of device to test that I guess would be a good way of working your own cycle out.

32:11Yeah I mean you can wear continuous glucose monitors to see how it changes to look at your peaks but also your dips and look at how you respond to different foods depending on things like you talked about like sleep but also time of day and this is another tip I think that's just come out of some new research we published a few weeks ago where we looked at people's blood sugar responses to carbohydrate-rich meal in the morning versus the afternoon. We know you have a higher blood sugar response in the afternoon compared to the morning on average but what we see is this time of day effect is even more pronounced in peri and postmenopausal women.

32:46So if you do want to have a cake with your coffee I would say if you're peri or postmenopausal women and you don't mind whether you have it in the morning or afternoon it's better to have it in the morning based on our research 11 o 'clock coffee break with your cake you see you're hurting from sarah not every day antoinette says are there any foods that can help with knee pain i'm already on hrt and someone else asked a similar question to this as well they said can you recommend any remedies for joint pain and swelling please yeah i think that's getting a little bit outside of my expertise but i was thinking when i saw that question about inflammation yeah so a lot of joint pain is due to inflammation we know that inflammation increases post-menopausally so that might be one of the reasons that people have flare ups post-menopausally there are some dietary components that there's some good evidence such as fish oil so we know that oily fish or fish oil supplements can reduce inflammation on average in most people, not in all people.

33:47And an ultra-processed food diet can increase inflammation. And so there is an index that we use called the Dietary Inflammatory Index. And if any listeners want to look that up, they can. But it lists hundreds of foods based on what we think the inflammatory potential of that food is. I think in brief, it's a case of adding in oily fish or fish oil supplements, or you can get algal oil supplements if you're vegan or vegetarian that do the same thing, reducing heavily processed unhealthy foods. So processed red meats, processed, you know, carbohydrate, ready-made meals, that sort of thing, adding plant-based foods back in.

34:20OK, thank you. Judith says, what supplements would you recommend? What do you think of collagen? So are we talking about supplements for menopause symptoms or just generally? I think for menopause symptoms. So I'm a bit sceptical around supplements for menopause symptoms, even though there are actually a lot of clinical trials looking at different supplements. They tend to be done in very small numbers of individuals. They tend to not be very well controlled. There is no silver bullet, unfortunately. The only supplement that I think that there is sufficient evidence to suggest someone might want to try is for soy isoflavones.

35:00So soy isoflavones are what we call phytoestrogens. And so they are particular chemicals that have almost the same structure to estrogen. so they can actually bind to the estrogen receptors in your body and soy isoflavones have three kind of core chemicals some are more active than other chemicals so from a very pragmatic point of view my interpretation of the many studies that have been published in this area is that if you're going to buy an isoflavone or phytoestrogen they might be packaged as the same And they might be in a general tablet that is geared towards women in this phase of life.

35:41You wouldn't necessarily see it as an isoflavin. No, I mean, if you go into kind of health stores like, I don't know, Holland Barrett, those kind of ones, you might see it separately packaged. I think the key ingredient to look out for is something called genistein. And I'm sorry to get technical, but I actually think it's really important people make sure they get the best one out there that's actually got the evidence behind it. So it might be 100 % isoflavone, but the most active or where we have the most evidence for is if that supplement contains 15 milligrams of the particular isoflavone called genistein, then that's what seems to have the best effect in terms of reducing symptoms.

36:22Brilliant. Thank you. Great answer. And I'm running out of time with you, but does metabolism slow down in perimenopause? Menopause is a question, which I kind of, maybe this comes into the next question. You've talked about gaining weight on the waist and related to this, M says, I'm exercising, I'm eating healthy. I cannot lose a pound. It's been six weeks. Help. Any advice in terms of nutrition? Well, I think you've delivered really what a woman in this phase of life should be eating. And if they're reducing the calories in terms of eating smaller amounts of those foods and exercising, it's possible to still lose weight.

36:59Yeah, there is some evidence to show that your metabolic rate does go down. There's a reduction in metabolic rate that happens with the loss of lean tissue mass. We know that lean tissue mass, so kind of muscle mass, for example, tends to go down in peri and postmenopausal women. Adipose tissue, so fat tissue, like we talked about, tends to go up or certainly the distribution of it. We know that therefore just this change in your muscle and your adipose tissue changes your metabolic rate. So if you're eating the same amount, then you're more likely to put weight on. And then there's all these other factors that I mentioned.

37:34And, you know, if you're feeling sleep deprived, fatigue, you're feeling rubbish, you're irritable, you know, etc. You don't want to exercise. What some new research that came out in the last year shows that actually it's the change in physical activity that occurs with most peri - and postmenopausal women that actually seems to account as well for quite a big shift in metabolic rate and what we see in terms of weight. So we've got to move more. Yeah. And it's that incidental kind of exercise that I think we see more of a change in. So I don't mean going for a run, but I mean just that kind of fidgeting.

38:07Well, you can see me, I'm moving around like crazy with my hand. But, you know, getting up and down from your desk, all of these sorts of kind of incidental things that might reduce in people as you get a bit older. Sarah, thank you so much. That's absolutely brilliant. You've kind of waded through those questions there, even some of them not quite. And the last one, which I haven't asked you because I just felt it was a bit unfair, was any advice for a husband supporting his wife through the menopause, please? Which seems like a cry for help from somebody who... Oh my gosh. I know. That's obviously everything you've said there.

38:35I guess if you are that husband is to just support your wife through her food choices, I guess. Yeah, I think one of the findings that I was most surprised by when we looked at symptom prevalence in people in our group who are peri or postmenopausal is actually how high the prevalence, so the proportion of people suffering from symptoms that we don't typically think about. and I think this is what I would love you know husbands people to be aware of actually one of the lowest prevalent symptoms was hot flushes only about 50 percent of people got those 85 percent of people had poor sleep 80 percent fatigue 80 percent irritability brain fog etc my own husband gets really frustrated when you know I forget I'm forgetting simple things and it's like if I was there sweating away and the bedsheets were wet it would be more obvious it would be more obvious And that's what I'd say to people who want to support someone around them.

39:31Be mindful of the invisible symptoms that are actually the most prevalent symptoms. Dr. Sarah Berry, thank you so much. Pleasure. Thank you.

39:45Huge thanks to Professor Sarah Berry for sharing all those key findings with us, as well as her vast knowledge on nutrition. And if you want to delve a bit deeper into Zoe's research, check out the link in this episode's description. and thanks for submitting your questions too. I love to know what you really want to learn about so please keep an eye on my Instagram at Gabby Logan for more opportunities to put your questions to our expert guests. It's quite remarkable that they recorded a 35 % reduction in menopause symptoms from improving diet alone. So please do share this episode far and wide if you can and if you leave a five-star rating and review it will help more people find it too.

40:21This episode was produced by Spiritland Creative. I'll be back next Wednesday with another brilliant guest who is at the midpoint. I'll catch you then.