How to track your menopause symptoms | Dr. Sarah Berry and Tamsen Fadal

24:41And this is where I think diet and lifestyle becomes so, so important as well. I do too. And I was, you know, it's funny, I went to the doctor and I had increased cholesterol. I had low cholesterol my whole life. I was shocked. I'm not running around eating cheese and drinking. Like I wasn't doing something that would cause that. And so then I learned, And, you know, after all these years of being, paying attention to this, I learned that as well. So it's really shocking. But I do think people want to know what to do so they can kind of have some type of control, you know. And I think eating is the one place that you actually can try to take some of your control back and do something about it early on.

25:19Yeah. And I think this is where we can use diet. We can use lifestyle to reduce risk. But at the same time, something I think we also need to be mindful of is about being kind to ourselves. so what we know is that with the change in estrogen levels where you deposit the fat on your body changes so in simple terms estrogen kind of directs the fat to your hips so you think of pear-shaped women once you become pairing postmenopausal women with the reduction in estrogen then the fat is directed around your tummy which is where it typically is directed with men so it's a scientific fact is what you're saying as you go into perimenopause suddenly your weight is going to change where it gets put and you are going to put weight on around your stomach in a way that you just didn't before that.

26:04And that's not because you suddenly changed, it's because your body has changed on you. Absolutely. And this is why I think we need to be kind because it's biologically what's happening. It's because estrogen, in simple terms, is directing the fat or the lack of estrogen to be around your tummy. Fat around your tummy is what we call visceral fat. We know this is very metabolically active. It's not healthy for us. That's why you have this increase in cholesterol, in inflammation, in blood pressure, for example, peri-impaced menopause because of that increased fat there. But the reason I'm saying it in the respect of we need to be kind to ourselves, I've suddenly got fat.

26:41I might be slim elsewhere, but I'm not comfortable wearing a bikini. Now, I recognize that it's just a natural part of menopause. And yes, I'm going to work hard to be healthy. But I think it's recognizing that, look, we can't have that six pack necessarily. I mean, maybe some women can, but I don't want to live such a virtuous life that I have no pleasures to get to it anymore. But it's recognizing that there's some things we can help with diet, with lifestyle, with hormone therapy, if that's our choice. But there's also some things, let's just accept it as part of aging. You know, aging can be a beautiful part of how we change as well.

27:19Thank you, Sarah. I'd like to ask the question that you teased to me before the show starts about gut health and menopause. Because I think, oh, I know that my gut health is really important for my health in general, but surely it has got nothing to do with menopause because that's all to do with estrogen. That's something completely different, isn't that? It's sort of what I was thinking until five minutes ago. So tell me, Sarah. So I will remind you of some data we've already published. And then I shall tell you about some new data that Tamsin, I have whispered to her already. So I'm sorry, Jonathan, that you're hearing.

27:56I feel like you've cheated on me, Sarah. I know, I do feel a bit like that. So we know from some research that we published a couple of years ago, where in our Zoe Predict cohort of a thousand individuals who we really deeply phenotyped. So we studied loads and loads of different aspects related to menopause and health. we know that peri and postmenopausal women have a different microbiome composition to premenopausal women which I think was really fascinating and this is even after we adjust for different confounders like is it to do with their diet or what else is going on we also looked in that data set to see is the microbiome why we're seeing some of these changes that I talked about related to health, the increased inflammation, the increased belly fat, etc.

28:45And really interestingly, we found that there were some species that were particularly elevated in the peri and post-menopausal women. And these were species that we had previously identified through a huge body of research that we'd done a few years before that. So we're looking at the relationship between the microbiome and health. These were species that we identified to be associated with inflammation, with higher blood pressure, higher blood cholesterol, and all of these kind of disease risk factors. And we found that there was one species in particular that was quite elevated in pairing postmenopausal women, which is associated with an increase in inflammation.

