How to track your menopause symptoms | Dr. Sarah Berry and Tamsen Fadal
01:04:26 Share

Welcome to ZOE Science and Nutrition, where world-leading scientists explain how their research can improve your health. Most women recognize one or two menopause symptoms. The infamous hot flashes or perhaps night sweats. But there are many more. Tingling in your hands, brittle fingernails, changes to your taste buds. The list goes on. In fact, there are more than 50 symptoms. And just one of these could suggest that it's menopause that's knocking at your door.

Today's guest found out that she was in menopause while she was live on TV. And it's been a long road since that day that threatened to derail her health and her career. Emmy Award-winning journalist Tamsyn Fadal interviewed 42 experts for her new book, How to Menopause, and is executive producer of the documentary The M Factor, shredding the silence on menopause.

Tamsin is joined by Professor Sarah Berry. Sarah is a professor in nutrition at King's College London and runs the world's largest study on nutrition and menopause here at ZOE. She's developed a free tool called the Menoscale Calculator that helps you track your symptoms so you can find relief. And today, she's sharing an exciting new breakthrough about how gut health impacts the menopause. Today's episode will help you track and treat your symptoms so you can take control of your health.

Tamsin and Sarah, thank you so much for joining me today. Thank you. Great to be here. So Tamsin, we have a tradition here at Zoe where we always start with a quick fire round of questions. Oh boy. With some very strict rules. You can say yes or no or a one sentence answer if you absolutely have to. Okay. You're willing to give it a go? I'm willing. I'm willing to give it a go. Once your menopause symptoms began, did you feel prepared? Not at all.

Are workplaces supporting women who are going through menopause? Not enough. Sarah, is there a simple medical test that diagnoses perimenopause? No. Have you developed a new tool for women to be able to make sense of their symptoms? Yes. Can the right changes in nutrition help with symptoms of menopause? Yes.

Tamsen, what is it that you wish you knew earlier about menopause? I wish that I knew that there was support out there and there were some answers and that I wasn't alone. I think that's really powerful. And actually this idea of being alone, I mean, it's very strong.

I'm really excited you're here. And for listeners around the globe who may not know you so well, you're one of America's most beloved news anchors. You covered Hurricane Sandy, the war in Afghanistan, and recently you've been covering this topic that we're going to talk about today, which is menopause. And your new book, How to Menopause, based on interviews with dozens of experts, really aims to break the taboo about this topic. And you've also found fame globally with your viral video about 34 symptoms of menopause.

A number that is staggeringly high. And yet I think today that Sarah is going to say she's found even more. So Tamsin, I'd like to start with your own experience. Could you tell us about the moment that you suspected you were entering menopause?

Yeah, you know, I had been, if I look back, dealing with a lot of symptoms of it, though I wasn't aware of it. I was a news anchor for about 30 years. In the last year or so, before I realized what was going on, I would have a hard time. I'd look at a word on the teleprompter, not be able to say the word, not know exactly what was happening. And I just thought, stress, I'm tired, I don't know what's happening. One night, it was November of 2019, and I was on the news desk, and we did live newscasts every night in New York City. And

And we were in a commercial break and we were all talking and everything was fine. And all of a sudden I felt this eruption from inside. My whole, everything broke out into a sweat. And my heart was just beating, beating, being fast. I could hear it in my ears. And I thought, I don't know what is happening, but I'm not going to make it through this next round of news. And I said kind of jokingly, because I was in a studio of all men, if I fall over, somebody catch me.

And I was a little uncertain. I wanted to feel like you're in control on live television. And I knew I wasn't going to be shortly. So one of my coworkers walked me off and I walked into the bathroom with him and dropped to the bathroom floor just to cool my body down and calm myself down.

I got up 15 minutes later, not something anybody in their right mind would do is get on the bathroom floor in a newsroom and left the studio. And that following week proceeded to go to my doctors to see what was happening. And I went to one doctor after another because I didn't know it was menopause at that time. I just knew I wasn't right. Something was happening. Wow. That's a really intense and shocking story. I always feel whenever I hear any of these stories, I think particularly as a man, I

It's sort of amazing because this is not something that anyone ever talked about with me until really the last few years. Sounds pretty terrible.

You know what's interesting is that the guy that walked me into the bathroom, he said, I thought you were having some kind of heart episode. I didn't know what was going on, but I just knew that something wasn't right. And since then, we've talked quite a bit, and now I hear men asking these questions to talk about it. But yeah, it was terrifying because I wasn't in control anymore, and I didn't know what was going on. And when you lack answers, and you can't go forward with knowing what you're dealing with to try to find a solution, I think that's the terrifying part.

And were you prepared for the fact that there was going to be an onset of symptoms and it's just that you were surprised that this happened now? I'll be honest. Not too long later, I got a message in my patient portal from my doctor. I'd gone to my OBGYN. I did blood tests, endocrinologist. I found a functional medicine doctor. And the message in the patient portal from the doctor said, in menopause, any questions? And I was in the airport at the time with my now husband. And I looked and I was like, oh.

I'm too young for menopause. I was 49, you know, beyond the average age of menopause. And so I had no idea because all I had ever seen were kind of media ha-has about hot flashes and joking about it and women sweating. And I didn't know very much else about it. So I was stunned to find those symptoms that I think some are very, you know,

uncommon to women. They just don't know about. And then there's the common ones. You don't realize how debilitating those are. And do you think your story is unusual or are most women not prepared for this? Well, that's what I thought was so strange. I was like, I have this unique story. And then I went and I

started talking to one woman after another and I went, this is not unique at all. This is common and all of us are in the same boat. And I think that's really what moved me forward with this purpose because I realized that there was such information lacking. I tell stories my whole life and I never talked about this. I never said the word perimenopause on television. We talked about diets. We talked about exercise. We talked about the latest fads and drinking green tea. We never talked about this. Why is that?

I ask myself that question a lot. I think there's a shame in a lot of ways of feeling not as productive anymore after your reproductive years have come to an end. I think maybe there's the shame that's wrapped up in aging and feeling not as useful once you hit this time in life. And I think that a lot of women feel like, like, my life is kind of over when I hit menopause. And that's a really sad thing because that's just not true.

Hey, I'm Dr. Will Bulsiewicz, Zoe's U.S. Medical Director. If you're a regular listener, you've probably heard us talk about how the foods you eat can transform your health. Zoe membership helps you make smarter food choices. According to Julie, one of our Zoe members, being a Zoe member can change your life tenfold. Before Zoe, she said she'd eat ultra-processed food for breakfast every weekend. Today, she no longer eats UPFs and no longer craves them.

