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New research reveals nearly half of women are worried their diet won’t support them through menopause.

https://www.hsis.org/supplement-research/menopause-nutrition-challenges-and-opportunities/

Menopause Nutrition Challenges and Opportunities

Almost half of women are worried their diets aren’t meeting their nutritional needs around the menopause. That’s according to a new research report[1] just about to be published by the Health & Food Supplements Information Service (HSIS; www.hsis.org) - Menopause Nutrition: Challenges And Opportunities. Packed with the very latest real-world research, the new HSIS report also found that too few women are taking the simple step of bridging the nutritional gaps with a dietary supplement.

HSIS expert panel member and dietitian Dr Carrie Ruxton says: “Around the menopause, women’s nutrient intakes need to adapt to support their changing health status. It’s more important than ever to have plenty of bone-strengthening vitamin D and calcium, for instance, as well as heart-healthy omega-3 fats and B-vitamins, which also support cognition and mood. But too many are simply unaware.”

This new HSIS report - Menopause Nutrition: Challenges And Opportunities - shows that seven in 10 women (71%) realize a healthy diet can help ease menopause symptoms. But this awareness is not backed up with action as almost half (49%) are concerned their diets may not provide the nutritional support they need during the menopause. Those in perimenopause and menopause – who are most likely to be experiencing symptoms – are understandably most likely to be worried. Two thirds of them felt this way (66%).

Menopause used to be a word that most people – even women – avoided. Thankfully we’re moving away from whispering about “the change” in hushed tones and more people are having open conversations about a natural part of the ageing process for half the world’s population.

However, we still have some way to go when it comes to raising awareness of women’s health and wellbeing needs around this time. Data from the National Diet and Nutrition Survey shows that the risk is a reality for many. For example, among women aged 19 to 64 years:

• Almost one in ten (9%) don’t get enough calcium in the diet;
• 15% are clinically deficient in vitamin D – vital for bone health and immunity;
• A quarter (24%) don’t achieve the target for potassium — a key nutrient for blood pressure control. 

More worryingly, the new HSIS research[2] reveals that one in five women (20%) are doing nothing to plug these nutrient gaps. Various reasons include simply not thinking about it (27%), believing they don’t need a supplement (23%) or expecting to get all the nutrients they need from the diet (22%).

The HSIS report also highlights the dire consequences this level of complacency can have on key areas of women’s health as they age.