29:19And we saw a huge increase in inflammation and also what we call postprandial inflammation, i.e. when you have a high carb, a high fat meal, you do have an increase in inflammation. It's a normal part of having a meal. But if it's excessive and repeated, we know that it increases our risk of chronic disease. So we saw that particular species was increased. Sarah, can I just check I've got that? Because we often talk about the fact, you know, the latest research from Zoe has identified these sort of 50 bad bugs that can be, you know, in your gut, Tamsin, and also these 50 good bugs. And are you saying that basically that one of those particular bad bugs, suddenly you're getting lots more of as you're going through perimenopause?

30:01Yeah, so we saw that on average there was a greater number of what you call bad bugs. Any microbiologist would hate that term, but I think it's a good term to summarize it simply. We see that there's an increase in these bad bugs, postmenopause versus premenopause, and in particular the bug that's associated with increased inflammation. This is research we've already published. We published this a few years ago. Some hot off the press research, and I even had a latest update yesterday afternoon on this research is that we have found that the microbiome, so the composition of the microbiome is related to menopause symptoms.

30:40This hasn't been looked at in humans before. We have data now on this 70 ,000 cohort. This is like phenomenal. 70 ,000 peri and postmenopausal women that we also have microbiome analysis from their poop or poop. And we can look at how is the microbiome composition related to the number of symptoms, the severity of symptoms and different types of symptoms. And what's really interesting is we see a really strong relationship to the makeup of the microbiome and how many symptoms you have. And we can do a particular kind of analysis that our genius team at Tamsin at Trento University who are world leaders in this area they do this analysis it kind of blows my mind I don't quite understand what they do so Jonathan don't ask me in depth but they can work out how predictive is your microbiome composition to a particular outcome so they do this analysis to say can we predict the number of symptoms that you have based on the bugs the species the microbiome that you have and they can predict with reasonable accuracy using the microbiome how many symptoms you will have.

31:51So how burdensome the menopause is. Is it that diet is impacting the symptoms independent to the microbiome or is it that diet is impacting the microbiome that's impacting the symptoms? My feeling based on the results that I've seen because they've done some more other complex stuff that again goes a little bit over my head is that there's a little bit of both going on. that diet is directly impacting symptoms through various mechanisms, but that there might also be this mediating effect of the microbiome. And then the new results that I saw yesterday, when we tried to look at different types of symptoms, was that the symptoms that the microbiome had the strongest relationship with was the psychological symptoms.

32:33And I think that's really fascinating because this is what we're starting to see when we think about food as well and psychological symptoms. So by this, I mean things like depression, anxiety, low mood, irritability, memory loss, brain fog. And they have a strong association. So I think this just really hammers home the importance of eating to feed our microbiome, but also eating based on our understanding that certain foods or a whole dietary pattern can improve the symptom burden that we experience. This latest research shows there is actually a relationship between like all those trillions of bacteria in your gut, this gut microbiome, and your menopause symptoms.

33:20Is that right, Sarah? That's correct. And what we need to go on to do, which we can do with our data, so in a few months hopefully we'll have those results, we need to see is it causal. And what I mean by that is, if we use diet to change the microbiome, does changing the microbiome change some of these symptoms? And we have this goldmine of data that I'm always talking about, I know, that will enable us to look at this. I want to start talking just a minute about, like, you know, actionable advice about, you know, what women can do. But just before that, Tamsa, I really wanted to pick up on a thread that you talked about earlier.

33:57I don't want to bounce over it, because it sounds like your symptoms really impacted your career. You know, you were lying on the bathroom floor instead of actually being reading the news. That's pretty dramatic. How unique is your story? It's interesting. When I started going into all this research, I was like, I don't know. Because there was no place to find information. Like, you can go online. You can find whatever you want in a lot of different areas. And I think that's what a lot of women do. And it becomes very scary. But I realized that my situation is not unique at all. I have a community of people that I talk to online constantly.

34:31and I hear one story after another way worse than what I went through, trying to do all sorts of things to remedy symptoms, understand symptoms, figure out where they are, understand what perimenopause means versus menopause versus postmenopause. So I don't think unique. It did impact my career. It wasn't the reason that I stepped away, but it was the reason I stepped away. The reason is because I just feel like there's a much larger story here to tell because we don't continue talking about this and we don't continue helping. We don't help that younger generation coming up and we're going to just keep repeating this cycle.

