There are multiple ways in which the right nutrition can help to support a healthy menopause, but there is one area that is absolutely crucial and, if you focus on getting this right, many of your other symptoms will probably settle down as well. So whatever else you decide to do, start by focusing on the information in this chapter, as this could make a huge difference to your overall wellbeing. What is this magic formula? It’s all about blood-sugar balance and can make a huge difference at a number of different levels.
In order to understand why blood-sugar levels are so important, we first need to take a step back to understand what’s actually going on during the menopause and what should be happening, if everything goes according to plan.
First of all, it’s important to remember that the menopause is not a medical condition. It’s a natural transitional phase that women have been experiencing for millennia, so of course Mother Nature has a cunning plan for when our oestrogen levels start to drop. The human body is a truly complex and wonderful thing: when our ovaries stop producing oestrogen, our adrenal glands take over as the back-up system. These small glands, which sit just above the kidneys, are a vital player during the menopause, because they produce a weak form of oestrogen that helps to keep us fit and well through midlife and into old age.
However, there is a catch: the adrenal glands are also responsible for producing our stress hormones, cortisol and adrenaline, and when they are too busy doing that, oestrogen production doesn’t even get a look in. If you’re struggling with chronic stress, then the chances are that your menopausal symptoms will be significantly worse, because your adrenal glands are distracted, depriving your body of the vital oestrogen it needs.
It’s fairly safe to say that the years around the perimenopause and the menopause are among the most stressful in a woman’s life: juggling the pressures of work with the needs of a growing family, or the clash of the hormones if puberty coincides with menopause in your household. Midlife is also often a time when women are reassessing their relationships, which can be painful; and we’re the sandwich generation, caught between caring for elderly relatives and for our children.
So, there’s plenty of stress going on, which distracts the adrenal glands at the very time when we need them to be focusing on producing oestrogen.
This chapter is all about a nutritional approach to reduce levels of stress hormones in the body, so that your adrenal glands have the time and the space to get on with the job of producing oestrogen. Diet and lifestyle can make a significant difference to your stress levels. Of course, they can’t remove that irritating work colleague or solve your financial problems, but they can make your adrenal glands more resilient, so that you’re better equipped to manage stressful situations. The right diet can also ensure that your body isn’t producing extra stress hormones, which will overburden the adrenals.
To achieve the right balance of hormones, we first need to understand how the stress response works in the body and how diet and lifestyle can influence this.
Our stress response is a protective mechanism that is specifically designed to support us in times of physical danger, because we’re still genetically programmed for life about 10,000 years ago, and we have an in-built “fight or flight” response. Whenever we encounter a stressful situation, whether it’s a near miss in the car, running late for an important meeting, or worrying about finances, the body releases cortisol and adrenaline.
This response is supposed to be a short-lived alarm reaction in which the stress hormones rise quickly in the face of physical danger, speeding up the heart rate and sending blood to the muscles to galvanize the body. They should then subside as soon as the perceived danger has passed. However, in our busy modern lives, it’s not quite so simple. We’re faced with multiple sources of stress on a daily basis and these can be emotional, psychological, physiological (that is, illness or injury) or physical stress. The rise of the Smartphone in recent years has only compounded our stress levels, because the persistent notifications and updates keep us in a constant state of red alert.
Chronic stress extends this alarm period, so that the adrenal glands continue to pump out stress hormones. As our exposure to stress continues, blood will be diverted to the muscles, away from perceived non-essential systems, such as the immune, digestive and reproductive systems. In the short-lived alarm phase, there is no need to be fighting infection, digesting food or making a baby, so this is not a problem. However, over time, a prolonged reaction to stress can lead to dysfunction of these key systems, creating a range of unwelcome symptoms.
These include:
• fatigue
• increased abdominal fat
• digestive problems
• increased premenstrual syndrome (PMS)
• back pain
• difficulty getting going in the morning
• reduced libido
• decreased tolerance of people or situations
• craving for salty foods
• weight gain
• poor focus and concentration
• less enjoyment of life
• digestive problems
• low mood
• dizziness
• headaches
• diminished memory/“brain fog”
• susceptibility to colds and infection
• increased time to recover from illness or injury
Stress really is the enemy of the menopause, because so many of the different symptoms you might experience, from hot flushes or anxiety to fatigue or vaginal dryness, are related to a drop in oestrogen levels.
