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NUTRITION AND MENOPAUSE

What is menopause?

Menopause is a natural event that occurs in every woman. It starts at different times in every woman; however usually in women who are past the age of 40. It occurs when ovaries produce fewer sex hormones, estrogen and progesterone.

Estrogen is responsible for keeping your breasts, bones, skin and brain healthy.
Progesterone balances the amount of estrogen in the body. It is responsible for preparing the body for pregnancy.

The signs and symptoms associated with the beginning of menopause occur over a period of time. This is called perimenopause. You are considered to have reached menopause when 12 months have passed since your last period. This is called postmenopause.

What are the symptoms of menopause?

These can range from PMS-like symptoms including mood swings, fluid retention, headaches, hot flashes, vaginal dryness, and forgetfulness.
It is at this stage of life that women are at an increased risk for developing heart disease, osteoporosis, and breast cancer increases.

Hormone Replacement Therapy (HRT): Yes or No?

Over the past two decades researchers have found that women on HRT (combination of estrogen and progesterone) had a lower risk of bone loss and heart disease. On the other hand however, they also found that women on HRT for more than five years are at an increased risk for breast cancer. Before 1998 HRT was considered the “gold standard” for treating heart disease and osteoporosis in peri- and postmenopausal women. However, in view of the recent evidence concerning breast cancer, HRT is not the first prevention therapy given to patients.

Risks and Benefits of HRT:

Increases the risk of: Decreases the risk of:
Coronary Heart Disease Colon Cancer
Blood clots Dementia
Breast Cancer Depression
Gallbladder disease Osteoporosis
Stroke Urinary tract infection
  Relieves menopausal symptoms


HRT Recommendations:

Today, HRT is prescribed by doctors to treat menopausal symptoms such as hot flashes, night sweats, and mood swings It is prescribed only for the shortest duration possible (anywhere between 6 months and five years) and only to women who do not have a history of breast cancer, heart disease, blood clots, or stroke. It is important to discuss with your doctor whether HRT is right for you

Natural Hormone Replacement Therapy:

The correct term is actually “bio-identical hormone replacement therapy”. Bio-identical hormones have the identical chemical structure as the ones that are produced in your body. Because these hormones match those hormones in our bodies, there is less chance for the side-effects that are associated with HRT. Bio-identical hormones can arise form plant sources (soy, wild yams) and animals (pigs, horses), or can be produced synthetically. It is important to discuss with your doctor whether Natural Hormone Replacement Therapy is right for you.

Dietary approaches to managing and treating your menopause symptoms:

SOY FOODS:

Soy contain compounds called Isoflavones, they have a similar chemical structure to estrogen (they are called phytoestrogens). Soy products are said to have a mild effect on minimizing symptoms of menopause including: hot flashes, and night sweats. Soy products are also said to have a bone preserving effect decreasing the risk of osteoporosis. Furthermore, they are said to play a role in reducing the risk of breast cancer. Soy products are now proven to have cholesterol lowering properties, reducing the risk of heart disease.

FDA determined that diets with four daily soy servings, making up a total of 25g of soy protein per day, can reduce levels of low-density lipoproteins (LDL’s), the so-called "bad cholesterol" that builds up in blood vessels, by as much as 10 percent. This health claim only refers to the soy protein.

To qualify for this health claim soy products must have per serving:

  • 6.25 grams of soy protein
  • low fat (less than 3 grams)
  • low saturated fat (less than 1 gram)
  • low cholesterol (less than 20 milligrams)
  • sodium value of less than 480 milligrams for individual foods, less than 720 milligrams if considered a main dish, and less than 960 milligrams if considered a meal

Types of soy foods:

- 4 ounces (120g) of firm tofu contains 13 grams of soy protein.
- 1 soy "sausage" link provides 6 grams of protein.
- 1 soy "burger" includes 10 to 12 grams of protein.
- An 8-ounce glass of plain soymilk contains 10 grams of protein.
- 1 soy protein bar delivers 14 grams of protein.
- ½ cup of tempeh provides 19.5 grams of protein.
- ¼ cup of roasted soy nuts contains 19 grams of soy protein

Despite the fact that soy has been said to help with menopausal symptoms, recent research has found that soy actually does not have any benefits on menopausal symptoms. An area of concern has been whether phytoestrogens carry the same risks as prescription drug hormone replacement therapy (HRT), which contains estrogens, such as increased risk of hormone-sensitive cancers (breast, ovarian, uterine) or blood clots. Studies have suggested that women, who have a history of breast cancer, not take soy as a way to relieve their menopausal symptoms.