35:06And I think in some ways, I do get sad that I wasn't here for my mother doing it. And I want to make sure that somebody else, you know, that comes up behind me does never have that feeling again. As a result of like this not being in play, are there a lot of women whose careers are being impacted right now? Yeah, I think we're seeing a lot of that. We're seeing a lot of women, you know, there's statistics that have come out And there's a lot of different surveys that are being done saying that a number of women are leaving the workplace or not looking to be promoted within the workplace because they're not feeling like they can, you know, balance or juggle some of those symptoms.

35:38And that bothers me, too, because we're staying in the workplace. This is longer now, right? Women are at the prime of many of their careers. They deserve to be where they have worked so hard to get. And I think we owe it to ourselves to try to help them be able to stay and maintain and go for promotions and not walk away from a job or career they've been working so hard for because of symptoms that we're learning more about. It's a pretty critical point, isn't it? I mean, it's basically my age and your late 40s. I sort of got very good at whatever you're doing at this point. And that's just the point that you're saying, like, instead of you're sort of having to potentially pull back because you're not being able to keep this under control.

36:15I think it's just another aspect, right, along with the personal symptoms that you've been describing, Sarah, and the health impact. Yeah, I think I always refer to the statistic that we have in the UK that 10 % of women have left their job, they say, due to menopause. But I've never actually thought about the point that you just made, that actually as well as people leaving, what about the people that stay, that aren't going for promotion, that aren't progressing their career? And I actually see that when I think of a lot of my friends. I'm 47, so lots of my friends as well are going to the menopause.

36:45And for a lot of them, it's their most insecure point of time in their life. And so they wouldn't be going either for that promotion yet. They've worked so hard and are so capable. And so, yeah, it's interesting you say that because it's just something that hadn't occurred to me. Yeah, it's real disturbing, right, though? Because you know how hard they work to get to where they are. And I think that, you know, when you asked about the symptoms earlier and what I really saw, you know, after I had that incident, I think it was a real lack of confidence that I had. I was a newsreader, but then also you are talking all the time, and to not feel like I could complete a sentence or retain a word or I would get lost in a string of thought didn't give me that confidence.

37:24And so I've talked to so many women that say whether they lost their train of thought in the middle of a presentation or they felt like they had that massive hot flash in a room full of men or in a boardroom, it can be really, really difficult. It can really just knock your confidence. And so those stories are not unique ones. I want to say again, thank you both for sharing. I think that just the sharing is very powerful in terms of, I think not just women hearing about this who maybe haven't gone through this, but I also think that for men to even be aware, this is really a thing. As I said, I literally didn't know it was a thing a couple of years ago, and I don't think I'm the only man in that situation.

38:03I'd love to transition now into actionable advice that women can take to alleviate their symptoms. And actually, Tamsin, can I start with you? Because in your book, How to Menopause, You pull together a lot of stories and strategies to help women going through menopause. And I'd love to hear about one or two. And I think one of the things you talk about, for example, is the best sleep of your life. And I know that sleep is one of the things, Sarah, that you mentioned is a very common symptom that's a problem. Can you share? Yeah. You know, when I was writing this book, I said, like, I don't even know how to get all my thoughts into this.

38:38But I think what was really important for me as a journalist is to find the best of the best out there to interview and to make sure women had something actionable because if they're going through brain fog and they're not feeling good, they just want to know what to do. Like, what do I do to get to feel better? And so sleep was a big one. And for a long time, I used to consider sleep a luxury. Like, oh, I'll sleep when I can, but I'm going to brag about the fact that I've gotten by four hours of sleep tonight and I can do all this stuff. But I've realized really how important it is. I've realized what it takes for me to get good sleep because it doesn't just happen.