Not only that, she's lost over 28 pounds and says she feels a lot healthier. As she puts it, Zoe completely changed my life. Clinical trials prove that Zoe membership works. You can feel healthier in weeks and improve your gut health in months.

If you want to try Zoe for yourself and start improving your health with every meal, the first step is to take our free quiz. We're offending listeners 10% off Zoe membership when you use the code podcast at Zoe.com. Now, back to the show. Well, first I'm going to say thank you for sharing the story. It's like very raw and powerful story.

I'd love, Sarah, if maybe you could try and explain a little bit what might have been happening, like what's going on in the body leading up to menopause. How could you have such a terrible experience? Well, I think firstly, before we even talk about the biology, I think it's because we don't talk about it. We are of the same generation, Tamson and I, where our parents didn't talk about it. You know, the generation before that didn't talk about it. So we are unprepared. And that's what I think is fantastic about the kind of things we're doing at Zorian that you're doing, that

I hope my daughter's generation will be ready for it because I think if you're ready for it, there's lots that you can do to prepare yourself for it. So what happens is that as you enter the menopause transition, which is what we call a perimenopause, you start to have a decrease in the hormone estrogen. Now, you don't go to bed one day where you're premenopausal and you wake up the next day and, hey, I'm postmenopausal. That's it. The menopause is done.

We know that on average people become postmenopausal at the age of 51 and basically all that means is one year post their last menstrual cycle, so post their last period. But there's this whole transition period. There's this transition period that can last for some women up to 10 years, although typically it's between like two to four to five years. And during this transition period you

You don't, again, have this nice, slow, lovely decline in oestrogen that your body adjusts to. You have this rollercoaster. It's like this state of just like, you know, craziness in your hormones. So it's like hormonal chaos, I often think of it like, where your oestrogen's going up and down from day to day, from hour to hour.

And so you're dealing with firstly a reduction in oestrogen, but you're also dealing with this rollercoaster in oestrogen. And the reason that has such wide reaching effects, so you talked about 34 symptoms and we know it's even greater than that, you know, it can be 50 and beyond in terms of number of symptoms. The reason it has such a big impact on so many different areas is because we have oestrogen receptors all over our body. Our brain is full.

It's full of estrogen receptors. Everywhere in our body has estrogen receptors. Nearly every cell has an estrogen receptor.

And so if your estrogen is declining, it's going to impact everything from our brain to our cardiovascular health, to our bone health, to our muscle health. And it's going to cause, therefore, all of these really unpleasant symptoms that we talk about often to do with menopause. Now, it will differ from woman to woman what symptoms they have. It will differ from woman to woman how impactful they are on their quality of life. And it will also differ day to day. And I think this is really, really key.

With the research that we're doing, yes, we know on average 99.8% of women in our ZOE cohort say that they have experienced at least one symptom. 66% of women in our ZOE cohort say that they've had 12 or more symptoms. 12 or more symptoms. On average, perimenopausal women in our ZOE cohort say that they have 13.5 symptoms out of 20 that we're measuring.

For postmenopausal, it's a little bit lower. It's 10, but that's still huge. But they vary day to day. And I think what's most interesting, and it's interesting listening to your story about what suddenly kind of made you like wake up and almost say, whoa, what's going on? Was that hot flash that you had? And actually, that's what's typically women think. Okay, I must be in the menopause because I've had a hot flash. That's actually one of the least common symptoms. So from our ZOE predict data, we know about 45% of women will experience hot flashes.

So Sarah, you could go through menopause and never have hot flashes. That's possible? That's possible. And some women, and what I hear a lot is what you've said, Tamzin, and this is what I experienced. I had one like overwhelming hot flash. I remember when it happened. It was just before Christmas. I was on the floor in the lounge wrapping my kids' presents and it was like, oh my God, what on earth is going on? I thought maybe I'm going to faint. Am I going to collapse? What is it? Never had them since. But what

But what I've had is all of these other symptoms. And these are the symptoms that we know from our own data are so common. So Tamsyn, I bet it would have been really great to have this little medical explainer from Sarah before you ended up in the bathroom floor of the studio. Yes, where have you been all my life? You know, it's interesting because we talk about this and you look back. I mean, I looked back and I'll say this because I thought to myself, wow, 12 months without a period.

And I did go through up, down a lot of, you know, a heavy period, crazy heavy period, none for four months. But I had endometrium polyps, which is another thing to add on top of this, which didn't give me that defined marker of, oh, I haven't,

I had what seemed like a period for 12 months. So I didn't even know that was a thing either. I didn't know that you go 12 months without a period and that's menopause. But if I look back at those transitional years now, I was gaining weight. I'd gone to see a doctor because I was having anxiety. I was put on antidepressants.

I had dealt with a lot of these other symptoms, the brain fog, the irritation with the brain fog, the lack of word retention. So I just didn't know that that's what it was. I attributed it to everything else. It's stress. It's difficult at work. I'm not sleeping well. Weight looks different on my body now. So I

I just didn't know what I didn't know. And that would have been really helpful to have just some indication. You're describing these symptoms before you actually hit the point where you'd have no periods and you're on the floor. I played whack-a-mole with them. You know, no sleep, feeling anxiety, got to work out harder, got to eat better. And I just didn't know looking back that that was what is perimenopause. I didn't even have the word. And how did your symptoms progress after that day on the bathroom floor? You know, there were

still bad for about a year plus. I am lost my mom to breast cancer when she was young and I was young. And that was always something that I was paying attention. I wasn't thinking about anything else, certainly not menopause. So when I did finally go to a doctor and say like, I've got to do something because I'm not functioning. Like I wasn't myself. And I was having, most of mine were, I feel like more anxiety issues, a lot of anxiety and physical in terms of weight. And

And so my doctor said, well, you can do hormone therapy. I think that you're eligible for it. I'm not quite sure because you had a mom with breast cancer. We don't know. So I went to a doctor that wasn't so sure. Then I found another doctor that felt very confident and cleared up a lot of misinformation there is about hormone therapy. So I was given hormones. And when I went on that...

It was about six months and I started to like see the light again. The fog had kind of cleared. But I had a rough go of those symptoms for a bit after that happened in the studio.