CALCIUM

Bone density accumulates during childhood and reaches a peak bone mass by around age 25. Bone density is then maintained for about ten years. After age 35, both men and women will normally lose 0.3 to 0.5% of their bone density per year as part of the aging process. Thus, increasing the risk for osteoporosis, and as a result, increasing the risk for bone fractures.

How can you prevent osteoporosis? Exercise, stopping smoking, and adequate calcium. Calcium is the most abundant mineral in the body, and 99% of it is housed in the bone and teeth.

How much calcium is needed?
19 – 50yrs: 1000mg/d of Calcium
50 – 70yrs: 1200mg/d of Calcium
> 70yrs: 1500mg/d of Calcium

Calcium-rich foods:
- 1 cup milk (300mg of calcium)
- 45g cheddar cheese (300mg of calcium)
- 45g swiss cheese (480mg of calcium)
- ¾ cup fruit yogurt (300mg of calcium)
- 1 cup cooked broccoli (94mg of calcium)
- 1 medium orange (50mg of calcium)
- ¼ cup almonds (100mg of calcium)
- 1 cup cooked black beans (102mg of calcium)

How can I boost calcium absorption?
- Take iron-rich foods with calcium-rich foods
- Taking Vitamin D together with calcium boosts absorption
- Large amounts of oxalates (a type of fiber found in wheat bran and other grains can limit absorption

Should I take calcium supplements?
If you find it difficult to get this much calcium in your diet because you cannot eat dairy products then calcium supplements might be a good idea. Look for calcium and vitamin D supplements in a single dose.

The calcium supplements are best taken in small divided doses with meals. The intestines may not be able to reliably absorb more than 500 mg of calcium all at once. Therefore, the best way to take 1000 mg of a calcium supplement is to divide it in two doses. Likewise, a dosage of 1500 mg should be divided into three doses.

VITAMIN D

An adequate calcium intake and adequate body stores of vitamin D are important foundations for maintaining bone density and strength. Vitamin D comes from the diet and skin (it is produced when the skin is exposed to sunlight.

Vitamin D, along with adequate calcium (1200 mg of elemental calcium), has been shown in some studies to increase bone density and decrease fractures in postmenopausal, but not in pre-menopausal women.

How much Vitamin D is needed?
19 – 50yrs: 200IU (in the absence of sunlight)
50 – 70yrs: 400IU
> 70yrs: 500IU

For young adults, two glasses of milk/day or a supplement is a simple way to meet this need. Older adults (those over the age of 50) may require a supplement to meet their needs. Most vitamin supplements provide 400 I.U. of vitamin D, which, when combined with a healthy diet, should provide sufficient vitamin D even to those aged 71 and above, who have the highest needs.

OMEGA-3 FATTY ACIDS – FLAXSEED

After menopause a woman’s risk for developing heart disease increases, due to the loss of estrogen. The risk of heart disease continues to rise with age. In addition to watching your diet – that is having a diet low-in fat, high in fiber, fruits and vegetables, it is now recommended that you also have a diet that is high in omega-3 fatty acids. One of the richest sources of omega-3 fatty acids are flaxseeds.

Omega-3 fatty acids are said to reduce blood triglycerides, lower blood pressure, raise HDL levels, (the good cholesterol) and lower LDL levels (the bad cholesterol), therefore, lowering the overall risk of heart disease.

Other sources of omega-3 fatty acids, in addition to flaxseeds are: omega-3 enriched eggs, canola oil, soybean oil, fatty fish (salmon, anchovies, sardines, mackerel, herring, rainbow trout, and albacore tuna)

Flaxseeds, in addition to being the main source of omega-3 fatty acids, they are also one of the richest sources of lignans. Lignans are a type of phytoestrogen. Lignans can be found in a variety of unrefined grains such as barley, buckwheat and oats. They are also found in legumes such as soybeans, and in some vegetable products, especially in broccoli, carrots and spinach. The richest source of lignans however is flaxseeds (not flaxseed oil as most of the lignans are destroyed in the processing).