In the run up to the menopause, a sophisticated communication system made up of the hypothalamus, pituitary and adrenal glands and called the HPA axis, is working hard to keep all your systems in balance, so that everything works well and you don’t experience unpleasant symptoms. However, this can all go wrong if you’re under prolonged stress, because it will overload the adrenal glands so that they can’t produce the oestrogen you need, triggering a whole range of menopausal symptoms.
Another significant result of chronic stress is weight gain. Oestrogen can also be produced by fat cells and if your body senses that the back-up system of the adrenals is not available to produce oestrogen, it will start to store your food as abdominal (visceral) fat, which then becomes incredibly hard to shift because it’s hormonal and not related to overindulgence.
If you can keep stress in check, then this will make a huge difference to your health and wellbeing through the menopause and beyond.
Balance your blood sugar
If you do only one thing, do this! Every time your blood sugar drops, your body releases the stress hormones cortisol and adrenaline. Most menopausal women don’t need any extra stress, so eating a diet that maintains blood sugar balance is the single most important thing to do during the perimenopause and the menopause to support adrenal function. Call it “nutrition 101” because, as well as reducing stress hormones, balancing your blood sugar offers so many other residual benefits that will significantly improve your wellbeing.
How does the blood sugar mechanism work?
Your body is programmed to keep blood sugar levels within a specific range, and if it goes above or below that, this creates a state of emergency because, either way, it poses a risk to your health. Eating high levels of sugary foods and refined carbohydrates (for example: white bread, white rice or processed breakfast cereals) leads to a spike in blood sugar, which generates the release of the hormone insulin. Caffeine, alcohol and nicotine can also trigger the insulin response.
The role of insulin is to clear out all this sugar from the blood and send it to the liver to be stored. If your sugar levels are high, the liver may not be able to take it all, so any excess sugar will be stored as fat. Insulin doesn’t carefully calculate how much sugar to remove to restore the balance, it just hoovers up the lot, so that in a short space of time, your blood-sugar levels fall. The higher the spike in insulin, the greater the crash in blood sugar.
When your blood sugar is low, you feel tired, irritable, anxious, shaky, headachy, dizzy and absolutely desperate for a pick-me-up. Sugar is the body’s primary source of energy, so a blood-sugar crash is bad news, which is why the stress hormones cortisol and adrenaline are released to redress the balance. They will send a message to the liver, instructing it to release sugar stores into the blood. Cortisol also generates powerful cravings for sugary foods and refined carbohydrates, or possibly a cup of coffee or a glass of wine, depending on what time of day it is, but it will be something that your body instinctively knows will give you that quick fix.
And so of course, it’s a double whammy – the liver releases the sugar stores; you’ll grab a sugary snack and, instead of settling back within the required range, your blood sugar will spike and the whole process will start all over again. You can see how easy it is for blood sugar levels to rollercoaster over the course of the day, which means that your adrenal glands are continually releasing stress hormones, and that puts oestrogen production very much on the back burner.
If you go to bed with your blood sugar high, insulin will kick in and blood sugar levels will start to drop, so that your stress hormones will be knocking at the door at around 2 or 3am and you’ll wake up for no apparent reason and find it difficult to drop off again. The physiological and psychological stress caused by insomnia just adds to the adrenal overload you’re already experiencing.
Typical symptoms of a blood sugar imbalance include fatigue, low energy, cravings for sugar or carbs, PMS, mood swings, insomnia, irritability, low mood, anxiety, headaches, dizziness, difficulty getting going in the morning, palpitations, reliance on caffeine or alcohol for a quick boost, and weight gain. Over time, this may lead to a pre-diabetic state called insulin resistance, when the body cells no longer respond to insulin.
How do I balance my blood sugar?