Again, whenever I hear these stories, I'm always shocked that there's these sort of two parts to it, Sarah, with all these symptoms that start and you really have no idea where they're coming from because there's no like test that just says, oh, you're in perimenopause in the way that, you know, I feel like we're used to like a blood test for everything. And then there are these symptoms also in menopause. Sarah, could you tell us about this sort of new research you've been doing about menopause symptoms? Like how many...

there are? And in particular, you just mentioned that it's not just night sweats and hot flashes. What are the other symptoms that actually you are seeing are frequent? Yeah, Jonathan. So we've been researching menopause symptoms, but also how menopause impacts our health. And this is really important to specify because often we think about menopause and we think because there's a lot more voices out there talking about symptoms, we forget that it also impacts our health.

It impacts our blood cholesterol, it impacts our blood lipids, it impacts our blood pressure and so much more. So we've actually been doing, looking at menopause across two areas. We've been looking firstly how it impacts our health in terms of disease risk and then how it impacts our symptoms. So these very kind of burdensome symptoms impact our quality of life.

So the research that we've been doing, looking at the relationship between symptoms and diet and lifestyle and many other exposures, we've had over 70,000 individuals who were taking part in our ZOE Predict study, which is part of this huge program of work that we're doing at ZOE. It's the world's largest nutrition research program. And

And we have studied 70,000 females, half of who are perimenopausal and half of who are postmenopausal.

And this is really important because there is some growing research in the area of post-menopause, but actually generally you're either asked, are you pre or are you post? So what we're really proud about is the work we're doing in the perimenopausal group. And this makes up about 35,000 of those individuals. And we've been asking these individuals lots of questions about their symptoms, how many symptoms they have, how impactful their symptoms are on their quality of life, because that's really important. Like Tamsin said, 10% of women leave their job

because of their symptoms. And then we've also been following these individuals up after they might make, you know, diet or lifestyle changes. But in this first body of research where in these 70,000 individuals, we asked them about their number of symptoms and the impact that they have on their quality of life.

It was amazing just how many people reported having symptoms. We know that there's loads more than 20 symptoms. There's up to 50 and beyond. But we've asked individuals about what we know from our own research are the 20 most common symptoms. And what we found really surprisingly is that actually the ones that we typically think of when we think of menopause, so the hot flushes, the night sweats, were the least common. Only about 45% of the women reported having these hot flushes, these night sweats.

And yet symptoms that the more we talk to individuals, we realize they talk about, don't know a part of menopause. These are the ones that are most common. Sleep disturbances, more than 80% of individuals have these. Memory loss, brain fog, irritability, anxiety, depression, low libido, weight gain, slowed metabolism. More than 80% of individuals reported having each of those different symptoms in the perimenopause.

Post-menopausally, it was lower, but there was still a high proportion of women that had those symptoms. You're still talking in the range of 50 to 60%. And I think this is important because I think often we think, oh, it's just during that transition period, you have these bothersome symptoms, suck it up, get on with it. After the menopause is over, it's fine. They reduce it.

Yes, we do see for every year post-menopause your symptoms go down. And this is really exciting research actually that we haven't published yet, Jonathan, but we've looked at the number of symptoms and how they go down per year past menopause.

the menopause, they reduce. But even 10 years post-menopause, so post that last period, you still have a big burden for menopause symptoms. And so this is why it's so important not to just think about it as the perimenopausal phase, but also realize this is something that's going to impact you for quite a number of years.

Why is it that the symptoms reduce over time in menopause? What's going on that it's not just sort of like constant from the point of menopause? So I don't think we fully understand that yet. What we do know is during the perimenopausal phase, the reason that they're so impactful on your quality of life is because of this roller coaster, like you've just explained. Also, our body hasn't adapted yet.

Our bodies are really, really clever. There's things like during the perimenopause, they're not quite clever enough at adapting. But we do adapt. We adapt to changes in the nutrients we're exposed to, the environment outside. We adapt to our internal environment as well. So our body over time adapts

to this reduction in estrogen, but also postmenopause, it becomes more stable. So you're not having this kind of roller coaster as well. We know at ZOE, because this is what we spend all of our time studying, that there's no one size fits all, that we all respond so differently to every kind of exposure that is put upon us. And so we do know that there are some women that will sail through it

There are some women that will say they sail through it because particularly I think our parents' generation, it's the generation you had grit. You sucked it up. Of course you didn't moan about it. Like you don't moan about having menstrual cramps. You don't moan about, you know, having your periods, any of that. But I hope that my daughter...

Well, she's 14 and so she's self-absorbed at the moment. But, you know, I hope that when it's her time as well to go through the menopause, that she has a very different experience. And I believe she will because of the kind of research we're doing, but because of the kind of voice that people like Tamsin have as well. It's sort of clear from the research that Sarah shares, like, this is a really big deal. And so to not talk about it at all seems mad.

And I find it very hard to believe that if we men had all been going through this, that like we never would have talked about it. So, you know, I think it's fantastic that it's starting to be talked about. It's also amazing how little study there's been, right? It's amazing, Sarah, that this

This is the first data that's actually understanding this at any scale. And I think, Jonathan, it's really important as well to talk about the increased disease risk that happens with menopause because this isn't talked about much. And I think it's great we're getting a bigger voice in terms of the symptoms. But actually, when you enter the perimenopausal phase and when you become postmenopausal, suddenly your risk of disease increases.

And women need to be aware of this because what is good about that is there's a lot you can do related to diet and related to lifestyle to reduce this. And we published some research a couple of years ago in eBiomedicine on the first large-scale study looking at how peri- and postmenopause impacts many intermediary risk factors related to disease. So by this, I mean things like blood pressure, blood lipids, insulin sensitivity,

glucose, inflammation, body fat, you know, and so much more. And what we found was that for all of these kind of health risk factors, shall we call them, up until the menopause, women are doing really well. It's the one time we're beating men at this. We've got lower blood pressure. We've got, on average, we've got lower blood cholesterol. We've got lower visceral fat, so the fat around the tummy. We have better insulin sensitivity. We have lower inflammation.

We reach the perimenopausal phase and suddenly this nice little, you know, imagine a figure and you see you're going up kind of year by year, but way below men. Suddenly, wham, it goes up. And in some instances, for example, with blood pressure, you actually even overtake men. So your blood pressure becomes even worse than men of that age.

