One cannot think well, love well, sleep well, if one has not dined well.
—Virginia Woolf
Many of the practitioners who shared their advice for this book emphasized how critical it is that we make good nutrition and a healthy diet a core of our overall health focus in perimenopause/menopause. There are a number of reasons to pay particular attention to diet during this time of life. First, many women gain weight during the transition from perimenopause to menopause. If there is a thyroid slowdown taking place at the same time, the metabolism is suffering a double whammy. So not only is eating well important for your overall health and hormonal balance, it’s also critical to prevent weight gain due to slowed metabolism and hormonal shifts. Ob-gyn Dr. Risa Kagan shares her thoughts on why it’s so important to adapt your diet:
Diet modification is essential…. You need to be looking at what you’re eating and how you’re eating. Not gaining those extra ten pounds during the forty-five to fifty-five age range is going to help you later in life, in terms of maintaining a normal body weight and reducing joint pain. You have to find what is going to work for you, and it has to be a way of life.
Second, improved nutrition can help with specific symptoms of perimenopause/menopause, such as hot flashes. Holistic physician Dr. Martin Mulders says that “while changing the diet is the hardest thing to do, changing the diet is perhaps one of the most important things that women can do to help with their hormone-related symptoms.” He shares the story of one patient:
A woman came in in menopause—she was having twenty hot flashes a day, she was on Premarin and Provera, and she was seeing me as a “last resort.” She also had digestive problems. I put her on a gluten-free, dairy-free diet. Three weeks later, she came back, and instead of twenty hot flashes, she was having only two or three hot flashes a day, she had lost ten pounds, and her digestive problems were gone.
Third, many thyroid patients have less-than-optimal immune systems (especially the many millions of us with autoimmune Hashimoto’s disease). Dr. Mulders says that we can view the immune system like a big bucket. When the bucket runs over, we call it a “disease.” When you take junk out of the diet, you’re essentially “scraping out the bucket” and leaving more space. When you add proper nutrients and support the hormones, “you actually make the bucket bigger.”
Finally, heart health becomes a concern at this time, as heart disease becomes more prevalent in women over age fifty. So improving our diet is even more essential as we get older. (Don’t forget that thyroid problems typically increase our risk for heart disease somewhat, even more reason to make sure your diet is heart healthy.)
There is no specific “menopause diet” that is a perfect fit for every woman. But there are a number of practical and effective recommendations that can help you feel and live well and apply, across the board, to most women who are dealing with hormonal changes due to thyroid problems, perimenopause, or menopause.
Chew, Chew, Chew
I love this recommendation, and I think it’s a wonderful one to start with. It comes from New York City–based holistic nutrition counselor Irma Jennings, who spoke with me at length for this chapter. Irma works with many women who are experiencing hormonal fluctuations, to help improve diet and nutrition. She believes that one of the most fundamental changes that women can make with regard to what we eat is to chew. In her presentations, Irma hands out raisins and has women eat one raisin, eyes closed, chewing it as many as twenty times, to experience the sensation of thoroughly chewing, savoring the flavor, and observing how chewing releases digestive enzymes and allows them to work properly. Says Irma:
Chewing is such an important action that is often rushed through using our fork as a shovel, and is often sandwiched between our multitasking, such as watching TV, reading, checking e-mail, working, talking on the cell phone, and dealing with children or any other interruptions. Gulping our food bypasses the enjoyment of feeding ourselves on the deepest level. The digestion process actually begins in the mouth, where we digest carbohydrates, simple and complex, and veggies, fruits, grains, etc., with the release of the enzyme in the saliva known as amylase. The more we chew, five to ten times, the easier the digestive process will be.
Reduce Portion Sizes
Americans eat huge portions. Even if you’re focusing on healthy foods, large portions can derail your efforts at good nutrition or weight management. To help reduce portions, use a smaller plate for your meals, and start with a small portion (and wait ten minutes before taking seconds). At most restaurants, where portions tend to be especially large, make it a habit to ask for a takeaway container or doggie bag at the beginning of the meal, and put some of your meal aside to eat at another time.
Eat More Fruits and Vegetables
It sounds so basic, but a healthy diet should include a good supply of fruits and vegetables. If you are trying to lose weight or are struggling with a slower metabolism, emphasize vegetables over fruit. Limit the higher glycemic fruits like bananas and starchy vegetables like potatoes and instead choose nutrition-rich, low-calorie green vegetables and high-fiber fruits like berries and apples.
You can limit high-glyemic carbohydrates while still eating a vegetable- and fruit-rich diet. The South Beach Diet and its updated edition, The South Beach Diet Supercharged, for example, have excellent recommendations on a nutritional approach that is well suited for people with thyroid problems who are in hormonal flux and who want to eat well and either maintain or lose weight.
Since fruits and vegetables are so good, should you become a vegetarian? Dr. Annemarie Colbin, a nutritionist, author, and founder of the Natural Gourmet Institute, a prestigious cooking school in New York City, says not necessarily. Dr. Colbin ate a vegetarian diet and followed macrobiotic diets at various points in her life, but she said that at menopause, she craved red meat and did not deny herself. Says Colbin:
Vegetarianism really only works for those who do it without thinking. It feels natural to some people; they just don’t even have to think about it. If you have to really work at being a vegetarian, then it’s not for you.