You need two key nutrients to balance your blood sugar:
• complex carbohydrates, which are high in fibre and will release more slowly into the body than refined carbohydrates.
• protein, which is hard to digest and which slows down the release of the carbohydrate, keeping you going for longer and maintaining that blood-sugar balance.
The trick is to eat a combination of protein and complex carbohydrate with every meal and snack. In parallel to this you need to avoid sugary foods and refined carbohydrates, such as cakes, cookies and chocolate.
This may seem like a gargantuan task, but if you keep your blood sugar stable, you’ll be far less prone to the sugar cravings that drive you during a blood-sugar crash and this will make things easier fairly quickly. In essence, your brain will determine your food choices and not your hormones. We all know that in a battle with the hormones, they tend to win every time!
Food Type |
Examples |
Protein |
Meat; fish; seafood; eggs; lentils; chickpeas; hummus; beans; soya; dairy; cottage cheese; authentic Greek yoghurt; quinoa; nuts and seeds; unsweetened nut butter. |
Complex Carbohydrate (Fibre) |
Vegetables; fruits with an edible skin e.g. apples, pears or berries; wholegrains, such as brown rice, wholemeal bread or wholewheat pasta or noodles; oat-based products, such as porridge, oatmeal or oatcakes; pulses; sweet potatoes. |
Fluids |
Water; sparkling water; diluted low-sugar cordials or squash; vegetable juices; herbal teas |
Food Type |
Examples |
Refined carbohydrate |
White bread; white rice; white pasta; white noodles; high-sugar breakfast cereals; cakes, biscuits, muffins and other baked goods; anything with a pie or pastry crust, like a quiche or a pasty. |
High-sugar foods and hidden sugars |
Chocolate and sweets; ice cream; desserts; processed pasta sauces and soups; fruit-flavoured yoghurts; dried fruits; high-sugar, fleshy tropical fruit, such as mangoes or pineapples; grapes; tomato ketchup. |
Drinks |
Alcoholic drinks, especially rosé wine or sweet white wine; sparkling wines; beers and lagers; colas and other carbonated drinks; energy drinks; fruit juices; excessive levels of caffeinated tea and coffee. |
Breakfast
Breakfast can be quite a pressured meal in any household, whether you’re trying to get everyone else fed and off to school or work, or whether you only have yourself to worry about and have stayed in bed until the last possible moment. Either way, time is short and you’re under pressure, so making drastic changes at breakfast time isn’t a smart move, because the chances are that your new regime won’t last the week. You probably worked out years ago what type of breakfast suits you, so the best thing to do is to stick with that and adapt it accordingly. Whether you’re a toast person, a cereal lover or an egg enthusiast, a few simple changes can make a world of difference to your blood-sugar balance.
Swap |
For |
What else could I do? |
Toast with jam, marmalade or Marmite |
Toast with unsweetened peanut, almond or cashew butter for extra protein |
Make sure you use wholemeal, seeded or rye bread for more fibre |
Poached or scrambled egg with white toast |
Poached or scrambled egg with wholemeal, seeded or rye toast for more fibre |
Use two eggs instead of one, for an extra protein boost |
Sugary breakfast cereal or granola with milk |
A low-sugar (less than 10g per 30–40g portion) cereal to avoid a blood sugar spike |
Add a tablespoon of pumpkin, sunflower or chia seeds to increase the protein content |
Natural yoghurt with berries or chopped fruit |
Natural yoghurt with berries or chopped fruit, plus a tablespoon of seeds for more protein |
Use authentic Greek (not Greek-style) yoghurt because this is highly concentrated protein |
Porridge with chopped banana |
Porridge with chopped banana and a tablespoonful of unsweetened cashew butter for extra protein |
Cinnamon has blood-sugar-balancing properties, so sprinkle some over your porridge before serving |
Homemade fruit smoothie |
Homemade fruit smoothie with a tablespoon of ground flaxseed for extra protein and fibre |
Use a combination of 1 fruit and 2 veg to reduce sugar levels and boost fibre, for example: cucumber, apple and avocado |
Bacon, eggs and wholemeal toast to increase fibre |
Swap the bacon for baked beans, which contain both protein and fibre |
|
Mashed avocado on rye bread |
Mashed avocado on rye bread with smoked salmon |
Add a sprinkling of sesame seeds for extra protein |
Blueberry muffin from a coffee shop |
High-fibre bran muffin from a coffee shop |
Grab a small bag of raw nuts for extra protein |
Lunch
With lunch, it all comes down to the planning. If you’re at work, things can easily go wrong if you’re relying on the local grab-and-go outlet, especially if you’re in a hurry and don’t have time to make a careful choice. A packed lunch is definitely the smart move if you want to keep control of your blood sugar during the day. It also means you won’t be wasting time queueing up to buy your lunch and you can take a proper break.
