It affects half of us, but there are still many unanswered questions about menopause.
The symptoms vary significantly from woman to woman, and they can include sleep problems, hot flashes, weight gain, and an increased risk of heart disease.
In one of the largest studies to date, ZOE researchers have uncovered a link between menopause and our diets — and this could hold the key to reducing the severity of menopause symptoms.
In today’s short episode of ZOE Science & Nutrition, Jonathan and Sarah ask: What role does diet play during menopause?
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If you want to uncover the right foods for your body, head to joinzoe.com/podcast and get 10% off your personalized nutrition program.
Sources referenced in today's episode:
Menopause from Nature Reviews Disease Primers.
What is menopause? from the National Institute on Aging.
This podcast was produced by Fascinate Productions.
[00:00:00] Jonathan Wolf: Hello and welcome to ZOE Shorts, the bite-sized podcast where we discuss one topic around science and nutrition. I'm Jonathan Wolf, and as usual, I'm joined by Dr. Sarah Berry. And today's subject is the menopause.
[00:00:23] Sarah Berry: So Jonathan, the menopause affects more than half the world's population, as you can imagine, and often with really severe symptoms like night sweats, bone loss, and even heart problems, and yet so many women just suffer through it.
[00:00:37] Jonathan Wolf: So is there anything that can be done about menopause symptoms?
[00:00:40] Sarah Berry: Well, at ZOE, we've been running the world's largest survey on nutrition and menopause and symptoms, and we've made some really interesting discoveries in this area.
[00:00:50] Jonathan Wolf: So don't leave me hanging. Let's hear all about them.
[00:00:58] Sarah Berry: So menopause is a really big deal because it has such a huge impact on most women. It impacts our health, impacts our disease risk, and importantly, it impacts how we feel. And yet, despite the fact that we know we'll all go through it, we still don't know enough about it. Now, if there was another kind of illness that made us feel this rubbish, I think lots more would be done about it, and lots more research would be done in that area.
[00:01:22] Jonathan Wolf: Think on that point, you know, the thing that's struck me as a man is that it's not discussed. There's just this air of secrecy around menopause.
[00:01:31] Sarah Berry: Yeah. There's so much stigma and I think this also means that there's so much misinformation out there about the menopause, and I think you are right. It's because in part we just don't talk about it, but also it's because there's still so much we don't know about it as well.
[00:01:47] Jonathan Wolf: And so maybe just to start with like what exactly is the menopause, Sarah?
[00:01:51] Sarah Berry: So technically speaking, the menopause is the 12 months after a woman's last period. So it's when the menstrual cycle stops, hence why the terms meno and pause.
And it's when our levels of estrogen fall and the years leading up to that where women have changes in their period and other symptoms. It's what we call the menopause transition, also known as perimenopause.
[00:02:13] Jonathan Wolf: We did some research and today in the US that transition usually starts between 45 and 55.
The average age of the menopause is 51, and the menopause transition can last about seven years, but up to 14 years for some, and that's similar really across the rest of the west. And that duration depends on factors that include smoking and race and ethnicity.
[00:02:37] Sarah Berry: So the term has coined Jonathan in 1821, but despite us talking about it since then, it's been massively understudied throughout history.
And this is the case for actually all women's health. Really in general. We don't still actually understand why we've evolved to go through the menopause. We also don't fully understand what happens to our ovaries when they begin to fail, and our hormone levels start to fluctuate. We don't even really know why about a quarter of women have almost no symptoms while others have problematic and burdensome symptoms.
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[00:03:11] Jonathan Wolf: And Sarah, is it these symptoms that make menopause a real burden for so many women?
[00:03:16] Sarah Berry: So its symptoms, but also our increased risk of certain diseases. So the menopause is a huge time of physical and mental upheaval for most women. And it's really important though, Jonathan, to remember that every woman's body responds differently to changes in estrogen levels during the menopause transition.
So not everyone will experience the same symptoms, and not everyone will experience the same health effects or disease risks during this phase as well. The most common symptoms can include sleep disturbances, hot flashes, vaginal dryness, muscle loss, anxiety, and even bone loss. And some women gain weight a lot more easily as well during the perimenopause and also postmenopausally.
[00:03:56] Jonathan Wolf: I'm always struck when you list it, just like how bad the symptoms are, how many of them there are. And then you know, we were talking before about how little this is discussed. So through our ZOE Health study, we're able to measure the symptoms from more than 25,000 people going through the menopause.