39:09and I don't just jump into bed and it happens. And I've realized it's more a lot of preparation and a lot of focus on it and working my schedule as much as I can because I know it's not possible to do all the time. And we have a lot of things going on at this part of life, but I think it's important to focus on. And that's really what I did in that chapter of the book. Sleep is something that impacts 85 % of the cohort that we've studied. And we know that sleep is so important in terms of all sorts of factors related to our health. we consider it to be one of the four key pillars of health so we've got diet we've got physical activity we've got stress we've got sleep we also know that sleep impacts the dietary choices that we make if you have a poor night's sleep the reward centers in your brain are on kind of fire and saying hey tamzin you've had a bad night's sleep go and eat that sugary breakfast that refined carbohydrate we also know if you've had a poor night's sleep your response to any meal is also worse and we've published research on this that shows that if you have a poor night's sleep your blood sugar response the next day to a meal is a lot worse so it's a lot higher compared to if you've had a good night's sleep so you kind of set yourself up on this roller coaster we also know from the Zoe menopause study as well that if you have better sleep that also offsets some of the other symptoms meaning that those people who have better sleep which we know is a symptom but they they have less symptoms and less impactful symptoms and so I think it's really great that actually you talk about that first because we can use that as the cornerstone maybe from which we can start to improve other symptoms.

40:43So Tamzin, what are the tips? Somebody's listening, they're like, great, what can I do? My sleep, let's jump into sleep. I don't know, drinking is a thing that I think that I have just moved off the table as much as possible. But if someone's having a glass of wine, having it anytime four hours close to bedtime is going to knock your sleep off completely. Trying to be really cognizant of devices. I'm not good enough or virtuous enough to take my device out of the bedroom, but I do try to make sure it's on that blue light mode and I try to make sure that I'm not dealing with problems closer to bedtime at all.

41:16I do make sure that I'm trying to go to bed at the same time and get up at the same time every day, which is not anything I'd ever done before. I was the kind that was up till two o 'clock in the morning. I'd get up at six, I'd go work out. And I do feel like that consistency has played a huge role for me in feeling better the next day. When I get up in the morning now, no matter if it's raining or sunny out, first thing I do is get outside. It's made a huge difference in my life. I started it about a year and a half ago when I was writing the book. I talked to a doctor who had really just focused on light and understanding how light impacted the body.

41:48And so I wanted to make sure that I was doing that and putting that practice into play. So those are some of the bigger things I do. My bedroom goes completely black. I have tape over any of those lights that are on every device that you have. I have a TV in the bedroom. That's my husband's fault. But I make sure that stays off a few hours before bed. And I used to be the person that went, does that really make a difference? It makes a huge difference. It really does. We've done some work looking at the importance of sleep consistency on different health outcomes and also on the dietary choices that you make.

42:21So we published some research at ZOE looking at what we call social jet lag. And 10 years ago, you would have been a prime target for this study. So this is where people have different sleep patterns. So it might be that, you know, you're very consistent in the week, but you're going wild at the weekend. Or it might be if you're hardworking like I am at ZOE, that you're going a bit wild in the week because you're too excited by your research and you stay up far too late working on it. And then you catch up at the weekend. But either way, you're inconsistent. Your pattern is inconsistent. and we've shown from our research on social jet lag that it does have an association with health and those people who have the social jet lag or the inconsistency also make poorer dietary choices so have higher sugar higher refined carbohydrates for example in their diet i mean i did that a long time in news during the news business i never had a nine to five job in news it was get up at two o 'clock in the morning and be at the uh station by 4 a.m yeah but i would reward myself and think like, I can eat some junk food now because I'm so tired.

43:21I just got to wake up a little bit. That was for about 10 plus years. And then on the flip side, about 15 years, I did the night shift. So I wouldn't get off of the air until 11 o 'clock at night. So I'd get home by midnight. I'd wind down a little bit. I'd have a snack. You know, I did all of those things. So those hours were so off. So I've definitely seen a difference in no longer saying I can just survive on three hours. It might come with age too. Do you know what? The World Health Organization have shift work listed with a health warning because they know that it has such a bad impact on our health.

43:53It's amazing. So Sarah's going to be really interested about this, I think, because, Tamsin, you talk about some recipes that some people believe can actually help alleviate these symptoms. You know, in the book, I talk a lot about a Mediterranean diet. I'm Lebanese, and it was what I grew up on, and it was a diet of whole foods. It was a diet of lots of olive oil and lots of all kind of plant-based vegetables, and then you'd throw in fish. And so I decided in the book, because I felt like a lot of these things were game changers for me. They were the basics that I went back to. And I took some old recipes from my family, old family recipes.