For the other factors, then you become more at the same risk of man. So your blood pressure is increasing, your glucose, your insulin, your inflammation. We see huge increases in inflammation. And we know this is really related as well. Or we believe there's evidence emerging it might be related to some of the symptoms and the neurological symptoms. And so it's a real point in time where I think women, as well as thinking how they can handle their symptoms, need to be really mindful about, okay, I'm now at increased risk of cardiovascular disease, of type 2 diabetes.

of obesity-related illnesses, which then link in with cancer as well. And this is where I think diet and lifestyle become so, so important as well. I do too. And I was, you know, it's funny, I went to the doctor and I had increased cholesterol. I had low cholesterol my whole life. I was shocked. I'm not running around eating cheese and drinking. Like I wasn't doing something that would cause that. And so then I learned, you know, you gotta think...

after all these years of paying attention to this, I learned that as well. So it's really shocking. But I do think people want to know what to do so they can kind of have some type of control. And I think eating is the one place that you actually can try to take some of your control back and do something about it early on. Yeah. And I think this is where we can use diet, we can use lifestyle to reduce risk. But at the same time, something I think we also need to be mindful of is about being kind to ourselves. So

What we know is that with the change in estrogen levels, where you deposit the fat on your body changes. So in simple terms, estrogen kind of directs the fat to your hips. So you think of pear-shaped women.

Once you become perimenopausal women with the reduction in estrogen, then the fat is directed around your tummy, which is where it typically is directed with men. So it's a scientific fact is what you're saying. As you go into perimenopause, suddenly your weight is going to change where it gets put and you are going to put weight on around your stomach in a way that you just didn't before that. And that's not...

because you suddenly changed, it's because your body has changed on you. Absolutely. And this is why I think we need to be kind because it's biologically what's happening. It's because oestrogen in simple terms is directing the fat or the lack of oestrogen to be around your tummy. The fat around your tummy is what we call visceral fat. We know this is very metabolically active. It's not healthy for us. That's why you have this increase in cholesterol, in inflammation, in and blood pressure, for example.

peri- and post-menopause because of that increased fat there. But the reason I'm saying it in the respect of we need to be kind to ourselves, I've suddenly got fat. I might be slim elsewhere, but I'm not comfortable wearing a bikini. Now, I recognize that it's just a natural part of menopause. And yes, I'm going to work hard to be healthy, but I think it's recognizing that, look, we can't have that six-pack necessarily.

necessarily. I mean, maybe some women can, but I don't want to live such a virtuous life that I have no pleasures to get to anymore. But it's recognizing that there's some things we can help with diet, with lifestyle, with hormone therapy, if that's our choice. But there's also some things, let's just accept it as part of aging. You know, aging can be a beautiful part of how we change as well. Thank you, Sarah.

I'd like to ask the question that you teased to me before the show starts about gut health and menopause. I think, oh, I know that my gut health is really important for my health in general, but surely it has got nothing to do with menopause because that's all to do with estrogen. That's something completely different, isn't that? It's sort of what I was thinking until five minutes ago. So tell me, Sarah.

So I will remind you of some data we've already published. And then I shall tell you about some new data that Tamzin, I have whispered to her already. So I'm sorry, Jonathan, that you're hearing secondhand. I feel like you've cheated on me, Sarah. I know, I do feel a bit like that.

So we know from some research that we published a couple of years ago, where in our ZOE predict cohort of a thousand individuals who we really deeply phenotyped. So we studied loads and loads of different aspects related to menopause and health. We know that peri- and post-menopausal women have a different microbiome composition to pre-menopausal women.

which I think was really fascinating. And this is even after we adjust for different confounders, like is it to do with their diet or what else is going on?

We also looked in that data set to see, is the microbiome why we're seeing some of these changes that I talked about related to health, the increased inflammation, the increased belly fat, etc. And really interestingly, we found that there were some species that were particularly elevated in the peri- and postmenopausal women. And these were species that we had previously identified through a huge body of research that we'd done a few years before that.

at ZOE looking at the relationship between the microbiome and health. These were species that we identified to be associated with inflammation, with higher blood pressure, higher blood cholesterol, and all of these kind of disease risk factors. And we found that there was one species in particular

that was quite elevated in peri- and postmenopausal women, which is associated with an increase in inflammation. And we saw a huge increase in inflammation and also what we call post-prandial inflammation, i.e. when you have a high carb, a high fat meal, you do have an increase in inflammation. It's a normal part of having a meal, but if it's excessive and repeated, we know that it increases our risk of chronic disease. So we saw that particular species was increased. So

Sarah, can I just check I've got that? Because we often talk about the fact, you know, the latest research from Zoe has identified these sort of 50 bad bugs that can be, you know, in your gut, Tamsin, and also these 50 good bugs. And are you saying that basically that one,

that one of those particular bad bugs, suddenly you're getting lots more of as you're going through perimenopause? Yeah, so we saw that on average, there was a greater number of what you call bad bugs. Any microbiologist would hate that term, but I think it's a good term to summarize it simply. We see that there's an increase in these bad bugs

post-menopause versus pre-menopause, and in particular, the bug that's associated with increased inflammation. This is research we've already published. We published this a few years ago. Some hot off the press research, and I even had a latest update yesterday afternoon on this research, is that we have found that the microbiome, so the composition of the microbiome, is related to menopause symptoms.

This hasn't been looked at in humans before. We have data now on this 70,000 cohort. This is like phenomenal. 70,000 peri- and postmenopausal women that we also have microbiome analysis from their poop. And we can look at how is the microbiome composition related to the number of symptoms, the severity of symptoms, and different types of symptoms.

And what's really interesting is that we see a really strong relationship to the makeup of the microbiome and how many symptoms you have.

And we can do a particular kind of analysis that our genius team at Tamsin at Trento University, who are world leaders in this area, they do this analysis. It kind of blows my mind. I don't quite understand what they do. So Jonathan, don't ask me in depth what they do. But they can work out how predictive is your microbiome composition to a particular outcome. So they do this analysis to say, can we predict the number of symptoms that you have based on the bugs, the species, the microbiome that you have?

And they can predict with reasonable accuracy using the microbiome how many symptoms you will have. So how burdensome the menopause is. Is it that diet is impacting the symptoms independent of the microbiome or is it that diet is impacting the microbiome that's impacting the symptoms independently?