If you’re at home at lunchtime, that should make things easier in principle, but it all depends what’s in the fridge and whether you’ll take the time to make a balanced meal. So many women ensure that their loved ones have proper, nutritious food and yet don’t really bother when it’s just for them. It’s time to realize that you’re definitely worth it.
For |
What else could I do? |
|
A tuna or egg mayo sandwich with white bread |
A tuna or egg mayo sandwich with wholemeal bread to add fibre |
Opt for a tuna or egg salad filling for extra fibre |
A mixed salad with lettuce, tomato, cucumber, peppers and other vegetables |
A mixed salad with lettuce, tomato, cucumber, peppers and other vegetables, plus a protein source like an egg, chicken, hummus or tuna |
Make sure that a protein-rich food makes up at least a quarter of the overall salad |
Tomato or mushroom soup |
Tomato and lentil or chicken and mushroom soup to increase the protein |
Add a tablespoon of ground flaxseed for extra protein and fibre |
A jacket potato with cheese |
A jacket sweet potato with cheese for extra fibre |
Add baked beans for a more concentrated source of protein |
A cheese omelette |
A cheese, mushroom and tomato omelette to increase the fibre |
Add a green salad on the side for an extra fibre boost |
Rye crackers or oat cakes with cheese |
Rye crackers or oatcakes with hummus or sliced egg, for a more concentrated source of protein |
Have a handful of cherry tomatoes or chopped cucumber on the side to boost the fibre |
Rice or pasta salad |
Quinoa salad to add a blast of complete protein to your salad |
Add a tablespoonful of chopped walnuts for extra protein |
Smart snacking is absolutely crucial to maintaining blood-sugar levels, because no matter how balanced your meal is, if you then leave it for five, six or more hours before you eat again, your blood sugar will drop and out will come the stress hormones. Everyone has a slightly different level of glycaemic sensitivity. In other words, some people can go for longer than others before their blood sugar drops, they feel tired and irritable and the cravings kick in. You probably already know where you are on the scale and can act accordingly, but on average, most people will need something roughly every 4 hours to keep their blood sugar on track. If there’s a long gap between lunch and dinner, it’s no surprise that the dreaded afternoon slump kicks in around 4pm. This is the time for a carefully balanced snack, and here are a few ideas:
Smart snacks |
6–7 raw unsalted nuts with an apple, plum or satsuma |
1–2 oatcakes with unsweetened nut butter or cottage cheese |
Carrot sticks, cherry tomatoes or other chopped veg with hummus |
Slices of apple dipped in unsweetened peanut butter |
A cereal bar containing at least 8g of protein and 4g of fibre |
A mini pot of plain yoghurt with blueberries and a tablespoonful of sunflower seeds |
A hard-boiled egg with a handful of spinach leaves |
For most of us, dinner is the meal that should be the easiest, because you’re usually back at home and in charge of the ingredients and cooking methods. The flipside to this is that it’s the end of a long day: you’re tired and possibly lacking in both inspiration and energy. This is the time when it’s really important to remember the principle of basing the meal on protein and fibre, because they keep your blood sugar nicely balanced, which in turn sets up your hormones to give you a good night’s sleep.
