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Menopause Diet

Definition

A menopause diet is a diet recommended for the special nutritional needs of women undergoing menopause and usually includes foods rich in calcium and vitamin D.

Origins

Between the ages of 45 and 55 women experience changes to their body that are associated with menopause, the time in a woman’s life when her period stops. It is a normal change in a woman’s body and menopause is considered reached when a woman has not had a period for 12 months in a row. It marks the permanent end of fertility. Leading up to menopause, a woman’s ovaries stop producing eggs, and her body slowly starts making less and less of the hormones estrogen and progesterone. As the ovaries become less functional and produce less of these hormones, the body responds accordingly. The density of the bone also begins to decrease in women during the fourth decade of life. However, that normal decline in bone density is accelerated during menopause. As a consequence, both age and menopause act together to decrease bone mass and bone density (osteoporosis). As a result, women are between 2 and 7 times more likely than men to suffer a bone fracture, the risk increasing with age and after menopause. Another consequence of getting older is that the digestive system becomes less efficient and digestion takes longer. After menopause, women are also more vulnerable to heart disease. Weight increases also seem to coincide with menopause. They are not believed to result from menopause itself, but rather to result from a slower metabolism and decreased energy expenditures due to lower activity levels. All of these changes that happen to women during menopause lead to different nutritional needs and nutrition for the changing female body during those years is accordingly focused on recommending foods that benefit the bones and the heart, while controlling weight. Overall, the American Dietetic Association (ADA) recommends that older

Signs and symptoms of menopause

  • Changes in periods (they may be shorter or longer, heavier or lighter, or have more or less time in between)
  • Hot flashes
  • Night sweats
  • Trouble sleeping through the night
  • Vaginal dryness
  • Mood changes
  • Hair loss or thinning on the head, more hair growth on the face

Although menopause itself is the time of a woman’s last period, symptoms can begin several years before that in a stage called peri-menopause. Menopause and peri-menopause affect every woman differently. (Illustration by GGS Information Services/Thomson Gale.)

women should have additional intake of nutrients such as calcium, vitamins D and B12 while increasing consumption of dairy foods, especially skim or low-fat milk and yogurt, to help with these extra nutrient needs.

Description

There is a consensus among health practitioners that a healthy diet containing a wide variety of foods will be good for women’s health and well-being during menopause. It is also considered a time to lower fat and increase fruit and vegetable intake to help maintain weight, and to ensure a daily intake of low-fat dairy products to keep bones strong. Women who suffer from specific menopausal symptoms should consult a physician for personal dietary advice. For most women, a menopause diet is considered healthy if it follows these guidelines:

  • Increase calcium. The way to reduce the loss of calcium from the bones is primarily to increase the intake of calcium from food. The recommended daily allowance (RDA) for calcium is 1200mg/day for women over 50. Eating and drinking 2 to 4 servings of dairy products and calcium-rich foods a day will help ensure that a woman is getting enough calcium in the daily diet. Calcium is found in dairy products, clams, sardines, broccoli and legumes.
  • Increase iron intake. Eating at least 3 servings of iron-rich foods a day will help ensure that an adequate amount of iron is present in the daily diet. Iron is found in lean red meat, poultry, fish, eggs, leafy green vegetables, nuts and enriched grain products.
  • Obtaining enough fiber. Foods high in fiber include whole-grain breads, cereals, pasta, rice, fresh fruits and vegetables.
  • Eating fruits and vegetables. At least 2 to 4 servings of fruits and 3 to 5 servings of vegetables should be included in the daily diet.
  • Include essential fatty acids (EFAs) in the diet. EFAs are found in nuts, seeds and oily fish. The best EFAs are those from the omega-3 and omega-6 families, which are found in pumpkin seeds, oily fish, walnuts, linseeds, dark green vegetables and oils such as sesame, walnut, soya and sunflower.
  • Drinking plenty of water. At least eight 8-ounce glasses of water a day are recommended.
  • Reducing high-fat foods. According to the National Academy of Sciences, the recommended daily calorie intake is 2,000 for women. Fat should provide 30% or less of this total. Saturated fat should be limited to less than 10% of the total daily calories because it raises blood cholesterol and increases the risk of heart disease. Saturated fat is found in fatty meats, whole milk, ice cream and cheese.
  • Moderate use of sugar and salt. Too much sodium in the diet is linked to high blood pressure. Also, smoked, salt-cured and charbroiled foods contain high levels of nitrates, which have been linked to cancer.
  • Limiting alcohol intake. Alcohol consumption should be limited to one or fewer drinks per day (3 to 5 drinks per week maximum) as alcohol can make hot flushes worse.