My feeling based on the results that I've seen, because they've done some more other complex stuff that again goes a little bit over my head, is that there's a little bit of both going on. That diet is directly impacting symptoms through various mechanisms, but that there might also be this mediating effect

of the microbiome. And then the new results that I saw yesterday, when we tried to look at different types of symptoms, was that the symptoms that the microbiome had the strongest relationship with was the psychological symptoms. And I think that's really fascinating because this is what we're starting to see when we think about food as well and psychological symptoms. So by this, I mean things like depression, anxiety,

low mood, irritability, memory loss, brain fog. And they have a strong association. So I think this just really hammers home the importance of eating to feed our microbiome, but also eating based on our understanding that certain foods or a whole diet pattern can improve the symptom burden that we experience.

The show you're listening to right now that's providing you the latest evidence-based health and nutrition information from the world's top scientists, while making it takes a lot of time, we think it's well worth it, all in the name of improving your health. All we ask in return is this. Send a link to this podcast to someone you think would benefit. And if you haven't already, click follow this podcast wherever you're listening right now. Okay, let's get back to the show. ♪

This latest research shows there is actually a relationship between like all those trillions of bacteria in your gut, this gut microbiome and your menopause symptoms. Is that right, Sarah? That's correct. And what we need to go on to do, which we can do with our data, so in a few months, hopefully we'll have those results, we need to see is it causal. And what I mean by that is if we use diet to change the microbiome,

does changing the microbiome change some of these symptoms? And we have this goldmine of data that I'm always talking about, I know, that will enable us to look at this. I want to start talking just a minute about, like, you know, actionable advice about, you know, what women can do. But just before that, Tams, I really wanted to pick up on a thread that you talked about earlier. I don't want to bounce over it because it sounds like your symptoms really impacted your career. Yeah.

You were lying on the bathroom floor instead of actually being reading the news. That's pretty dramatic. How unique is your story? It's interesting. When I started going into all this research, I was like, "I don't know." Because there was no place to find information. You can go online, you can find whatever you want in a lot of different areas. I think that's what a lot of women do and it becomes very scary. But I realized that my situation is not unique at all.

I have a community of people that I talk to online constantly, and I hear one story after another, way worse than what I went through, trying to do all sorts of things to remedy symptoms, understand symptoms, figure out where they are, understand what perimenopause means versus menopause versus postmenopause.

So I don't think unique, it did impact my career. It wasn't the reason that I stepped away, but it was the reason I stepped away. The reason is because I just feel like there's a much larger story here to tell because we don't continue talking about this and we don't continue helping. We don't help that younger generation coming up and we're going to just keep repeating this cycle. And I think in some ways I...

do get sad that I wasn't here for my mother doing it. And I want to make sure that somebody else, you know, that comes up behind me does never have that feeling again. As a result of like this not being in play, are there a lot of women whose careers are being impacted right now? Yeah, I think we're seeing a lot of that. We're seeing a lot of women, you know, there's statistics that have come out and there's a lot of different surveys that are being done saying that a number of women are leaving the workplace or not

looking to be promoted within the workplace because they're not feeling like they can, you know, balance or juggle some of those symptoms. And that bothers me too, because we're staying in the workplace is longer now, right? Women are at the, you know, the prime of many of their careers. They deserve to be where they have worked so hard to get. And I think we owe it to ourselves to try to help them be able to stay and maintain and go for promotions and not walk away from a job or career they've been working so hard for because of symptoms that we

you know, that we're learning more about. It's a pretty critical point, isn't it? I mean, it's basically my age and your late 40s, like, sort of got very good at whatever you're doing at this point. And that's just the point that you're saying, like, instead of

you're sort of having to potentially pull back because you're not being able to keep this under control. I think it's just another aspect right along with the personal symptoms that you've been describing Sarah and the health impact. Yeah I think I always refer to the statistic that we have in the UK that 10% of women have left their job they say due to menopause but I've never actually thought about the point that you just made that actually as well as people leaving what about the people that stay that aren't going for promotion that aren't progressing their career.

And I actually see that when I think of a lot of my friends. I'm 47, so lots of my friends as well are going through the menopause. And for a lot of them, it's their most insecure point of time in their life. Yeah.

And so they wouldn't be going either for that promotion yet. They've worked so hard and are so capable. And so, yeah, it's interesting you say that because it's just something that hadn't occurred to me. Yeah, it's real disturbing, right, though, because you know how hard they've worked to get to where they are. And I think that, you know, when you asked about the symptoms earlier and what I really saw,

you know, after I had that incident, I think it was a real lack of confidence that I had. You know, I was a newsreader, but then also you are talking all the time and to not feel like I could complete a sentence or retain a word or, you know, I would get lost in a string of thought didn't give me that confidence. And so I've talked to so many women that say like,

You know, whether they lost their train of thought in the middle of a presentation or they felt like they had that massive hot flash in a room full of men or in a boardroom, it can be really, really difficult. It can really just knock your confidence. And so those stories are not unique ones.

I want to say again, thank you both for sharing. I think that just the sharing is very powerful in terms of, you know, I think not just women hearing about this who maybe haven't gone through this, but I also think that for men to even be aware, this is really a thing. So as I said, I literally didn't know it was a thing a couple of years ago. And I don't think I'm the only man in that situation.

I'd love to transition now into actionable advice that women can take to alleviate their symptoms. And actually, Tamsen, can I start with you? Because in your book, How to Menopause, you pull together a lot of stories and strategies to help women going through menopause. And I'd love to hear about one or two. And I think one of the things you talk about, for example, is the best sleep of your life. And I know that sleep is...

It's one of the things, Sarah, that you mentioned is a very common symptom that's a problem. Can you share? Yeah. When I was writing this book, I said, I don't even know how to get all my thoughts into this, but I think what was really important for me as a journalist is to find the best of the best out there to interview and to make sure women had something actionable. Because if they're going through brain fog and they're not feeling good, they just want to know what to do. What do I do to get to feel better?

And so sleep was a big one. And for a long time, I used to consider sleep a luxury. Like, I'll sleep when I can, but I'm going to brag about the fact that I've gotten by. I have four hours of sleep tonight and I can do all this stuff. But I've realized really how important it is. I've realized what it takes for me to get good sleep because it doesn't just happen. I don't just jump into bed and it happens. And I've realized it's more...

A lot of preparation and a lot of focus on it and working my schedule as much as I can because I know it's not possible to do all the time. And we have a lot of things going on at this part of life, but I think it's important to focus on. And that's really what I did in that chapter of the book. Sleep is something that impacts 85%.

of the cohort that we studied. And we know that sleep is so important in terms of all sorts of factors related to our health. We consider it to be one of the four key pillars of health. So we've got diet, we've got physical activity, we've got stress, we've got sleep. We also know that sleep impacts the dietary choices that we make.