And this is one of the biggest studies in the world. And I found the results shocking because here you sort of saw in black and white this data and it showed that 81% of people were experiencing disturbances in their sleep. 65% were feeling anxious, and 68% were having brain fog along with a whole host of other symptoms.
[00:04:36] Sarah Berry: Yeah, it's shocking, Jonathan. And in our survey, we found that only about 2% of the perimenopausal women that we studied had no symptoms. And the thing is, it's also not just about the symptoms, there's the risk of disease too, as well. So in another study that we did call the ZOE Predict Study, we found that menopause is a time not just of major upheaval in how we feel, but it's also a time of major metabolic upheaval, which can have long-term impacts on our health.
[00:05:07] Jonathan Wolf: And I know that in this study you analyzed data from more than a thousand ZOE participants, right? Who came into the hospital, and were very intensively studied. I think they were giving blood at 10-time points. They were having these body scans, these DEXA scans, and so on. So what did you find when you were able to do this really in-depth examination about the links between menopause and things like body composition and sleep and so on?
[00:05:32] Sarah Berry: So we found that menopause impacted so many different health measures. We found that there was a link between menopause and excess weight, particularly around our belly area. We found that people had a higher risk of heart disease postmenopausally. We found that menopausal women had worse sleep. They ate more sugary foods, they had worse blood sugar responses, higher levels of inflammation, higher blood pressure, and worse blood lipids. I mean, the list is endless nearly.
[00:06:01] Jonathan Wolf: And a lot of those things are risk factors, right? For sort of chronic conditions like type two diabetes and heart disease and obesity, which are amongst the biggest killers of us today.
[00:06:11] Sarah Berry: Yeah, that's correct. But I think it's important to say, Jonathan, I don't think it's all doom and gloom for women.
[00:06:17] Jonathan Wolf: So we always like a bit of positivity here too. So tell us a bit more Sarah.
[00:06:22] Sarah Berry: Among the findings from the ZOE Predict study, we found that the quality of diet that women consume, as well as the bacterial species that were present in women's guts, were partially responsible for modifying some of these unfavorable effects of menopause on health, such as fat around the body, particularly around the belly and inflammation.
[00:06:40] Jonathan Wolf: So that sounds quite exciting. Does that mean that women may be able to counteract some of these symptoms of the menopause rather than just saying, Hey, this is gonna happen and there's nothing you can do about it?
[00:06:50] Sarah Berry: I think we need to do more research in this area before we can confidently say yes to this. But the current data I think looks promising and this is that changes could be lessened through diet and gut health alongside those that choose to take HRT, take HRT.
[00:07:05] Jonathan Wolf: And Sarah for people listening. What is hrt?
[00:07:08] Sarah Berry: So HRT is hormone replacement therapy. In addition to the research I just mentioned, Jonathan, in our ZOE Health study, we found that body weight had a significant impact on the likelihood of suffering from menopausal symptoms.
For example, mood changes were found in about 60% of people with a healthy weight, but about 70% of women suffered from mood changes when they had severe obesity. So we also saw quite a big difference in the likelihood of hot flushes between women of a healthy weight. Which were about 54% and those with severe obesity, about 66% of them had these hot flushers.
[00:07:47] Jonathan Wolf: And what about links between diet and menopause symptoms? Is there any evidence that diet can reduce some of these symptoms?
[00:07:55] Sarah Berry: Yeah, so you are lucky today, Jonathan. Cause we've just finished analyzing some new data that we've collected in the ZOE Health Studies looking at the relationship between diet and between the likelihood of suffering different symptoms. And what we found is that those who consume a high-quality diet were much less likely to suffer from many symptoms, and this is even if they're already overweight. And so what we found is that hot flushes and sleep disturbances. Which are considered by many women to be the kind of the most debilitating symptoms were 30% less likely to be reported by women who ate a gut-friendly diet with plenty of healthy plants in their diet. And this was irrespective, like I said, of their weight.
[00:08:36] Jonathan Wolf: Well, that's good news. What do you recommend sort of specifically for people who might be listening to this and saying, Okay, what can I change today?
[00:08:43] Sarah Berry: So I think this evidence shows that diet and lifestyle changes have the potential to make a noticeable difference in how you feel around the menopause. So I think firstly, what you eat could reduce some of the undesirable health impacts of menopause, either directly by reducing the inflammation that I talked about or these blood sugar spikes, or even indirectly by altering the composition of our gut microbiome.
[00:09:06] Jonathan Wolf: And so what about hormone replacement therapy, which you just touched on earlier? Is that risky?