Since it has been shown that there is a direct relationship between the lack of estrogen after menopause and the development of osteoporosis, it is believed that the onset of osteoporosis can be delayed by taking supplements of calcium and vitamin D. The National Institute of Aging (NIA) recommends taking these two supplements if the diet can not provide them in sufficient amounts. Consultation with a health practitioner is highly recommended as excessive intake may cause adverse effects.

  • Calcium: Some sources recommend 1500mg/day for postmenopausal women not taking hormone replacement therapy. Maximum dose to avoid adverse effects (kidney problems) is 2000mg/day.
  • Vitamin D: The RDA for vitamin D is 10mg/day for women aged 51-69 and 15p,g for women aged 70+. Vitamin D is present in fortified milk and cereals, salmon, cod liver oil, and other foods. Vitamin D deficiency is not uncommon in the elderly and those with little sun exposure. Maximum recommended is 50(j,g to avoid vitamin D toxicity.

In some cases, a physician may also recommend Vitamin B12 and folic acid supplements. The RDA for vitamin B12 is 2.4μday for women. Vitamin B12 is present in liver, kidney, fish, poultry, eggs and milk, and in B12-fortified foods. The RDA for folic acid is 180(j,g/day for women. It is found in juices spinach, asparagus, and green leafy vegetables.

KEY TERMS

Blood cholesterol—Cholesterol is a molecule from which hormones, steroids and nerve cells are made. It is an essential molecule for the human body and circulates in the blood stream. Between 75 and 80% of the cholesterol that circulates in a person’s bloodstream is made in that person’s liver. The remainder is acquired from animal dietary sources. It is not found in plants. Normal blood cholesterol level is a number obtained from blood tests. A normal cholesterol level is defined as less than 200 mg of cholesterol per deciliter of blood.

Bone mineral density (BMD)—Test used to measure bone density and usually expressed as the amount of mineralized tissue in the area scanned (g/cm2). It is used for the diagnosis of osteoporosis.

Calorie—A unit of food energy. In nutrition terms, the word calorie is used instead of the scientific term kilocalorie that represents the amount of energy required to raise the temperature of one liter of water by one degree centigrade at sea level. In nutrition, a calorie of food energy refers to a kilocalorie and is therefore equal to 1000 true calories of energy.

Estrogen—A hormone produced by the ovaries and testes. It stimulates the development of secondary sexual characteristics and induces menstruation in women.

Fat-soluble vitamins—Vitamins, such as A, D, E and K that are found in fat or oil-containing foods, and which are stored in the liver, so that daily intake is not really essential.

Fatty acid—A chemical unit that occurs naturally, either singly or combined, and consists of strongly linked carbon and hydrogen atoms in a chain-like structure. The end of the chain contains a reactive acid group made up of carbon, hydrogen, and oxygen.

Hormone replacement therapy (HRT)—Use of the female hormones estrogen and progestin (a synthetic form of progesterone) to replace those the body no longer produces after menopause.

Phytoestrogens—Compounds that occur naturally in plants and under certain circumstances can have actions like human estrogen. When eaten they bind to estrogen receptors and may act in a similar way to oestrogen.

Progesterone—A female steroid hormone secreted by the ovary; it is produced by the placenta in large quantities during pregnancy.

Water-soluble vitamins—Vitamins that are soluble in water and which include the B-complex group and vitamin C. Whatever water-soluble vitamins are not used by the body are eliminated in urine, which means that a continuous supply is needed in food.

Women’s Health Initiative (WHI)—Major 15-year research program sponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) to address the most common causes of death, disability and poor quality of life in postmenopausal women, namely cardiovascular disease, cancer, and osteoporosis. The WHI was launched in 1991 and consisted of a set of clinical trials and an observational study, which together involved 161,808 generally healthy postmenopausal women. The study results were published in the February 16, 2007 issue of The New England Journal of Medicine.

Function

A menopause diet is a nutritious diet designed not only to minimize all the additional medical health risks of menopause and general aging, but also to lower both physical and mental symptoms of menopausal life. These commonly include hot flashes and skin flushing, night sweats, insomnia and mood swings and irritability.