If you have a poor night's sleep, the reward centers in your brain are on kind of fire and saying, hey, Tamsin, you've had a bad night's sleep. Go and eat that sugary breakfast, that refined carbohydrate. We also know if you've had a poor night's sleep, your response to

to any meal is also worse. And we've published research on this that shows that if you have a poor night's sleep, your blood sugar response the next day to a meal is a lot worse. So it's a lot higher compared to if you've had a good night's sleep. So you kind of set yourself up on this roller coaster. We also know from the Zerumenopause study as well, that if you have

better sleep, that also offsets some of the other symptoms, meaning that those people who have better sleep, which we know is a symptom, but they have less symptoms and less impactful symptoms. And so I think it's really great that actually you talk about that first, because we can use that as the cornerstone, maybe from which we can start to improve other symptoms. So Tamsin, what are the tips? Somebody's listening, they're like, great, what can I do? My sleep, let's jump into sleep.

I don't know. Drinking is a thing that I think that I have just moved off the table as much as possible. But if someone's having a glass of wine, having it anytime four hours close to bedtime is going to knock your sleep off completely. Trying to be really cognizant of devices. I'm not good enough or virtuous enough to take my device out of the bedroom. But I do try to make sure it's on that blue light mode and I try to make sure that I'm not

dealing with problems closer to bedtime at all. I do make sure that I'm trying to go to bed at the same time and get up at the same time every day, which is not anything I'd ever done before. I was the kind that was up till two o'clock in the morning. I'd get up at six, I'd go work out. And I do feel like that consistency has played a huge role for me in feeling better the next day. When I get up in the morning now, no matter if it's raining or sunny out, first thing I do is get outside and

it's made a huge difference in my life. I started it about a year and a half ago when I was writing the book. I talked to a doctor who had really just focused on light and understanding how light impacted the body. And so I wanted to make sure that I was doing that and putting that practice into play. So those are some of the bigger things I do. I set my bedroom goes completely black. I have tape over any of those lights that are on every device that you have

I have a TV in the bedroom. That's my husband's fault. But I make sure that stays off a few hours before bed.

And I used to be the person that went, I don't know, does that really make a difference? It makes a huge difference. It really does. We've done some work looking at the importance of sleep consistency on different health outcomes and also on the dietary choices that you make. So we've published some research at ZOE looking at what we call social jet lag. And 10 years ago, you would have been a prime target for this study. So this is where people have different sleep patterns.

So it might be that you're very consistent in the week, but you're going wild at the weekend. Or it might be if you're hardworking like I am at ZOE that you're going a bit wild in the week because you're too excited by your research and you stay up far too late working on it and then you catch up at the weekend. But either way, you're inconsistent. Your pattern is inconsistent.

And we've shown from our research on social jet lag that it does have an association with health. And those people who have the social jet lag or the inconsistency also make poorer dietary choices. So have higher sugar, higher refined carbohydrates, for example, in their diet. I mean, I did that a long time in news, during the news business. I never had a nine to five job in news. It was get up at two o'clock in the morning and be at the station by 4 a.m.,

Yeah. But I would reward myself and think like, I can eat some junk food now because I'm so tired. I just got to wake up a little bit. That was for about 10 plus years. And then on the flip side, about 15 years, I did the night shift. So I wouldn't get off of the air until 11 o'clock at night. So I'd get home by midnight. I'd wind down a little bit. I'd have a snack. You know, I did all of those things. So those hours were so off. So I've definitely seen a difference in no longer saying I can just survive on three hours. It might come with age too.

Do you know what? The World Health Organization have shift work listed with a health warning because they know that it has such a bad impact on our health.

It's amazing. So Sarah's going to be really interested about this, I think, because Tamsin, you talk about some recipes that some people believe can actually help alleviate these symptoms. You know, in the book, I talk a lot about a Mediterranean diet. I'm Lebanese, and it was what I grew up on, and it was a diet of whole foods. It was a diet of lots of olive oil and lots of all kind of plant-based vegetables, and then you throw in fish.

And so I decided in the book because I felt like a lot of these things were game changers for me. They were the basics that I went back to. And I took some old recipes from my family, old family recipes. And the one in particular was one that my dad, we did growing up. We had grape leaves growing up. So I changed out the rice for quinoa. You know, we had the grape leaves rolled, drizzled with olive oil, all of these like

really super healthy for your diet. We did a salmon instead of a chicken, and then we made sure we had some Mediterranean vegetables with all sorts of spices and a tabbouleh salad. So those are like the kind of recipes that I put in the book because one, that's what I grew up eating. Two, a lot of them go back to the whole foods that I think are really, really important for this diet.

And I think they're easy to do. They're not these difficult, I can't do recipes with 20 ingredients in them. I need it simple and I need to know that I'm going to be consistent about it. So that's what I did in the book. Sounds delicious. I want to be invited around to your house. I would love it. I'll be there. You're welcome too. We've already broken bread together.

It often manifests like, I don't know if this is true or not, but the next day is when I just feel awful. If I've eaten poorly one day or made choices that just didn't make sense because I

you know, didn't have time. I just feel differently the next day. So that's been another kind of consistency I've tried to have. Yeah, we know that food impacts how you feel that day, but we also know how you eat, so the timing that you eat and what you eat actually can impact how you metabolize food the next day and also how you feel the next day. And it's interesting you mentioned the Mediterranean diet. There's been very little research on how diet can impact

menopause symptoms. Apart from the work we've been doing, there is one study that's looked at the Mediterranean diet and people were randomly allocated to either follow like a typical UK, US style diet or the Mediterranean diet. Those people following the Mediterranean diet had a 30% reduction in some symptoms. They only measured a few symptoms.

Because, you know, until recently, people weren't talking about all the other symptoms. And so this is why the work that we've been doing, looking at all the other symptoms, I think in relationship with diets are really, really interesting. Yeah, I do too. I'd love to hear that too, because I feel like women are constantly asking, like, what can I do? And to be able to have an answer like that is really important. Is someone in your life experiencing one of the symptoms we've talked about today? Maybe they don't suspect it could be menopause. Why not share this episode with them right now?

With the right advice, there could be a simple way to help them feel better. I'm sure they'll thank you. Well, I'd love to ask that because, you know, when we set up Zoe seven or eight years ago now, I never thought at all that food could have any impact on menopause symptoms. If you'd asked me, I'd have said that sounds completely crazy. Is it completely crazy, Sarah?