1. Increased need for calcium and vitamin D for bone health: Calcium and vitamin D become increasingly important to slow the bone loss that typically occurs in the perimenopausal years. This is due to falling oestrogen levels, but vitamin D uptake is also dependent on vitamin K.[3]
   GP, Dr Nisa Aslam says, “We actually absorb less than half the calcium in the food we ingest, and without sufficient vitamin D, this plunges to 10 to 15%.[4] The effect is compounded by the lack of oestrogen seen during menopause since oestrogen boosts calcium uptake. So, our ability to absorb calcium falls just when we need it most.”[5]
2. Reduced nutrient absorption: Nutrient absorption in the gut becomes less efficient, and this inhibits uptake of a wide range of vitamins, minerals, the amino acids which make up proteins, and lipids, including cardio-kind omega-3 fatty acids.[6]
   Dr Nisa Aslam says, “Malabsorption increases the risk of shortfalls of B vitamins, particularly B2, B6 and B12, and this may contribute to the increased risk of cardiovascular disease and dementia seen in studies of menopausal women.”[7]
3. Falling oestrogen impairs lipid metabolism:
   Falling oestrogen impairs lipid metabolism which causes a surge in levels of unhealthy LDL cholesterol[8] and is also thought to be one of a number of mechanisms driving the increased risk of heart disease and type 2 diabetes associated with menopause.
   HSIS nutritionist, Dr Pamela Mason notes, “One study found there was also a significant increase in the proportion of LDL cholesterol particles that were very small and high-density — the most dangerous type — with this rising from 10-13% in premenopausal women to 30-49% after menopause.[9]
   “This underlines the importance of a diet rich in antioxidant vitamins and polyphenols and heart-healthy omega-3 fats.”[10]
4. Gut microbiome imbalance: During ageing, the gut microbiome becomes less balanced, with fewer 'friendly' bacteria and more species that promote inflammation. This escalates with falling oestrogen.[11]   HSIS Dietitian, Dr Carrie Ruxton says, “The gut is the engine-room of nutrient absorption and we know that the microbiome – our unique community of bacteria living in the gut – influences the metabolism of a number of vitamins and minerals. Having a less balanced gut microbiome has also been linked with greater risk of obesity, type 2 diabetes and neurological problems in older adulthood.[12]
   “Beneficial gut bacteria also play an important part in the production of body chemicals including serotonin, dopamine and tryptamine which help regulate mood and sleep. There is huge potential around the use of prebiotics and probiotics to rebalance gut bacteria and there is already evidence that probiotic supplements can ease some menopause symptoms.”[13]
5. Increasing prescription medicine use disrupts nutrient uptake: The use of prescription medicines increases in the perimenopausal period, and many disrupt nutrient uptakes.[14] Drugs which are known to impact nutrient status include metformin, commonly prescribed for type 2 diabetes; proton-pump inhibitors which reduce stomach acidity and are often used to protect against other medications such as non-steroidal anti-inflammatory drugs (NSAIDs); and diuretics used to treat heart failure.[15]
6. Spiking inflammation increases antioxidant needs: Ageing is associated with chronic inflammation, and there is emerging evidence that this spikes during perimenopause.[16, 17] HSIS women’s health specialist, Dr Catherine Hood details that, “Oestrogens are important for regulating immunity and inflammation, but the protection they provide ebbs away with menopause.
   “This increases the need for antioxidants such as vitamins A and E and anti-inflammatory omega-3fatty acids.”[18,19]
7. Lower oestrogen increases choline needs: HSIS nutritionist, Dr Emma Derbyshire adds, “Lower oestrogen in the blood increases the need for choline, a nutrient which the body converts into the messenger chemical acetylcholine. This is important for memory, mood, muscle control, and other brain and nervous system functions.
   “Studies confirm that post-menopausal women need higher intakes of choline and shortfalls of this nutrient increase the risk of non-alcoholic fatty liver.”[20]

Last Word

Menopause increases the risk of many serious conditions which are impacted by diet and metabolism, including some of the UK’s biggest lady killers and life-limiting conditions such as heart disease, stroke, dementia, and osteoporosis. 

Dr Catherine Hood adds: "Given the importance of vitamin D for bone health and disease prevention, every woman who is perimenopause, or has gone through menopause, would be wise to take supplementary vitamin D, particularly during winter but there is no reason not to, and indeed it would be practical common sense to, take vitamin D all year round".

Omega-3 protects against heart disease, which becomes more of a risk as oestrogen declines, and it damps down inflammation, which is now known to be a factor in multiple health problems. [21]  

Dr Carrie Ruxton adds: “Since not everyone enjoys eating oily fish, taking an omega-3 supplement, or a multivitamin and multimineral which includes this important fatty acid, is a sensible step – particularly for women who are postmenopausal or currently struggling with menopause symptoms.”

Further Information

For more information see www.hsis.org

References

1. Menopause Nutrition: Challenges And Opportunities; Edition 1; ahead of print Summer 2023; GP - Dr Nisa Aslam; dietitian – Dr Carrie Ruxton; nutritionists – Dr Emma Derbyshire and Dr Pamela Mason; women’s health specialist, Dr Catherine Hood
2. A Perspectus Global omnibus survey of 1,526 women aged 18 to 60 years: Summer 2023
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613455/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669834/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117023/
6. https://pubmed.ncbi.nlm.nih.gov/11977925/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372850/
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019719/
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019719/
10. https://www.mdpi.com/2072-6643/14/13/2649
11. https://www.nature.com/articles/s41575-022-00605-x
12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379122/
13. https://pubmed.ncbi.nlm.nih.gov/34109594/
14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109862/
15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5874849/
16. https://www.southampton.ac.uk/news/2018/01/inflammation-old-age.page
17. https://jneuroinflammation.biomedcentral.com/articles/10.1186/s12974-020-01998-9
18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8308420/
19. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00277-7/fulltext
20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2954445/
21. https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/fats-and-cholesterol/types-of-fat/omega-3-fats/