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ESPEN Congress Cannes2003

Organised by the Israel Society for ClinicalNutrition

Session: Dietitian Symposium: Nutrition throughout the woman life cycle

Nutrition and the Menopause

Ms. Gaynor BussellSt. Albans, United Kingdom

email gaynor@gaynorbussell.co.uk

Education and Clinical Practice Programme

What is the menopause?What is the menopause?

Menopause is the name given to thetime when women’s ovaries slowlystop working. This leads to a fall inlevels of the oestrogen and isthought to be related to a variety ofsymptoms such as hot flushes,irritability and joint pains.

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Why is diet important during themenopause

• Osteoporosis• Heart disease and blood pressure• Weight gain• Menopausal symptoms• Certain cancers

Top 10 tips for menopause

1 Have a varied, balanced diet and keep an interest and enjoyment in eating.

2 Eat the right amount for you

3 Watch fats

4 Include fruit, veg and wholegrains

5 Have enough calcium and vitamin D

6 Eat some oily fish

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Top Ten Tips: Nutrition for theMenopause (cont..)

• 7 Eat plenty of starchy foods

• 8 Watch alcohol and caffeine

• 9 Watch salt

• 10 Feel free to try alternatives such as soya

Eat a variety of foods;This will ensure your body gets amixture of all the nutrients you need

Don’t forget to take an interest in foodand enjoy your food.

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Weight issues

• A BMI of 25-26 is fine.

• Metabolic rate may be lower at middle age so lessfood is required than when younger.

• Some causes of extra weight:

– fall in metabolic rate

– less active

– creeping obesity

– HRT does not lead to weight gain per se

Does reaching the menopause haveto equal central adiposity?

No!No!

• Physical activity alone can offset centralweight gain as measured by waistcircumference

• Maintaining a normal weight will help

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Physical activity: the 3 S’s

Stamina: an extra 2000 steps a day will burnup 100 calories which is responsible forcreeping obesity. Buy a pedometer!

Suppleness: if you don’t use it you loose it-try Yoga, Pilates, Stretching

Strength: pump it up with those baked beancans

Fats!Benefits of reducing fat in the diet:

– improved lipid profile

– reduced incidence of heart disease

– weight loss

– possible reduced incidence of dementia

– reduced breast tenderness

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Types of fats• Benefits are seen with following the

Mediterranean diet- fruit and vegetables,olive oil, fish and some wine!

• Monosaturated fats are termed ‘good fats’andinclude rapeseed oil (canola), olive oil,avocado oil, linseed oil, hempseed oil (theseare also good vegeterian sources of omega 3oils)

• Avoid trans fats

4.Fruit and Vegetables4.Fruit and VegetablesIt is recommended to eat at least 5 portions offruit and vegetables daily. Fruit andvegetable intake is associated with increaseBMD, increase antioxidant levels andprovides the mood regulating mineral,magnesium, which is often low inmenopausal women.

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What is osteoporosis?What is osteoporosis?“It is a progressive systemic skeletal disease

characterised by low bone mass and micro-architectural deterioration of skeletal tissue. Itresults in bone fragility and an increasedsusceptibility to fracture.

It is a silent disease, such that the deteriorationof skeletal tissue occurs with no outward signuntil fracture occurs”

Diet for osteoporosis

• A balance of nutrients is important,including fruit and vegetables.

• Have a diet rich in calcium with enoughvitamin D to help you absorb thecalcium. Calcium is found in dairyfoods, tofu, green vegetables, beansand fish that contain edible bones.

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Calcium supplements• Most benefit seen for calcium in late menopause and

in elderly.

• Seems little effect during peak of the menopause.

• 500mg supplement is sometimes recommended ifthere is osteoporosis (UK NOS)

• May be best taken with Zn, Cu, Mn, Mg and vitaminD

• A soluble form of calcium is best

• Do not exceed 2000mg calcium from diet andsupplement

Other factors affecting bone health

• Vitamin A• Coffee• Phytates• Protein• Salt• Alcohol

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Vitamin D and oily fish• UK recommendation is to eat 2 portions of fish a

week, one of them should be oily. This will providesome vitamin D and essential fatty acids that helpprotect the heart.

• Vitamin D is found also in eggs, butter and margarineand fortified breakfast cereals.

• 10-15 mins sun on face and forearms during summermonths is also recommended

• In the UK, people over 60 are recommended to takea 10 mcg supplement daily.

Benefits of fish oil• Reduces CVD risk, especially beneficial for reducing

subsequent heart attack after first, and in Type 11diabetes.