Precautions

Supplements and prescription drugs have a lot in common. Both are used in an attempt to improve health. But “natural” remedies marketed as “dietary” supplements unfortunately do not have a Patient Package Insert, the document, required by the U.S. Food and Drug Administration (FDA) for all marketed prescription medications, that provides vital information on how to take a drug safely, identify its negative side effects, and avoid potentially dangerous interactions with other drugs. Before considering nutritional supplements for menopause, it is advised to proceed with caution and consult a healthcare provider prior to using any supplement.

In their 40s and 50s, women often gain weight, and they sometimes attribute this gain to menopause. Midlife weight gain appears to be mostly related to aging and lifestyle, but menopause also contributes to the problem. In general, fewer calories are needed after midlife because less energy is expended. Whether weight gain is linked to menopause itself and/or age, the available studies show that weight gain around menopause years can be prevented by exercise and diet, by minimizing fat gain and maintaining muscle, thus reducing body size and burning more calories.

Risks

Nowadays, numerous menopause diets and supplements including mega vitamin supplements and medicinal creams are commercially advertised as the cure-all for menopause and its symptoms. While some may contribute to feeling good, there is a risk of adverse side effects associated with supplements taken above recommended level and a lot of uncertainty concerning their interactions with medications and hormone replacement therapy. This is why following a simple, well-balanced diet is presently considered the best way to reduce menopause symptoms and chances of developing some of the complications that go along with menopause, the two most serious being accelerated osteoporosis and heart disease. The advantage of following a varied diet that includes calcium and vitamin D is that there are no risks associated with it, provided that the general health of a woman is good.

Research and general acceptance

There is broad consensus among women’s health practitioners that a healthy diet combined with regular

QUESTIONS TO ASK YOUR DOCTOR

  • How will my body change with menopause?
  • What kinds of dietary adjustments should I make?
  • Can you recommend a menopause diet?
  • Are there any specific foods that I should avoid?
  • Is it safe to take dietary supplements to help my menopause symptoms?
  • I’m finding it harder to lose weight now that I’m older. Does it have anything to do with menopause?
  • As I go past menopause, how can my diet help me achieve the best possible health?
  • I suffer from hot flashes at night that keep me from sleeping. Are there any dietary approaches that can help me have a good night’s sleep?
  • Are there certain foods that you could suggest to help with menopause symptoms?
  • What foods are recommended to slow down osteoporosis?
  • I really dislike dairy products. Is there a way to obtain calcium in other foods or as supplements?
  • I use hormone replacement therapy. Should I have a special diet?

physical exercise really does make a difference to alleviate the symptoms and side-effects of menopause.

Calcium and vitamin D supplements in healthy postmenopausal women have been shown to provide a modest benefit in preserving bone mass and prevent hip fractures in certain groups including older women but do not prevent other types of fractures or color-ectal cancer, according to the results of a major clinical trial, part of the Women’s Health Initiative (WHI). While generally well tolerated, the supplements are associated with an increased risk of kidney stones.

Many women also believe that soy foods and the phytoestrogens they contain can alleviate menopausal symptoms but research has shown that their benefits are mild if they occur at all. When phytoestrogens act as estrogens, they are much weaker than the estrogen produced in humans. Published studies mostly indicate that increased consumption of phytoestrogens (soy, linseed) by postmenopausal women is no more effective than placebo (wheat diet) for reducing hot flushes. Despite conflicting study results, evidence strongly suggests that soy can help reduce total and LDL cholesterol levels.

Agencies as diverse as the American Dietetic Association (ADA), the American College of Obstetricians and Gynecologists (ACOG), the American Academy of Family Physicians (AAFP) and the U.S. Food and Drug Administration (FDA) have issued findings on the following supplements and nutrients in the context of menopause:

  • Glucosamine. Current evidence suggests that a potential benefit exists with little risk, even at doses of 1,500 mg/day in nondiabetic, nonpregnant women. The product should not be used by those at risk for shellfish allergy. Available evidence from randomized, controlled clinical trials supports the use for improving symptoms of osteoarthritis.
  • Black cohosh. Black cohosh (known as both Actaea racemosaand Cimicifuga racemosa)is a member of the buttercup family, a perennial plant that is native to North America. It is an herb sold as a dietary supplement in the United States. The American College of Gynecology states that black cohosh supplementation may be helpful in short-term use (6 months or less) for the sweating and palpitations symptoms of menopause. Few adverse effects have been reported; however, long-term safety data are not available.
  • Dehydroepiandrosterone (DHEA). DHEA has been studied extensively for the treatment of many diseases. Trials are inconsistent regarding the efficacy of DHEA supplements in the prevention of heart disease and the treatment of depressive symptoms. To date, no large-scale, controlled trial of DHEA has been conducted regarding the action of DHEA in the treatment of menopausal symptoms. It may have either additive or antagonistic effects with other hormone therapies.
  • S-Adenosyl-L-Methionine (SAM-e). SAM-e is an amino acid produced naturally from methionine. It is an important molecule in cell function and survival, present in nearly every tissue in the body. To date, no controlled trials have been conducted on the efficacy of SAM-e in the treatment of depressed mood associated with menopause.
  • Magnesium. Studies have suggested that magnesium supplementation may improve bone mineral density, but not that it decreases risk for fracture. Deficiency in magnesium may be a risk factor for postmenopausal osteoporosis. Some scientists believe more research is needed to establish the relationship between magnesium and bone density.

Other herbal supplements claim to alleviate menopausal symptoms, but there is little hard evidence to support the use of any of the following supplements: fish oil, omega-3 fatty acids, red clover, ginseng, rice bran oil, wild yam, calcium, gotu kola, licorice root, sage, sarsaparilla, passion flower, chaste berry, ginkgo biloba and valerian root.

BOOKS

Alexander, E., Knight, K. A. 100 Questions & Answers About Menopause. Sudbury, MA: Jones and Bartlett Publisher; 2005.

Cheung, T. The Menopause Diet: The natural way to beat your symptoms and lose weight. New York, NY: Ver-million (Random House), 2007.

Fiatarone Singh, M. A. Exercise, Nutrition and the Older Woman: Wellness for Women Over Fifty. Boca Raton, FL: CRC Press, 2000.

Gates, R., Whipple, B. Outwitting Osteoporosis: The Smart Woman’s Guide to Bone Health. Hillsboro, OR: Beyond Words Publishing; 2006.

Gillespie, L. The Menopause Diet. Beverly Hills, CA: Healthy Life Publications, 2003.

Gillespie, L. The Menopause Diet Mini Meal Cookbook. Beverly Hills, CA: Healthy Life Publications, 1999.

Kagan, L., Kessel, B., Benson, H. Mind Over Menopause: The Complete Mind/Body Approach to Coping with Menopause. New York, NY: Free Press Simon & Schuster; 2004.

Klimis-Zacas, D., Wolinsky, I. Nutritional Concerns of Women. Boca Raton, FL: CRC Press, 2003.

Magee, E. The Change of Life Diet & Cookbook. New York, NY: Penguin Group, 2004.

Magee, E. Eat Well for a Healthy Menopause: The Low-Fat, High Nutrition Guide. New York, NY: Wiley, 1997.

Phillips, R. N. The Menopause Bible: The Complete Practical Guide to Managing your Menopause. Buffalo, NY: Firefly Books; 2005.

Shulman, N., Kim, E. S. Healthy Transitions: A Woman’s Guide to Perimenopause, Menopause & Beyond. Amherst, NY: Prometheus Books; 2004.

ORGANIZATIONS

American Dietetic Association. 216 W. Jackson Blvd, Chicago, IL 60606-6995. 1-800-877-1600 ext. 5000. <www.eatright.org>.

National Institute of Aging. Building 31, Room 5C27, 31 Center Drive, MSC 2292, Bethesda, MD 20892. 1-800-222-4225. <www.nia.nih.gov>.

The North American Menopause Society. 5900 Lander-brook Drive, Suite 390 Mayfield Heights, OH 44124. (440-442-7550). <www.menopause.org>.

U.S. Food and Drug Administration, Office of Women’s Health (OWH), 5600 Fishers Lane,Rockville, MD 20857. 1-800-216-7331. <www.fda.gov/womens/default.htm>.

U.S. Department of Health and Human Services, 5600 Fishers Lane,Rockville, MD 20857. 1-800-994-9662. <www.4woman.gov>.

Monique Laberge, Ph.D.


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