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Diet and Exercise after perimenopause

Menopause expert Dr Kelly Teagle, Exercise Physiologist Gillian Logan and Nutritionist Kate Freeman reveal what’s really important to stay fit and healthy through the Next Phase of your life.

Live-streamed Diet and Exercise workshop, Wed 17th June, 2020

Menopause Recap

Menopause is when you’ve had no ovulations for 12 months, usually between 45 and 55yo. This is usually signalled by a loss of periods for 12 months, unless your periods had already stopped due to a hysterectomy or hormonal contraceptives like the Mirena IUD. The hormonal fluctuations of perimenopause (and the associated symptoms) can start many years before you actually reach menopause.

Your Body Changes at Menopause

Due to the changes in hormones during perimenopause, especially oestrogen, our bodies change.

One of the changes you may notice is an increase in belly fat (known as central adiposity) and more total body fat. Besides just not feeling great about how our shape is changing, the increased body fat more importantly impacts on our overall health and wellbeing, putting us at higher risk of chronic disease. Research has shown that if your waist is >90cm and/or your waist to hip ratio is > than 0.85, this places you into this higher risk category for health issues – like hypertension, cardiovascular disease and metabolic diseases like diabetes.

In addition, if your Body Mass Index is less than 30 the severity of your menopause symptoms, like hot flashes, unexplained mood swings and sleep disturbances can be less.

Other physiological changes in menopause include

  • reduced bone density
  • change in muscle fibre type so we can lose strength
  • disturbed sleep
  • increased mood swings and anxiety

Nutrition after Perimenopause

Very few Australians eat in accordance with recommended nutritional guidelines. If we did there would be hugely reduced rates of diabetes, heart disease, obesity, cancers, and other chronic diseases.

As we age we require less calories because of overall reduction in activity levels and reduced lean muscle mass (which burns calories 24/7). Our bodies are also less efficient at absorbing nutrients as we age, but we still require the same amount of nutrients so what we eat has to be more nutritionally dense and less calorie dense.

Eating this way also lets you eat bigger portions of food for the same amount of calories, so you feel fuller with less calories. It also helps in losing weight or preventing weight gain.

The Link Between Diet and Mental Health

Mental health issues are incredibly common around perimenopause, with women 3x more likely to have depression at menopause than pre-menopausally. The Jean Hailes article “Foods for your future” quotes studies demonstrating that a Mediterranean diet is linked to higher psychological resilience, ie. coping better with stress.

“The Mediterranean diet is rich is natural wholefoods, with a particular focus on vegetables, as well as olive oil, fruits, legumes and wholegrains,” …”In this study, consuming high amounts of antioxidants present in these foods and including a large variety of fruits and vegetables was associated with higher mental resilience and stress-coping ability.”

A Mediterranean diet has also been shown to reduce risk of heart disease, type 2 diabetes and some cancers. That leads us to…

Heart Health

Heart disease and dementia are the equal highest killers of Australian women. CVD was responsible for 1/3 of all female deaths in 2016 (around 28000 women). A Mediterranean diet is not only protective of your mental health, it also is protective against heart disease.

Other key strategies to improving heart health are:

  • Decrease saturated fats and increase monounsaturated fats
  • Increase soluble fibre in your diet such as oats, barley and psyllium which can reduce cholesterol, and
  • Eat high fibre/ wholegrain for optimal nutrition and bowel health.

Bone Health

Bone density drops sharply with the estrogen decline at menopause. Calcium intake is important for bone health. Good sources include dairy (such as milk, yoghurt and cheese), sardines or salmon (with the bones in). Calcium is also found in vegetarian/vegan-friendly food such as calcium-enriched tofu, soy, almonds and broccoli. Vitamin D helps uptake of calcium; if you are dark skinned, vit D deficient or don’t get much sunlight a vit D supplement might be helpful.

Iron

Perimenopause often brings frequent or heavy periods (menorrhagia), which can lead to iron deficiency. If you have menorrhagia ask your doctor about getting your iron level tested. Ways to improve your iron levels include lean red meat, or eating green leafy vegetables with a carbohydrate and some vitamin C to boost its absorption. Avoid eating your iron-rich foods or taking iron supplements with tea or calcium-rich foods such as dairy, as they inhibit iron absorption in the gut.

Soy

About one-third of women may get some improvement in their menopausal symptoms from eating soy- these are the women with the right type of gut bacteria to process it into the required molecules.

Protein

Quality lean proteins help you build and retain lean muscle mass, and can help you feel full at meals. Protein also contains zinc which is protective against mood disorders and is important for brain functions like memory, learning and concentration.