44:27And the one in particular was one that my dad, we did growing up. We had grape leaves growing up. So I changed out the rice for quinoa. We had the grape leaves rolled, drizzled with olive oil, all of these really super healthy for your diet. We did a salmon instead of a chicken, and then we made sure we had some Mediterranean vegetables with all sorts of spices and a tabbouleh salad. So those are like the kind of recipes that I put in the book because one, that's what I grew up eating. Two, a lot of them go back to the whole foods that I think are really, really important for this diet. And I think they're easy to do.

45:00They're not these difficult, I can't do recipes with 20 ingredients in them. I need it simple, and I need to know that I'm going to be consistent about it. So that's what I did in the book. Sounds delicious. I want to be invited around to your house. I would love it. I'll be there.

45:18You're welcome too. We've already broken bread together. It often manifests like, I don't know if this is true or not, but the next day is when I just feel awful. If I've eaten poorly one day or made choices, it just didn't make sense because I didn't have time. I just feel differently the next day. So that's been another kind of consistency I've tried to have. Yeah, we know that food impacts how you feel that day, but we also know how you eat. So the timing that you eat and what you eat actually can impact how you metabolize food the next day and also how you feel the next day. And it's interesting you mentioned the Mediterranean diet.

45:51There's been very little research on how diet can impact menopause symptoms. Apart from the work we've been doing, there is one study that's looked at the Mediterranean diet and people were randomly allocated to either follow like a typical UK-US style diet or the Mediterranean diet. those people following the Mediterranean diet had a 30 % reduction in some symptoms. They only measured a few symptoms because, you know, until recently, people weren't talking about all the other symptoms. And so this is why the work that we've been doing, looking at all the other symptoms, I think, in relationship with diets, are really, really interesting.

46:23Yeah, I do too. I'd love to hear that too because I feel like women are constantly asking, like, what can I do? And to be able to have an answer like that is really important. Is someone in your life experiencing one of the symptoms we've talked about? today. Maybe they don't suspect it could be menopause. Why not share this episode with them right now? With the right advice, there could be a simple way to help them feel better. I'm sure they'll thank you. Well, I'd love to ask that because when we set up Zoe seven or eight years ago now, I never thought at all that food could have any impact on menopause symptoms.

47:01If you'd asked me and I said that sounds completely crazy. Is it completely crazy, Sarah? It's crazy that it does because I thought exactly the same. So we've done this really exciting study where we have followed up just over 4 ,000 women who are peri and post-menopausal who are following the ZOE program. So the ZOE membership is this program of personalized nutrition and at the heart of it is eating according to the personalized guidance that we give a very plant-based, diverse, fiber-rich kind of diet. We also encourage other healthy lifestyle changes, but it's predominantly focusing on diet.

47:46So the ZOE members following the personalized nutrition program had a 35 % reduction after an average of 18 weeks in their symptoms. And we also saw differences in the level of reduction depending on the kind of symptoms. So where we saw the biggest reduction was in these psychological symptoms. When you say psychological symptoms, what does that mean? So these are symptoms such as the brain fog, the memory loss, the irritability, the low mood, the anxiety, the depression. They don't sound really, to me, I don't know what you think, Tanya. They sound like pretty real, like brain fog doesn't sound.

48:22They're real. That sounds pretty real. It's very real. Rage is another one. There are some real symptoms that I, mood swings, up, down, up, down. I mean, you think of a, you know, we went through puberty. Like those are, you know, those are the up, downs. And they're real. They're real symptoms. And I think that that's what we're talking about when we say like, you don't feel like, I don't feel like myself anymore. I can't tell you how many times I've said that over the course of this whole transition. Probably the majority of long-term listeners are Zoe members, but a lot of people listening to this who don't know what that is.