Lignans are said to have anti-cancer properties. This statement however has been suggested but has not been concluded. Studies of lignans and breast cancer are currently underway.

How much flax should I take?

We should all aim to have at least one serving of omega-3 fatty acids in our diet per day. One serving of flaxseed is 15ml of ground flaxseed. Other sources of omega-3 fatty acids are:

Omega-3 Fatty Acid Content of Specific Foods

EPA & DHA per 100 grams ALA= Alpha Linolenic Content of Specific Food
Sardines 3.3 g 100 g (3 ½ oz) fresh soy beans 3.2 g
Mackerel 2.5 g 1 tablespoon ground flaxseed 1.9 g
Herring 1.7 g 1 tablespoon of canola oil 1.3 g
Lake Trout 1.6 g 1 tablespoon olive oil 0.8 g
Salmon, wild Atlantic 1.5 g 1 tablespoon walnut oil 1.7 g
Tuna, albacore 1.5 g ¼ cup walnuts 1.3 g
Salmon, sockeye 1.2 g ½ cup firm tofu 0.7 g
1 omega-3 egg 0.3 g 2 tablespoons pecans 0.3 g

B-VITAMINS (FOLATE, B-6 AND B-12)

Three B vitamins are essential in helping to prevent the progression of heart disease. The way that they do this is by controlling a compound homocysteine in our blood. High levels accumulating in the blood are said to damage blood vessel walls, promoting the build-up of cholesterol.
Homocysteine is produced naturally in our bodies, but the B vitamins help to convert it to other harmless products. As we get older the ability to of our bodies to convert homocysteine to harmless products is hindered.

Folate is also thought to help prevent certain cancers, such as lung, breast, cervix, rectum and colon cancers.

How much of folate, B-6 and B-12 do I need?


0.4mg Spinach (1/2 cup = 0.13mg)orange juice (1 cup = 0.11mg) lentils (1 cup = 0.357mg)wheat germ(1/4 cup = 0.10mg) broccoli (1 cup = 0.06mg)
Vitamin B-6 1.3 – 1.5mg Whole grains (1 slice ww bread = 0.05mg), Bananas (1 small = 0.578mg)potatoes (1 small = 0.695mg)legumes (1 cup navy beans = 0.272mg) Fish (1 fillet = 0.460mg)Meat ( 90g = 0.27mg)Poultry (100g = 0.55mg)Fortified soy beverage (1 cup = 0.1mg)
Vitamin B-12 2.4 mcg (0.0024mg) Meat (90g = 0.005mg)Poultry(100g = 0.004mg)Fish (1 fillet = 0.0015mg) fortified soy beverage (1 cup = 0.001mg)eggs (1 egg = 0.0005mg)

B vitamin Recommended dietary allowance Best food sources
Folate 0.4 g Spinach (1/2 cup = 0.13mg)orange juice (1 cup = 0.11mg) lentils (1 cup = 0.357mg)wheat germ(1/4 cup = 0.10mg) broccoli (1 cup = 0.06mg)
Vitamin B-6 1.3 – 1.5mg Whole grains (1 slice ww bread = 0.05mg), Bananas (1 small = 0.578mg)potatoes (1 small = 0.695mg)legumes (1 cup navy beans = 0.272mg) Fish (1 fillet = 0.460mg)Meat ( 90g = 0.27mg)Poultry (100g = 0.55mg)Fortified soy beverage (1 cup = 0.1mg)
Lake Trout 1.6 g Meat (90g = 0.005mg)Poultry(100g = 0.004mg)Fish (1 fillet = 0.0015mg) fortified soy beverage (1 cup = 0.001mg)eggs (1 egg = 0.0005mg)

 

Should I take Vitamin B supplements?

If you have difficulty having a varied diet, a vitamin B supplement would be beneficial, especially if you are a vegetarian. Women over the age of 50 should be taking a Vitamin B-12 supplement.
Most good-quality supplements will provide you with 100% of your requirements for the B vitamins.
If you are taking a folate supplement, make sure it is in combination with vitamin B-12
If you do take a multi-vitamin, you can increase the absorption by taking it with food.