• Reduces heart fibrillation.• Reduces blood pressure.• Reduces triglyceride level.• Anti-coagulatory (will help prevent clotting).• Anti-inflammatory (especially beneficial to raise ratio

of omega 3 to omega 6).• May help to reduce symptoms of rheumatoid arthritis.• May help reduce risk of age-related macular

degeneration and dry eye syndrome.

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7.Eat more starch!• Dietary advice for maximum health benefits

include the recommendation to eat 50% ofcalories as carbohydrate, with as much aspossible coming from unrefined sources.

• A starchy and fibre rich carbohydrate shouldbe eaten at each meal. This will help keepbowels healthy, will provide a long lastingsupply of energy and may help reducecholesterol levels.

8. Alcohol!Excess alcohol is associated with:.

• hot flushes

• osteoporosis

• weight gain.

• Cancer, especially of the breast

Moderate drinking seems to be cardioprotectiveafter the menopause.

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CaffeineExcess caffeine during the menopause may

be associated with :

• sleep problems

• anxiety

• reduced bone density

• blood pressure

• Parkinson’s disease (taken with HRT)?

• breast tendernes

Black coffee seems to be the main concern

9. Salt!9. Salt!• Salt can lead to high blood pressure.

• Salt may cause hypercalciurea, thuspredisposing to osteoporosis.

• A high salt diet may also exacerbate bloatingand fluid retention.

To cut down:

Reduce the amount of processed foods you eatand don’t add salt to your food (use moreherbs and spices).

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10. PhytoestrogensShown Benefit:

• Some menopausal symptoms e.g. hot flushes

ß Prostrate cancer

ß Cholesterol lowering

Some evidence:

ß Bone health

ß PMS

ß Breast and endometrial cancer,

ß Cognitive function

ß Blood pressure

ß CVD in postmenopausal women

Isoflavone content

• Soya milk 10mg/100ml

• Soya yogurt 10mg/100ml

• TVP 33mg/100g

• Soya cheese 7mg/100g

• Tofu 27mg/100g

• Red clover supplement 40mg

40-60mg required /day for any effect

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Food Sources of phytoestrogen

• Soya and soya products such as soyamilk, tofu, soya yogurts

• Vegetables and fruit

• Seeds especially flax seeds(linseed).

• Nuts

• Peas, beans and lentils

Other alternatives to HRT• Menopause designer supplements: Expensive and

may not be the best.

• Herbals e.g. Black Cohosh, Chinese angelica, AgnusCastus, Don quoi, Wild yam, St john’s wort, Hops,Ginseng: May have a role, but watch safety and seekmedical advice if on other medication.

• Isoflavone supplements e.g. Red clover: Not aseffective as dietary sources

• Other supplements e.g. vitamin E, EPO, vitamin B6:may be helpful for symptoms such as breasttenderness and bloating.

• Healthy lifestyle- raises the threshold above whichsymptoms appear

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THE MENOPAUSE EXCHANGETel: 020 8420 7245 Fax: 020 8954 2783

E.mail:mexchange@btinternet.com

References

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99:445-452• Horn-Ross P et al. Regular phytoestrogen consumption reduces endometrial cancer risk. J Nat Cancer inst. Aug.

6 2003• Key T Obesity boosts cancer-causing hormones J. National Cancer Inst, August 19 2003

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• McTiernan A. Exercise ‘prevents breast cancer’ JAMA Sept. 10 2003• Moroney JT, Tang MX, Berglund L. Low–density lipoprotein cholesterol and the risk of dementia

with stroke. JAMA 1999; 282:254-260• North American Menopause Society. The role of isoflavones in menopausal health. Menopause

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• Scientific Advisory Committee on Nutrition (SACN) Draft report on salt. [cited 2002 November 4].Available from: URL: http://www.sacn.gov.uk

• Teede H et al. Soy protein with isoflavones has favourable effect on lipids in postmenopausalwomen. Clin Endocrinology 2003;58:704-709

• Teede H et. Al. Isoflavones reduce arterial stiffness in healthy men and women. ArteriosclerThronb Vasc Biol 2003; 23: 1066-1071

• Tice J Phytoestrogen supplements bot useful for menopause symptoms. JAMA 2003;290:207-214

• Washburn S, Burke GL, Morgan T, Anthony M. Effect of soy protein supplementation on serumlipoproteins, blood pressure and menopausal symptoms in perimenopausal women. Menopause1999; 6:7-13

• Whiteman MK. Smoking and Obesity Increase risks of severe Hot Flashes. Obstet Gynecol 2003;101:264-272

• Genistein has similar effects to oestrogen Am J Med. 2003 Apr 15;114 (6):470-6