48:51What are the key parts of that membership that people are going through that was achieving that change? Because I think a lot of people listening are like, well, what does that involve? Okay, so the Zoe membership involves getting this lovely yellow box that has various tests that allows us to test people's individual responses to food through their microbiome, through wearing a glucose monitor, and lots of other ways as well. we then deliver about personalized dietary advice that enables people to follow the best diet for their biology with support from coaches lots of fun things like recipe cards we have you know links to grocery deliveries that sort of stuff and then you can opt at the end of a certain period so let's say 12 weeks to actually have certain things retested like your microbiome retested and also answer again lots more questions about your health and it's This data that we've been using for menopause research to look at those who are ZOE members and following the ZOE Personalized Nutrition Programme, how their change in diet is linked to their change in menopause symptoms.

49:58And what we see is that on average, people following the ZOE program and therefore making these dietary changes reduce their symptoms on average by 35%, but that there's big differences in the different symptoms. So psychological symptoms, for example, some of those can reduce as much as 40%. And I think that's really interesting because there's now a huge body of work coming out from Lisa Moschini's group looking at how the brain is regulated. and you know people are putting forward this idea now that actually menopause is a state of neurological disruption which explains why the most common symptoms are these neurological uh you know psychological symptoms and the fact that on the Zoe program we're seeing these ones reduce the most I think is really encouraging and I think that's because we also know from our own work where we've done conducted a randomized controlled trial where we compared the ZOE program versus the US average diet, we actually saw that some of the psychological symptoms that we asked people about.

51:01So mood, for example, had the biggest improvement on the ZOE program as well. So it all kind of ties in quite nicely. We've got all these different pieces of the puzzle now fitting together. I think that it's so important for us to feel like two things, we're not alone, we're not going crazy. And I think that those are the two things I kept overwhelmingly hear women say, which kept pushing me into this area of like, wow, what is what is going on that everybody is going through this and that everybody feels so alone. I can't wrap up without talking about this amazing brand new free tool, which I'm amazed, Sarah, you haven't already plugged three times in this podcast.

51:36It's a sign you must be a little jet lagged. You've done something on the back of all of this research. Would you explain what it is? I would. So we have developed a new tool called the Menno Scale. And this is a tool that basically allows women very easily at no cost to record the burden that menopause has on them. So it allows them to look at how many symptoms they have and the impact that they have on people's quality of life. And the reason we've done this is because there's actually nothing out there and enables us to track our symptoms. And as a scientist, we always say, if you can't measure it, you can't change it.

52:15And for me, that's what's at the heart of this menoscale calculator. so people can go online they can go to zori forward slash menoscale.com it takes a couple of minutes to complete it we ask you a few very basic questions about your age whether you're on hrt for example and then you tick whether you have 20 of what we now know so it's informed by our research of the most common symptoms and then you grade them in terms of how much impact they have on your quality of life you then get a score of zero to 100 now then what you can do with this score is lots of things. Firstly, you can use it to track how anything that you might want to do to help your menopause can impact it, whether it's changing our diet and changing our physical activity, going on HRT, for example.

53:01It enables you to then see what works for you, which I think is really, really important. When I started on HRT, I went to my GP. They said, well, can you track your symptoms? Well, how am I going to do that on some scrappy piece of paper that I know I'm going to lose somewhere. If I'd have had that a couple of years ago, that would have been fantastic. And that allows you to titrate your dose if you want to do that or change your diet according to what works best for you. The other thing as well, Jonathan, I think it allows us to talk about our symptoms and going back to what you were saying, Tamsin, that it means that, I could talk to my friends and say, actually, this is how I'm scoring.

53:38And I don't mean it in a competitive way, but I mean it as in getting that reassurance that we're not alone. So when you get your score back you get also how this compares to a woman of a similar age the average woman of a similar age on HRT or not on HRT and it also tells you about your top symptoms and how that compares to other people so it kind of enables you not to feel alone but it also enables you to share and discuss it with people around you but I think that and also selfishly I get if you tick the consent that we can use it for research I get to look at all of this data and also enable us to move forward, you know, even further on the menopause research that we're doing at Zoe.