[00:09:13] Sarah Berry: Yeah, I think that's a really important question, Jonathan, because there was a lot of noise over the past few decades with studies highlighting the possible risk of heart. But I think that recent evidence clearly shows that the risks are tiny, and for most people outweighed by the benefits, especially if women have estrogen, only HRT and HRT can relieve most menopause symptoms.
And our research has shown that it was also associated with lower levels of risk factors as well as reduced symptoms. So lower levels of risk factors for chronic diseases, such as lower blood pressure, lower blood lipids, and reduced body fat.
[00:10:01] Jonathan Wolf: Sort of summarizing what I hear from all of this, Sarah, it sounds like there are options for women suffering from the difficult effects coming from menopause.
[00:10:08] Sarah Berry: Yeah. I think the future's more promising, and I think it's exciting for me as a researcher in this area with the kind of studies that we are doing at ZOE.
There are still many unknowns and especially how disease risk and menopause symptoms are related to diet and nutrition. But I think given how our research shows links between metabolic changes and menopause, I think it highlights the place for diet in reducing some of these symptoms, but also highlights how diet can also attenuate some of this increased risk we have also when we are postmenopausal.
[00:10:41] Jonathan Wolf: Just wanted to come back to something talked about at the beginning about how this is not talked about. So I'm struck that until I got involved in ZOE five and a half years ago, this wasn't something that I thought about at all. My mother never mentioned it once, and I discussed this with her more recently when we did all this research and she said, 'my symptoms were not very significant, so I didn't find it that hard.
This might be true, but also I know my mother is someone who doesn't make a fuss. So to be honest, I'm not sure really whether she might not rate quite similarly to what we're seeing here. So, why is this, and do you think it's important that this is gonna change if we're going to make progress against all of these symptoms?
[00:11:20] Sarah Berry: So I think there's a couple of issues here. I think one is I hope that with all the awareness there is now around menopause in the last year or so, people will talk about it and that it won't be a taboo subject. I also really hope that in general there'll be more investment in research on women's health and I don't just mean around menopause. I mean generally in women's health. I've worked in nutritional research for 25 years. I've run more than 30 randomized control trials. So clinical trials. Only two of them. One of which is our 'predict research' have involved men and that's shocking as a female researcher.
And it's simply because it's so challenging to study and research women because we have to factor in menopause menstrual cycle.
[00:12:04] Jonathan Wolf: So you're saying that apart from two of them, they were only on men? Is that what you're saying? Sarah?
[00:12:10] Sarah Berry: My previous research has only been on men because I would have to recruit, double or triple the number of participants in my studies if I wanted, to study women.
Cause I would have to think of factors such as, are they pre-post or perimenopausal? Where are they in their menstrual cycle? And at a time when research funding is so difficult. We do everything we can to reduce the amount of money we're asking for. So we have greater success in getting research income. So I'm guilty of being one of those people that haven't studied women enough, and I hope with this growing awareness things will change and grant bodies will start to, which I think they're beginning to put more of a focus on women's health research, including the menopause.
[00:12:51] Jonathan Wolf: And finishing off on this topic of menopause, I think you are now running some really exciting studies looking at the impact of following your own ZOE personalized program and seeing whether it is going to have an impact on these menopause symptoms. Cause I think what you've been looking at so far is all these associations as opposed to saying, 'Well, what happens if we change the diet for somebody'?
Can we improve their symptoms, where are we on that?
[00:13:14] Sarah Berry: Yeah, so that's a really important next step to be able to show that there's this causal link to show that if we change the diet, we do see a change in symptoms. And this is what we're doing with our ZOE program. So we are looking at symptoms before people start the ZOE program, and then we're looking at symptoms and the severity of the symptoms after they've completed the program.
And what we can do is we can look overall at how the ZOE program helps them with symptoms. But also from a research perspective, what's interesting is we can look at what components of people's diet are helping specifically with their severity and the type of symptoms they're suffering.
So we should have results from this in the next year, which I'm excited to be able to delve into hopefully in the future with you, Jonathan.
[00:14:02] Jonathan Wolf: Brilliant. Well, if you'd like to understand more about how to eat the right foods for your body and potentially help with menopause symptoms based on the latest data, you can find out more about ZOE's personalized nutrition program and get 10% off by going to joinzoe.com/podcast.
I'm Jonathan Wolf.
[00:14:18] Sarah Berry: And I'm Sarah Berry.
[00:14:20] Jonathan Wolf: Join us next week for another ZOE podcast.