Menopause: Does diet play a part?
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Hello, and welcome to Zoe Shorts, the Bite Size podcast, where we discuss one topic around science and nutrition. I'm Jonathan Wolfe, and as usual, I'm joined by Dr. Sarah Berry. And today's subject is the menopause.

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. So is there anything that can be done about menopause symptoms? 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. So don't leave me hanging. Let's hear all about them.

So menopause is a really big deal because it has such a huge impact on most women. It impacts our health, it impacts our disease risk and really 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 actually lots more would be done about it and lots more research would be done in that area.

And I think on that point, you know, the thing that's really struck me as a man is that it's not really discussed. There's just this air of secrecy around menopause. 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're right. It's because in part we just don't talk about it. But also it's because there's still so much we actually don't know about it as well.

And so maybe just to start with, what exactly is the menopause, Sarah? So technically speaking, the menopause is the 12-month period after a woman's last period. So it's when the menstrual cycle stops, hence why the term menopause. And it's when our levels of oestrogen fall. And the years leading up to that, where women have changes in their period and other symptoms, is what we call the menopause transition, or also known as the perimenopause.

And 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.

So the term was actually 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.

And 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 really problematic and burdensome symptoms.

And Sarah, is it these symptoms that make menopause a real burden for so many women? So it's 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 oestrogen 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.

So 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.

And I'm always struck, you know, when you list this, 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 actually 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, you know, I found the results really 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.

Yeah, it's shocking Jonathan and in our survey we actually 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.

And so in another study that we did called the Zoe Predicts 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 really long term impacts on our health.

And I know that in this study, you analyzed data from more than a thousand ZOE participants, right? Who came into hospital, who 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 like really in-depth examination about the links between menopause and things like body composition and sleep and so on? 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, worse blood lipids. I mean, the list is endless nearly.

And a lot of those things are risk factors, right? For sort of chronic conditions like type 2 diabetes and heart disease and obesity, which are amongst the biggest killers of us today. 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.

So we always like a bit of positivity here. So tell us a bit more, Sarah. In amongst 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 unfavourable effects of menopause on health, such as fat around the body, particularly around the belly and inflammation.

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 going to happen and there's nothing you can do about it? 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 really promising. And this is that changes could be lessened through diet and gut health alongside for those that choose to take HRT, take HRT. And Sarah, for people listening, what is HRT?

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 with menopausal symptoms. For example, mood changes were found in about 60% of people with a healthy weight, but actually about 70% of women suffered from mood changes when they had severe obesity.

And so we also saw quite a big difference in the likelihood of hot flushes between women of a healthy weight, which was about 54%, and those with severe obesity, about 66% of them had these hot flushes. And what about links between diet and menopause symptoms? Is there any evidence that diet can reduce some of these symptoms?

Yeah, so you're lucky today, Jonathan, because we've actually just finished analysing 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 consumer high quality diet were much less likely to suffer from any 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 as 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. Well, that's good news. What do you recommend sort of specifically for people who might be listening to this and saying, OK, what can I change, you know, today?

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 inflammation that I talked about or these blood sugar spikes, or even indirectly by altering the composition of our gut microbiome.

And so what about hormone replacement therapy, which you just touched on earlier? Is that risky? Yeah, I think that's a really important question, Jonathan, because there was a lot of noise over the past two decades with studies highlighting the possible risk of HRT.

But I think that recent evidence really clearly shows that the risks are tiny and for most people outweighed by the benefits, especially if women have oestrogen-only HRT. And HRT can relieve most menopause symptoms. And our research has showed that it was also associated with lower levels of risk factors as well as reducing symptoms. So lower levels of risk factors for chronic disease, such as lower blood pressure, lower blood lipids and reduced body fat.

Sort of summarizing what I hear from all of this, Sarah, it sounds like there really are options for women suffering from the difficult effects coming from menopause. 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're doing at ZOE.

There is still many unknowns and especially how disease risk and menopause symptoms relate to diet and nutrition. But I think given how our research shows links between metabolic changes and menopause, I think it really 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're post-menopausal.

And I just wanted to come back to something you sort of talked about at the beginning about how this is not really talked about. So I'm struck that until I got involved in ZOE sort of five and a half years ago, this wasn't something that I thought about at all. My mother never mentioned it once. And I actually discussed this with her more recently when we did all this research. And she said, you know, my symptoms were not very significant, so I didn't find it that hard.

Which might be true, but also I know my mother is someone who doesn't make a fuss. So to be honest, you know, I'm not sure really whether she might not rate quite similarly to what we're seeing here. So, you know, why is this? And do you think it's important that this is going to change if we're going to really make progress against all of these symptoms?

So I think there's a couple of issues here. I think one is, I really hope that with all the awareness there is now around menopause in the last year or so, that people will talk about it, that it won't be a taboo subject. I also really hope that in general, there'll be more investment in research in women's health. And I don't just mean around the menopause, I mean generally in women's health. I've worked in nutritional research for 25 years. I've run more than 30 randomised 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. So you're saying that apart from two of them, they were only on men. Is that what you're saying, Sarah? Yeah. My previous research has only been on men because

I would have to recruit double or triple the amount of participants into my studies if I wanted to study women because 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 of getting research income.

So, you know, I'm guilty of being one of those people that haven't studied women enough. And I really 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.

And finishing off on this topic of menopause, I think you're 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. Because I think what you've been looking at so far is all these associations as opposed to saying, well, what happens if we actually change the diet for somebody? Can we actually improve their symptoms? Where are we on that?

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 programmes. So we're looking at symptoms before people start the ZOE programme and then we're looking at symptoms and the severity of the symptoms after they've completed the programme. And what we can do is we can look overall how the ZOE programme helps them with symptoms

But also from a research perspective, what's really interesting is we can actually look at what components of people's diet are helping, specifically who with their severity and the type of symptoms they're suffering. And so we should have results from this in the next year, which I'm really excited to be able to delve into hopefully in the future with you, Jonathan.

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 slash podcast. I'm Jonathan Wolfe. And I'm Sarah Berry. Join us next week for another Zoe podcast.