Download What is the menopause?

ESPEN Congress Cannes
2003
Organised by the Israel Society for Clinical
Nutrition
Education and Clinical Practice Programme
Session: Dietitian Symposium: Nutrition throughout the woman life cycle
Nutrition and the Menopause
Ms. Gaynor Bussell
St. Albans, United Kingdom
email
[email protected]
What is the menopause?
Menopause is the name given to the
time when women’s ovaries slowly
stop working. This leads to a fall in
levels of the oestrogen and is
thought to be related to a variety of
symptoms such as hot flushes,
irritability and joint pains.
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Why is diet important during the
menopause
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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 the
Menopause (cont..)
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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 a
mixture of all the nutrients you need
Don’t forget to take an interest in food
and 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 less
food 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 have
to equal central adiposity?
No!
• Physical activity alone can offset central
weight gain as measured by waist
circumference
• Maintaining a normal weight will help
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Physical activity: the 3 S’s
Stamina: an extra 2000 steps a day will burn
up 100 calories which is responsible for
creeping obesity. Buy a pedometer!
Suppleness: if you don’t use it you loose ittry Yoga, Pilates, Stretching
Strength: pump it up with those baked bean
cans
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’and
include rapeseed oil (canola), olive oil,
avocado oil, linseed oil, hempseed oil (these
are also good vegeterian sources of omega 3
oils)
• Avoid trans fats
4.Fruit and Vegetables
It is recommended to eat at least 5 portions of
fruit and vegetables daily. Fruit and
vegetable intake is associated with increase
BMD, increase antioxidant levels and
provides the mood regulating mineral,
magnesium, which is often low in
menopausal women.
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What is osteoporosis?
“It is a progressive systemic skeletal disease
characterised by low bone mass and microarchitectural deterioration of skeletal tissue. It
results in bone fragility and an increased
susceptibility to fracture.
It is a silent disease, such that the deterioration
of skeletal tissue occurs with no outward sign
until fracture occurs”
Diet for osteoporosis
• A balance of nutrients is important,
including fruit and vegetables.
• Have a diet rich in calcium with enough
vitamin D to help you absorb the
calcium. Calcium is found in dairy
foods, tofu, green vegetables, beans
and 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 if
there is osteoporosis (UK NOS)
• May be best taken with Zn, Cu, Mn, Mg and vitamin
D
• A soluble form of calcium is best
• Do not exceed 2000mg calcium from diet and
supplement
Other factors affecting bone health
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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 provide
some vitamin D and essential fatty acids that help
protect the heart.
• Vitamin D is found also in eggs, butter and margarine
and fortified breakfast cereals.
• 10-15 mins sun on face and forearms during summer
months is also recommended
• In the UK, people over 60 are recommended to take
a 10 mcg supplement daily.
Benefits of fish oil
• Reduces CVD risk, especially beneficial for reducing
subsequent heart attack after first, and in Type 11
diabetes.
• 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% of
calories as carbohydrate, with as much as
possible coming from unrefined sources.
• A starchy and fibre rich carbohydrate should
be eaten at each meal. This will help keep
bowels healthy, will provide a long lasting
supply of energy and may help reduce
cholesterol levels.
8. Alcohol!
Excess alcohol is associated with:.
• hot flushes
• osteoporosis
• weight gain.
• Cancer, especially of the breast
Moderate drinking seems to be cardioprotective
after the menopause.
© ESPEN 2003. For personal use.
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Caffeine
Excess 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!
• Salt can lead to high blood pressure.
• Salt may cause hypercalciurea, thus
predisposing to osteoporosis.
• A high salt diet may also exacerbate bloating
and fluid retention.
To cut down:
Reduce the amount of processed foods you eat
and don’t add salt to your food (use more
herbs and spices).
© ESPEN 2003. For personal use.
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10. Phytoestrogens
Shown 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
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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 soya
milk, 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, Agnus
Castus, Don quoi, Wild yam, St john’s wort, Hops,
Ginseng: May have a role, but watch safety and seek
medical advice if on other medication.
• Isoflavone supplements e.g. Red clover: Not as
effective as dietary sources
• Other supplements e.g. vitamin E, EPO, vitamin B6:
may be helpful for symptoms such as breast
tenderness and bloating.
• Healthy lifestyle- raises the threshold above which
symptoms appear
© ESPEN 2003. For personal use.
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THE MENOPAUSE EXCHANGE
Tel: 020 8420 7245 Fax: 020 8954 2783
E.mail:[email protected]
References
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• 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
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