54:15Also, while you're getting the research and women are able to be a part of it, you get more data, you're creating a community helping move this message forward and helping solve this. There's something to that that is so valuable for women to feel that they're taking part in helping. Like, we're all in this together. And I think that that's what I've noticed more than anything with this conversation. And I love that because at Zoe, we talk about community science and that's at the heart of what we do, that everyone that becomes a Zoe member, if they consent to share their data with us as scientists, they are becoming community scientists because their data, they are pushing forward our understanding of research.

54:56And it's the same with the Menno Scale. They're becoming community menopause scientists. So everyone, please go fill it out. Well, we'll put a link in the show notes for anybody. Pretty much the time, but Tamsin, And I really want to end on a message that I felt was really powerful from your book, because you talked about how often there's this fear of like almost becoming invisible. You don't want to think about this. And you talk about feeling of growing bolder through menopause. And I'd love you to maybe share that before we wrap. Oh, thank you for pulling that out. Yeah, I was trying to like figure out, you know, what I've learned through this whole experience of aging and of menopause and of being very vocal about the story.

55:35Because I don't know that I would have done it five years ago. I would have said, I'm not getting any older. But I said, I don't think we're going into these as golden years. I think these are our golden years. I feel like I've gotten, you know, I always have a little bit of fear, of course, but I feel like I'm a little more vocal. I'm advocating for myself. I want to do amazing things next, you know, and I'm not in that game of comparison and that game of competitiveness. I'm in that wanting to feel good going forward and knowing that I'm living my someday today, right? And so I want to get every part out of it.

56:09And that's really important to me. So I feel like we're a little bolder, a little sexier, a little wiser these days than what commercials may indicate that we're two older people sitting on a bench in a park petting a cat. That's not what I want to be. And if anyone's listening to this and saying, well, I would like to be growing bolder, do you have any advice for other women to achieve the same? Yeah, absolutely. I mean, I think first and foremost, I'm big about you've got to take control of your health because if you don't feel good, you can't do that next step of acting. It doesn't work. And I think that that gives you control.

56:41It makes you feel like you're in the right place moving forward. I think stop putting these old narratives into place that I'm too old, that my best years are behind me, that I should have done it back then. Like we have a long road ahead of us. It's very different. We're living longer. I think we're living healthier. I think we're living with more opportunity ahead of us. And so that's my advice is to really embrace that and not leave it for someday because today is someday. That's beautiful. I'd like to wrap up as always with like a little summary and both of you keep me honest if I get it wrong.

57:15We started with this incredibly powerful story, Tamsin, about how you could end up lying on the bathroom floor with like the sudden impact of these symptoms, not even realizing really that you'd been having this series of symptoms maybe for years, it sounds like potentially. And then suddenly it's like bang and your body is saying, no, you can't ignore this anymore. This is like a big deal. And so it makes you realize this is a big deal and it's important to talk about. It's important to understand whether it's affecting you or your loved ones, as it's going to be in my case, that there are a huge number of symptoms associated.

57:47I think you said on average 13 symptoms in perimenopause, Sarah. Correct. And then you said 10 or something in perimenopause. So like an enormous number of symptoms. It's just very different from most things where there's like this one very clear symptom. And so it's obviously complicated. It's not just symptoms. this has a big impact on your health. And you were saying, Sarah, women are on average much healthier than men until perimenopause. And then there's this like catching up or even getting worse at this point. So you've really got to see that change. And you talked about, you know, your biology really changing.

58:16So that just one example of that, that I think a lot of listeners will stuck on is suddenly the estrogen that was pushing, you know, any fat, you know, towards your legs. It's like, no, no, no, put it on your tummy. And that's real. It's not because suddenly you're eating worse. It's because your body has changed. and that's a reality you've got to deal with. You can take control of your health. This isn't something that is just genetics. There's nothing you can do like you're stuck with it, which is something that comes up a lot on this podcast, but here I think is particularly powerful. You can't duck the fact that this is going to happen, but you can take control of its impact on your health.