It's crazy that it does because I thought exactly the same. So we've done this really exciting study where we have followed up just over 4,000 women who

who are peri and postmenopausal, who are following the ZOE program. So the ZOE membership is this program of personalized nutrition. And at the heart of it is eating according to the personalized guidance that we give, a very plant-based, diverse, fiber-rich kind of diet. We also encourage other healthy lifestyle changes, but it's

but it's predominantly focusing on diet. So the ZOE members following the personalized nutrition program had a 35% reduction after an average of 18 weeks in their symptoms. And we also saw differences in the level of reduction depending on the kind of symptoms. So where we saw the biggest reduction was in these psychological symptoms. When you say psychological symptoms, what does that mean?

So these are symptoms such as the brain fog, the memory loss, the irritability, the low mood, the anxiety, the depression. They don't sound really, to me, I don't know what you think, Tanya. They sound like pretty real, like brain fog doesn't sound. They're real. That sounds pretty real. It's very real. Rage is another one. You know, there are some real symptoms that I, mood swings, up, down, up, down. I mean, you think of a, you know, we went through puberty, like that, those are, you know, those are the up downs and they're real.

They're real symptoms. And I think that's what we're talking about when we say, like, you don't feel like, I don't feel like myself anymore. I can't tell you how many times I've said that over the course of this whole transition. Probably the majority of long-term listeners are Zoe members, but a lot of people listening to this who don't know what that is. What are the key parts of that membership that people are going through that was achieving that change? Because I think a lot of people listening are like, well, what does that involve? Okay, so the Zoe membership involves getting this lovely yellow box.

that has various tests that allows us to test people's individual responses to food through their microbiome, through wearing a glucose monitor and lots of other ways as well. We then deliver about personalized dietary advice that enables people to follow the best diet for their biology with support from coaches, lots of fun things like recipe cards. We have links to grocery deliveries, that sort of stuff.

And then you can opt at the end of a certain period, so let's say 12 weeks, to actually have certain things retested, like your microbiome retested, and also answer, again, lots more questions about your health. And it's this data that we've been using for our menopause research to look at those who are ZOE members and following the ZOE Personalized Nutrition Program, how their change in diet is linked to their change in menopause symptoms.

And what we see is that on average, people following the ZERI program and therefore making these dietary changes reduce their symptoms on average by 35%, but that there's big differences in the different symptoms. So psychological symptoms, for example, some of those can reduce as much as 40%. And I think that's really interesting because there's now a huge body of work coming out from Lisa Moschini's group looking at how the brain is regulated differently.

And, you know, people are putting forward this idea now that actually menopause is a state of neurological disruption, which explains why the most common symptoms are these neurological, you know, psychological symptoms. And the fact that on the ZOE program, we're seeing these ones reduce the most, right?

I think is really encouraging. And I think that's because we also know from our own work where we've conducted a randomized controlled trial where we compared the ZOE program versus the US average diet, we actually saw that some of the psychological symptoms that we asked people about, so mood, for example, had the biggest improvement on the ZOE program as well. So it all kind of ties in quite nicely. We've got all these different pieces of the puzzle now fitting together. I think that it's so important for us to feel like

Two things. We're not alone. We're not going crazy. And I think that those are the two things I kept overwhelmingly hear women say, which kept pushing me into this area of like, wow, what is going on that everybody is going through this and then everybody feels so alone.

I can't wrap up without talking about this amazing brand new free tool, which I'm amazed, Sarah, you haven't already plugged three times in this podcast. It's a sign you must be a little jet lagged. You've done something on the back of all of this research. Would you explain what it is? I would. So we have developed a new tool called the Menoscale.

And this is a tool that basically allows women very easily at no cost to record the burden that menopause has on them. So it allows them to look at how many symptoms they have and the impact that they have on people's quality of life. And the reason we've done this is because there's actually nothing out there and it enables us to track our symptoms. And as a scientist, we always say, if you can't measure it, you can't change it.

And for me, that's what's at the heart of this Menoscale calculator. So people can go online. They can go to zory4.com. It takes a couple of minutes to complete it. We ask you a few very basic questions about your age, whether you're on HRT, for example, and then you tick whether you have 20 of what we now know. So it's informed by our research of the most common symptoms. And then you grade them in terms of how much impact they have on your quality of life.

You then get a score of 0 to 100. Now, then what you can do with this score is lots of things. Firstly, you can use it to track how...

anything that you might want to do to help your menopause can impact it, whether it's changing your diet, changing your physical activity, going on HRT, for example. It enables you to then see what works for you, which I think is really, really important. When I started on HRT, I went to my GP. They said, well, can you track your symptoms? Well, how am I going to do that on some scrappy piece of paper that I know I'm going to lose somewhere?

If I'd have had that a couple of years ago, that would have been fantastic. And that allows you to titrate your dose if you want to do that or change your diet according to what works best for you. The other thing as well, Jonathan, I think it allows us to talk about our symptoms and going back to what you were saying, Tamsin, that

It means that, you know, I could talk to my friends and say, actually, this is how I'm scoring. And I don't mean it in a competitive way, but I mean it as in getting that reassurance that we're not alone. So when you get your score back, you get also how this compares to a woman of a similar age, the average woman of a similar age on HRT or not on HRT.

And it also tells you about your top symptoms and how that compares to other people. So it kind of enables you not to feel alone, but it also enables you to share and discuss it with people around you. But I think that, and also selfishly, I get, if you take the consent that we can use it for research, I get to look at all of this data and also enable us to move forward, you know, even further on the menopause research that we're doing at ZOE. Also, while you're getting the research and women are able to be a part of it, you get more data.

You're creating a community helping move this message forward and helping solve this. There's something to that that is so valuable for women to feel that they're taking part in helping. Like we're all in this together. And I think that that's what I've noticed more than anything with this conversation. And I love that because at Zoe, we talk about community science and that's at the heart of what we do that community.

Everyone that becomes a ZOE member, if they consent to share their data with us as scientists, they are becoming community scientists because their data, they are pushing forward our understanding of research. And it's the same with the Menno Scale. They're becoming community menopause scientists. So everyone, please go fill it out.