How Good is Your Nutritional Intake?

Take the Healthy Eating Quiz to compare your nutritional intake to the Australian healthy eating guidelines.

 The quiz is linked to the “No money, No time” recipe planning site, which ties in with quiz’s recommendations.

Does Menopause Cause Weight Gain?

Scientific studies show that central weight gain is associated with increasing Body Mass Index (BMI) rather than menopause itself.

BMI increases in response to lifestyle changes, many of which are exacerbated by hormonal changes however. For example, it’s harder to exercise and make good food choices when you’re exhausted from lack of sleep caused by hot flushes. As previously mentioned, the women who changed what they were doing managed to avoid weight gain.

What’s Estrogen Got To Do With It?

Importantly, evidence confirms that reduced estrogen levels lead to more centrally-located fat deposition, so whatever weight you do gain tends to go on around the middle. This is yet another risk factor for heart disease.

The key to avoiding tummy fat accumulation then is to maintain a healthy weight during the menopausal transition through physical activity and healthy eating… It can be done!

Reduced estrogen levels also led to a reduction in incidental movement in animal studies, so there may be hormonal triggers contributing to reduced activity levels. It really does take extra effort to remain active after menopause

How to NOT Gain Weight at Menopause

Lauren Williams from Griffith University found that the average weight gain during menopausal transition is 2.5kg. Contributors include hormonal changes amplified by life changes: physical work reduces, alcohol intake increases for many women, busier at work, more disposable income and eating out more.

Importantly, ALL women are prone to weight gain during menopausal transition, regardless of having a lifetime of good fitness habits. NONE OF US ARE IMMUNE!

BUT here is the really exciting thing: Lauren’s research shows that women who changed something at perimenopause DID NOT GAIN WEIGHT.

Basically, the key to not gaining weight at menopause is to not do the same things you’ve been doing pre-menopausally. Increase your activity levels, decrease your portion sizes, cut out snacks, cut out alcohol, increase the proportion of non-starchy vegetables on your plate… just do something differently to shift the balance between calories in and calories out.

Why Am I So Bloated?

Bloating can be caused by many things, not all of them dietary. Hormones and fluid retention are big culprits. Think not just of estrogen and progesterone but also stress hormones if you’re very stressed or anxious.

Medical causes can include a variety of gut disorders like infections, inflammatory bowel diseases, coeliac disease, abdominal fluid (from some serious disorders including cancer), eating disorders and reflux. Significant or persistent pain associated with bloating should always be investigated by your GP.

Dietary Causes of Bloating

  • Constipation – if you’re backed up and things aren’t moving through quickly this will often cause bloating. Ensuring you’re consuming adequate fibre and drinking enough water can help with this.
  • Fecal loading– This is what happens when the amount of poo you’re eliminating is insufficient for the amount of food you’re ingesting… basically a big traffic jam of poo in your bowels. It’s actually quite a common cause of generalised abdominal pain, and can be present even if you think you’re “going” regularly. Your GP can order an abdominal xray to diagnose it and give you advice about the right kind of laxatives the get that traffic jam moving.
  • Gas – gas production from bacteria in your gut can also cause bloating, and sometimes you just need to let the gas out. Don’t hold in farts! An increase in pre-biotic foods (foods that feed your gut bacteria) can lead to more gas production. Foods like onion, garlic, legumes, some vegetables and fruits – all really healthy foods – give your bacteria something to ferment which creates gas. This is nothing to be worried about and often settles down after a few weeks of the extra fibre.
  • IBS – irritable bowel syndrome is a complex cluster of gut symptoms that greatly impair an individual’s wellbeing and quality of life. Stress, hormones and other life events can exacerbate IBS symptoms, or they could be the result of a food intolerance. If you suspect you may be intolerant to certain foods, don’t guess and just eliminate. See an accredited practicing dietitian for a systematic approach to determining your food intolerances and maximising your gut health.

Where Can I Get Help with my Diet?

Kate Freeman and her team at the Healthy Eating Clinic offer a free Telehealth Nutrition Assessment with a gut health dietitian. What have you got to lose?

***NEXT WEEK: Kate’s top tips to lose weight and keep it off***

The Importance of Exercise

The good news is that with lifestyle changes like improved diet and increased exercise we can change our shape and body composition ie. increase muscle and reduce fat. It can also help reduce the impact of the severity of peri-menopausal symptoms.