Swap |
For |
What else could I do? |
Pasta with tomato sauce |
Pasta with tomato sauce and tuna, prawns or tofu to add protein to the dish |
Swap white pasta for wholegrain pasta for extra fibre |
Chicken and vegetable stir fry with white rice |
Chicken and vegetable stir fry with brown rice for extra fibre |
Stir through some cashew nuts for a protein boost and extra crunch |
Salmon with spinach and mashed potatoes |
Salmon with spinach and mashed potatoes, plus at least one more vegetable portion for sufficient fibre |
Swap mashed potato for mashed sweet potato for extra fibre |
Roasted vegetables with white rice |
Roasted vegetables with quinoa to add protein to the meal |
Sprinkle with a tablespoon of sesame seeds for extra protein |
Meat or fish with rice or pasta and a vegetable portion |
Meat or fish with rice or pasta and 2–3 different vegetables to increase fibre |
Make sure that the rice or pasta is only a quarter of the overall meal, to keep carbohydrate levels in proportion |
Steak with sweet potato fries, which are slow-releasing carbohydrates, helping to maintain blood sugar levels |
Add peas or a side salad to boost the fibre content |
• At lunch and dinner, the protein portion should be about a quarter of the meal and roughly the size of your clenched fist, for example, a small chicken breast or a salmon steak.
• At main meals, the carbohydrate or starch portion (for example, bread, rice, potato, pasta and so on) should be the same size as the protein portion, even when it’s wholegrain starch.
• Vegetables should represent half of the overall meal. Most people get this the wrong way round and have more starch than vegetables.
The great thing about balancing your blood sugar is that it’s practically a one-stop shop of solutions to your menopause symptoms. Think of nutrition as one of those massively complex Venn diagrams where there are lines all over the place and lots of different connections being made. Or, if you prefer, imagine a huge old-fashioned switchboard with all the different wires. This is how nutrition works in the body, so that improving one element of your diet to target a particular symptom will very often positively impact an entirely different symptom.
Here is a whole range of other ways that balancing your blood sugar will improve your wellbeing during the menopause. These are explored in more detail in Chapter 3:
• Increasing your intake of fibre will support the elimination of old oestrogen from your body after your period, keeping the hormone balance right, which helps to reduce heavy periods and flooding.
• You’re likely to be adding more plant proteins to your diet, such as flaxseed, soya or pulses and this will expose you to phytoestrogens, which balance hormones and can help reduce hot flushes.
• The vegetable boost at lunch and dinner will probably mean you’re eating more leafy greens – this will give you a great boost of magnesium, which helps to calm the nervous system and regulate the body’s response to stress.
• Your vitamin B12 levels may increase if you’re eating more animal protein, such meat, fish or eggs. Low levels of B12 can lead to poor concentration and memory, which are typical symptoms of the menopause.
• Adrenaline interferes with the release of progesterone in the second half of the cycle, which can increase premenstrual symptoms of low mood and anxiety, so trying to avoid a blood-sugar crash is a smart move if you struggle with PMS.
• The focus on protein will support your iron levels, because foods rich in animal and plant protein are excellent sources of iron. This will be especially important for anyone experiencing heavy periods or flooding, because this can lead to anaemia. It will also give you the amino-acid building blocks required to produce neurotransmitters, which govern mood, memory and concentration.
• The more vegetables you eat to balance your blood sugar, the happier your liver will be, because they’re full of micronutrients, which support the detoxification pathways that process and eliminate old hormones, helping to maintain the correct hormone balance.
• You’ll be reducing alcohol and caffeine, which are both killers when it comes to hot flushes. They’re also massively disruptive to your sleep.
• Limiting your intake of sugar will not only help with weight management, but keep you feeling calm and cheerful. Too much sugar disrupts neurotransmitter function, which can contribute to anxiety and mood swings.
Along with blood-sugar balance, a diet rich in vitamin C and B vitamins will help to keep your adrenal glands in great shape. This obviously won’t remove external stress from your life, but it will regulate your body’s response to stress, so that your hormones don’t go into overdrive and you feel more resilient and better equipped to deal with daily pressures (see Chapter 4 for more information about how these vitamins are beneficial).