We'll put a link in the show notes for anybody. Pretty much the time, but Tamsin, I really want to end on a message that I felt was really powerful from your book because you talked about how often there's this fear of like almost becoming invisible. You don't want to think about this. And you talk about feeling of growing bolder through menopause. And I'd love you to maybe share that.

before we wrap. Oh, thank you for pulling that out. Yeah, I was trying to figure out what I've learned through this whole experience of aging and of menopause and of being very vocal about this story because I don't know that I would have done it five years ago. I would have said, I'm not getting any older. But I said, I don't think we're going into these as golden years. I think these are our bolden years. I feel like I've gotten...

I always have a little bit of fear, of course, but I feel like I'm a little more vocal. I'm advocating for myself. I want to do amazing things next, and I'm not in that game of comparison and that game of competitiveness. I'm in that wanting to feel good going forward and knowing that I'm living my someday today, right? And so I want to get every part out of it, and that's really important to me. So I feel...

you know, like we're a little bolder, a little sexier, a little wiser these days than, you know, what commercials may indicate that we're two older people sitting on a bench in a park petting a cat. You know, that's not what I want to be. And if anyone's listening to this and saying, well, I would like to be growing bolder,

Do you have any advice for other women to achieve the same? Yeah, absolutely. I mean, I think first and foremost, you know, I'm big about, you know, you've got to take control of your health because if you don't feel good, you can't do that next step of acting. It just, it doesn't work. And I think that that gives you control. It makes you feel like you're, you know, you're in the right place moving forward. I think stop putting these old narratives into place that I'm too old, that my best years are behind me, that, you know, I should have done it back then. Like we have a long road ahead of us. It's

It's very different. We're living longer. I think we're living healthier. I think we're living with more opportunity ahead of us. And so that's my advice is to really embrace that and not leave it for someday because today is someday.

That's beautiful. I'd like to wrap up as always with a little summary, and both of you keep me honest if I get it wrong. We started with this incredibly powerful story, Tamsin, about how you could end up lying on the bathroom floor with this sudden impact of these symptoms, not even realizing really that you'd been having this series of symptoms maybe for years, it sounds like potentially, and then suddenly it's like bang and your body is saying no.

you can't ignore this anymore, this is like a big deal. And so it makes you realize this is a big deal and it's important to talk about it. It's important to understand whether it's affecting you or your loved ones, as it is going to be in my case, that there are a huge number of symptoms associated. I think you said on average 13 symptoms in perimenopause, Sarah? Correct. And then you said 10 or something in menopause? Correct. So like an enormous number of symptoms. It's just very different from most things where there's like this one very clear symptom. And so it's obviously complicated.

it's not just symptoms, this has a big impact on your health. And you were saying, Sarah, women are on average much healthier than men until perimenopause, and then there's this like catching up or even getting worse at this point. So you've really got to see that change. You talked about

your biology really changing. So just one example of that, that I think a lot of listeners will stuck on is suddenly the estrogen that was pushing any fat towards your legs, it's like, no, no, no, put it on your tummy. And that's real. It's not because suddenly you're eating worse. It's because your body has changed. And that's real.

That's a reality you've got to deal with. You can take control of your health. This isn't something that is just genetics. There's nothing you can do. Like you're stuck with it, which is something that comes up a lot on this podcast. But here I think it's particularly powerful. You can't...

You can't duck the fact that this is going to happen, but you can take control of its impact on your health. Sarah has just launched this amazing new free tool. And the first step to taking control of your health is just to understand actually the symptoms you have. It's called the Menoscale Calculator. It's based upon this huge study that you've done. You can find it at zoe.com slash menopause. It'll be on the links as a way to sort of understand where you are.

And then I think, you know, to wrap up, we talked about this really amazing new research that suggests that diet and your microbiome actually is interrelated with your menopause, despite the fact that Sarah and I both thought that sounded crazy. There's all this data, Sarah, you shared that menopause is changing your microbiome, that you can get more of particular bad microbes, which I'm going to say even if your microbiologist friends don't like it, because I don't have a lot of microbiologist friends, Tamsin, so it's okay. But interesting, brand new research that actually

you can see this link between how bad your symptoms are and your microbiome. So you can see that this thing is sort of really deeply interlinked. And that's especially around things like brain fog and low mood, which are exactly the same things that you also said are most linked to the food you eat. And just, you know, to wrap up,

diet really can improve your menopause symptoms in a big way. And you shared the results of the study of Zoe membership, saying that on average, it actually reduced these menopause symptoms as calculated through your, you're calculated by 35%, which is like a really big amount. And I think that just fits into this incredibly positive story that you're not completely stuck. It's not like there's nothing you can do about it. And I think it is fascinating how much the

The lifestyle that we lead impacts this. It's not only a question of whether you're taking hormone replacement or not, which is, I think, something we've touched on on a number of other podcasts if people are interested.

Did I catch the key bits? You are a genius at summing up. A genius. Jonathan, I think one thing to emphasize is what Tamsin said about sleep. And although it's a symptom of menopause, I think it's often so overwhelming when you're in the menopause, the amount of things that are going on, the amount of changes that you might need to make if you are following an unhealthy diet. So I think that actually maybe to start with, a really good action is to focus on some of the things that Tamsin said.

said about sleep and make that the first thing that anyone's listening to do today why don't you make sleep the priority this week and then that might give you the strength to then make some of the other changes brilliant thank you both so much i always find this is incredibly powerful as a topic to to talk about and i always feel both privileged to be in the room and slightly embarrassed somehow as if i shouldn't be in the room so thank you very much thank you

Now, if you listen to the show regularly, you already believe that changing how you eat can transform your health. But you can only do so much with general advice from a weekly podcast. If you want to feel much better now and be on the path to live many more healthy years, you need something more. And that's why more than 100,000 members trust Zoe each day to help them make the smartest food choices. Combining our world-leading science with your Zoe test results, Zoe is your daily companion to better health for life. So how does it work?

Zoe membership starts with at-home testing to understand your unique body. Then Zoe's app is your health coach using weekly check-ins and daily guidance to help you shift your food choices to steadily improve your health. I rely on Zoe's advice every day and truly it has transformed how I feel. Will you give Zoe a try? The first step is easy. Take our free quiz to find out what Zoe membership could do for you. Simply go to zoe.com slash podcast where as a podcast listener you'll get 10% off.

As always, I'm your host, Jonathan Wolfe. Zoe's Science and Nutrition is produced by Julie Pinero, Sam Durham, and Richard Willoughby. The Zoe's Science and Nutrition podcast is not medical advice. And if you have any medical concerns, please consult your doctor. See you next time.