The other benefits of exercise that you may be aware or unaware of include:

  • Improved immunity (important during a pandemic) and reduced inflammation.
  • Improved mental health including better managed depression and anxiety and a positive effect on mood and motivation.
  • Improved self-esteem – you feel stronger and look better.
  • Improved sleep quality – you may find you fall asleep faster, sleep longer and in a deeper sleep waking refreshed.
  • Increased muscle mass which boosts our metabolic rate that increases your body’s ability to burn calories; but it also keeps us strong helping us age well, reducing the incidence of aches and joint pain which may often be the first sign of menopause.
  • Improved bone health and bone density (declining oestrogen results in less calcium absorption and bones are not as strong as they used to be) ie osteoporosis. It’s scary to think over 50% of women over 60 suffer fractures related to osteoporosis.
  • You also tend to eat better – speaking from experience when I exercise, I don’t want to undo the benefits of what I have just done by indulging in high sugar or processed food.
  • Prevent Chronic Conditions – exercise reduces the risk of disease like diabetes, cardiovascular disease, breast cancer and lower back pain.
  • Helps us reduce effect of stress and better manage stress – research shows that exercisehas a huge impact on mental health.

How much and what type of exercise?

Try to achieve the following each week:

  • cardiovascular exercise: if you are new to exercise aim for a minimum of 150 minutes of moderate intensity cardiovascular exercise building it up to 300 minutes. For example, try walking, cycling, swimming or jogging at a moderate pace. Or, if you have been exercising for a while and you are comfortable exercising aim for 75-150 minutes of vigorous exercise e.g. interval training. However, if your goal is weight loss aim for 300 minutes of moderate exercise. This is to get you to the point where your energy coming in is less than the energy going out
  • strength/resistance-based exercise: 3 sessions per week at least, preferably on non-consecutive days, doing 8-10 different exercises;
  • balance exercises to reduce falls risk;
  • stretching 5-10 minutes after exercise and during the week;
  • pelvic floor exercises daily;
  • and limit the amount of sitting for long periods like desk work and tv time by changing positions and what you are doing often e.g. stand up every 20 minutes, walk around during ad breaks etc.

How hard do I need to work?

To know if you are working at the right level:

  • At a light intensity you can talk comfortably and sing comfortably and feel like you could go like this all day – will burn energy at a slow and steady rate.
  • At a moderate intensity you can talk comfortably but not sing and feel like you are slightly challenged – will burn energy at a moderate rate.
  • At a vigorous/high intensity you can neither talk nor sing comfortably. You’re working hard at a level you can sustain for a short period and and feel like you are really challenged – will burn energy at a faster rate.

Tips for starting and staying motivated

  • Talk to an exercise physiologist to assess you, support you, to help set goals and keep you accountable. Find me at www.clearep.com.au.
  • Start slow and build up the amount of time. For example, start with 10 minutes and build up to 30 minutes a day.
  • Make a plan for the week – when, where and what you are going to do.
  • Use an exercise tracker and set a goal for increasing your average steps each week.
  • Find a buddy to exercise with.
  • Aim for consistency and doing some form of activity most days.
  • Enjoy the great feeling you get at the end of each session and focus on the benefits – enhanced mood, increased self-esteem and increased energy.
  • Find the exercise you love and do lots of that!

Reframe Your Thinking About Menopause

Start looking at perimenopause as an opportunity rather than a burden; an opportunity to remind us to take care of ourselves. Take stock of where you are up to in regard to your health and well being and ask yourself the following questions:

  • Am I exercising at the optimal level for me?
  • Am I eating to meet my nutritional needs?
  • Am I getting enough sleep and practicing good sleep hygiene?
  • Am I looking after my mental health with good strategies to manage stress, competing priorities anxiety and mood changes?

If you can answer yes to all the above, you’re well set up for good long-term ageing and an independent healthy life well into your 80s and 90s.

Where Can I Get Help With Exercise Planning?

If you’re finding it hard to to get started with exercise Gillian will send you her activity planner and tracker and to help you on your way. Email her at gilllogan6@gmail.com

Tune in for next week’s Blog post: Kate’s top tips for losing and maintaining weight.

REFERENCES:

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What is WellFemme About?

If you can’t find the professional help you need for your perimenopausal symptoms then book a telehealth consultation with a female WellFemme menopause doctor.

Heavily discounted consultations are also available for women in regional, rural and remote areas who agree to complete short questionnaires for WellFemme’s Pilot Study.

Not sure if Telehealth is for you? Free trial consultations are available to find out how WellFemme can help with your menopausal symptoms.