Magnesium is also a key player, because it supports the nervous system due to its role in the transmission of nerve and muscle impulses. A deficiency in magnesium can contribute to feelings of irritability, low mood, anxiety and fatigue. If your diet is rich in magnesium, you’re likely to feel calmer and better able to cope with stress. (See Chapter 4 for food sources of magnesium.)
One quick and easy way to get a blast of magnesium is an Epsom salts (magnesium sulphate) bath or foot bath. Just add 2–3 handfuls of salts, soak for about 20 minutes and your skin will absorb the magnesium, relaxing your muscles and calming your nerves. The combination of magnesium and much-needed “me-time” is a great stressbuster that will set you up for a good night’s sleep.
Camomile, valerian and lemon balm teas all have calming properties, which can help to reduce stress and anxiety. Certain herbs, such as rhodiola, Siberian ginseng and ashwagandha, are known as adaptogens and these may help to counteract the effects of stress in the body by supporting the central nervous system, reducing fatigue and relieving symptoms of low mood and anxiety. The longer you use an adaptogen, the more effective it’s likely to be. If you’re considering using herbal supplements, it’s important to consult your doctor if you have any medical conditions or are taking medication to avoid any potentially harmful interactions.
It’s absolutely essential that you are kind to yourself during the menopause, because it will make a world of difference to your journey through midlife and this extends to lifestyle as well as food. Diet is only a part of the picture when it comes to managing stress; it’s vital to address your lifestyle or it won’t matter how good your diet is.
Women are hardwired to nurture, and if you have children you’ll have probably spent the past decade or two focusing on them and making sure they are well, happy, sufficiently rested and eating nourishing food. If you don’t have children, you’ll probably still have found a way to put other people or other things first. Whatever your situation, you may not have been particularly good at looking after yourself, so this is your time to nurture yourself.
Self-care is crucial at this critical phase of your life, so it’s time to put your own health and wellbeing ahead of everything and everyone else, because it will significantly reduce your stress levels, easing the symptoms of the menopause and making life much, much better for you. If this doesn’t come naturally to you, remember that your loved ones will benefit too because, if you collapse, then everything else is likely to fall apart too, because women are generally at the heart of the household.
• Take time to walk in the fresh air for at least 20 minutes every day, ideally in a natural environment like a park, because studies have shown that spending time in nature can help to reduce excessive levels of cortisol.
• Remember to breathe! Closing your eyes and taking 10 slow deep breaths in and out will slow down your heart rate and calm your stress levels. Do this at least four times a day.
• Give yourself time and headspace: actively schedule “me-time” into your diary so that you have space for yourself.
• Don’t over commit. Manage your diary carefully so you’re not putting yourself under too much pressure with work meetings or family commitments, because that will add to the stress burden. It’s okay not to be Wonder Woman all the time.
• Try not to work at weekends (or make sure you have other days off during the week, if weekend work is part of your job) and plan regular holidays or rest days with no commitments, if possible.
• Treat yourself to a favourite relaxing activity at least three times per week. This could be: a massage; playing a musical instrument or singing; doing something creative with art or crafts; walking in nature; reading; listening to music or simply having a long bath.
• Switch off the social media and email notifications on your phone, tablet and laptop, so that you choose when to check in with the world and you’re not in a state of constant red alert. If people need you urgently, they’ll phone you.
• Schedule in exercise at least three times per week, as this will help to moderate your cortisol levels.
• Talk about your symptoms to family and friends – they’ll be much more supportive and sympathetic if they know what you’re going through.
• Do a regular yoga class, because the stretching and breathing exercises help immensely in relaxing you and relieving stress.
• Seek help: speak to your doctor if you’re worried about your symptoms. Speak to your line manager, HR or Occupational Health if you need extra support at work; talk to your partner, a close family member or your best friend if you’re struggling at home. People can’t help if they don’t know that you’re finding things difficult.
• Have a good belly laugh! This will reduce cortisol levels more quickly and effectively than almost anything else. Spend time with friends who make you laugh.