58:54Sarah has just launched this amazing new free tool and the first step to taking control of your health is just to understand actually the symptoms you have. It's called the Menoscale Calculator. It's based upon this huge study that you've done. You can find it at zoe.com slash menopause. It'll be on the links as a way to sort of understand where you are. And then I think, you know, to wrap up, we talked about this really amazing new research that suggests that diet and your microbiome actually is interrelated with your menopause, despite the fact that Sarah and I both thought that sounded crazy, that there's all this data, Sarah, you said that menopause is changing your microbiome, that you can get more of particular bad microbes, which I'm going to say, even if your microbiologist friends don't like it, because I don't have a lot of microbiologist friends, Tamsin, so it's okay.

59:42But interested, brand new research, actually, you can see this link between how bad your symptoms are and your microbiome. So you can see that this thing is sort of really deeply interlinked. And that's especially around things like brain fog and low mood, which are exactly the same things that you also said are most linked to the food you eat. And just to wrap up, diet really can improve your menopause symptoms in a big way. And you shared the results of the study of Zoe membership, saying that on average, it actually reduced these menopause symptoms as calculated through your calculated by 35%, which is like a really big amount.

1:00:19And I think that just fits into this incredibly positive story that you're not completely stuck. It's not like there's nothing you can do about it. And I think it is fascinating how much the lifestyle that we lead impacts this. It's not only a question of whether you're taking hormone replacement or not, which is, I think, something we've touched on on a number of other podcasts that people are interested. Did I catch the key bits? You are a genius at summing up. A genius. Jonathan, I think one thing to emphasize is what Tamsin said about sleep. And although it's a symptom of menopause, I think it's often so overwhelming when you're in the menopause, the amount of things are going on, the amount of changes that you might need to make if you are following an unhealthy diet.

1:01:04So I think that actually maybe to start with, a really good action is to focus on some of the things that Tamsin said about sleep and make that the first thing that anyone's listening to do today. Why don't you make sleep the priority this week? And then that might give you the strength to then make some of the other changes. Brilliant. Thank you both so much. I always find this is incredibly powerful as a topic to talk about. And I always feel both privileged to be in the room and slightly embarrassed somehow as if I shouldn't be in the room. So thank you very much. Thank you. Now, if you listen to the show regularly, you already believe that changing how you eat can transform your health.

1:01:44But you can only do so much with general advice from a weekly podcast. If you want to feel much better now and be on the path to live many more healthy years, you need something more. And that's why more than 100 ,000 members trust Zoe each day to help them make the smartest food choices. Combining our world-leading science with your Zoe test results, Zoe is your daily companion to better health for life. So how does it work? Zoe membership starts with at-home testing to understand your unique body. then Zoe's app is your health coach using weekly check-ins and daily guidance to help you shift your food choices to steadily improve your health.

1:02:24I rely on Zoe's advice every day and truly it has transformed how I feel. Will you give Zoe a try? The first step is easy. Take our free quiz to find out what Zoe membership could do for you. Simply go to zoe.com slash podcast, where as a podcast listener, you'll get 10 % off. As always, I'm your host, Jonathan Wolfe. Zoe Science in Nutrition is produced by Julie Pinero, Sam Durham, and Richard Willough. The Zoe Science in Nutrition podcast is not medical advice. And if you have any medical concerns, please consult your doctor. See you next time.

1:03:19I'll leave you with one final thought. What if there was one simple habit that, when repeated, could change how you feel for the better? I'd like to tell you about something that I do daily for my own health. It's called Daily 30, the gut supplement developed by our scientists here at Zoe. Daily 30 is made of over 30 hand-picked plants, including seaweed, fungi, and different types of fiber. It's a source of plant protein, omega-3, and vital minerals. You simply add a scoop to any meal once a day to support your health and increase the plant diversity in your diet. And unlike synthetic supplements, Daily 30 actually tastes great.

1:03:58It's designed to be enjoyed because when a habit brings you joy, you're far more likely to stick with it. So next time you feel like your plate is missing extra plants, do yourself a favor. Try Daily 30. It's a delicious and healthy habit that you'll feel good about and one that your gut will definitely thank you for. By the way, whenever we talk about Daily 30 as a good source of fiber, we're required to say that it contains four grams of total fat per serving. Obviously, that's all amazing healthy fats from plants. So order yours today at zoe.com slash daily 30. See you next time.

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