For those who are vegetarians, Dr. Colbin cautions against being what she refers to as a “junk food vegetarian.”
Junk food vegetarians often live on sugar, sweets, and canned foods, which have nothing to do with health.
Eat Healthier, Low-Fat Sources of Protein
Everyone can focus on shifting from high-fat protein sources like red meat, toward more of the healthy, low-fat sources of protein in your diet, including nuts, seeds, and legumes (like beans). If you are a meat eater, you don’t need to stop eating meat, but you should cut back on the amount of meat you eat. When you do eat meat or poultry, use organic, hormone-free, grass-fed meat and poultry whenever possible, and trim visible fat. And try to choose the lower fat cuts of meat, including
With poultry, skinless white meat is always your best choice.
Eliminate Processed Foods and Refined Sugars
Most of the practitioners I spoke with felt that eliminating processed foods and refined sugars as much as possible is an important nutritional goal for women.
Nutritionist Irma Jennings summarized some of the concerns:
Processed foods typically have a long shelf life due to the preservatives and processed added oils. They often come in brightly colored packaging to attract the attention of the consumer and are typically high in sugars, such as high fructose corn syrup and artificial sweeteners.
Sugar can easily become an addiction. As with any addiction, the body leads one to believe that sugar is needed. The packaged/fast food industry relies on this addiction to sell their foods.
Sugars are acid forming and known for leaching calcium from our bones. The preponderance of sugar in most processed and packaged foods (even in many so-called health foods) and in our American culture hides the fact that refined sugar is a recent, and growing, phenomenon.
The processed and sugar-laden packaged foods are most often found in the center aisles of the average supermarket, so many nutrition experts suggest you shop the perimeter of the grocery store, where the fruits and vegetables are typically located.
Ignore the claims on processed and packaged foods that promise “low-fat,” “low-carb,” “low sugar,” or “fortified with” because these are typically misleading.
Eat Organic, Pesticide-Free, Hormone-Free Food
Irma Jennings recommends buying organic foods whenever possible:
Whole organic produce is far superior. They are grown in healthy soils, whose crops are rotated from year to year, allowing the soil to retain its nutrients, as opposed to the depleted, over-farmed produce that we find at the markets. They naturally have a significant nutritional impact, are rich in the vitamins, minerals, and phytonutrients our body needs, and are grown without synthetic pesticides, herbicides, chemical fertilizers, or hormones.
Incorporate Good Fats
If you are trying to lose weight, you may need to cut back on fats in general, because they tend to be higher in calories, compared with protein and carbohydrates. But eating healthy in the perimenopausal/menopausal years does not necessarily mean eating low-fat; it means eating some good fat. As discussed in Chapter 3, cholesterol, which is a component of fat, is the building block for all our sex hormones. Dr. Annemarie Colbin explains:
I don’t like low-fat diets; we need good fats, for fat-soluble vitamins, for hormones, for the brain and the nervous system, and to feel that we’ve had enough to eat. But fats should be good quality—organic butter, extra virgin olive oil, coconut oil. You need to include some fat in the diet; otherwise you’re not going to be happy.
So minimize or eliminate the saturated and trans fats, found in red meat, full-fat dairy products, many fried foods, and many processed foods. Instead, focus on polyunsaturated and monounsaturated fats found, for example, in nuts, oily fish, avocado, olive oil, canola oil, and flaxseed oil.
About Drinks: Water, Coffee, Soda, and Alcohol
First, remember not to drink your calories. Sugary soft drinks, juices, and special coffee drinks are all calorie-laden. Studies have shown that beverages do not fill you up like foods, and even if you drink these high-calorie beverages, you’ll still eat the same amount.
Nutritionist Irma Jennings suggests that we should replace sodas in particular with other drinks. According to Jennings:
Soft drinks are high in phosphoric acid and sugar, making these drinks high acidic. Calcium is the main mineral the body uses to neutralize that acid. Phosphoric acid depletes calcium levels by causing it to be pulled from the bones. In my research on bone health, I have never come across one article that suggests that diet soda is good for bone health. If you drink diet soda, start adding one glass of water a day for a week. Then replace one diet soda with a glass of water.
Jennings also encourages women to drink plenty of clean water. But how much water should we be getting? Recommendations vary, but acupuncturist and holistic practitioner Dr. Jocelyne Eberstein feels that perimenopausal and menopausal women should be drinking at least 100 ounces of clean water a day.
How and where you get your clean water will depend on how much effort and money you want to put into your water supply. Some women use a Brita, PUR, or similar filter to remove basic impurities from tap water. Others buy calcium-rich mineral waters, like Perrier and San Pellegrino, for regular drinking or have a water service that delivers spring water to the home or office. Some households install more elaborate, higher-end reverse osmosis and specialized whole-house water filter systems to remove toxins.
As far as alcohol is concerned, we know that the jury is out on how healthy it is. Some studies show that moderate drinking, that is, less than two glasses of wine a day, may help heart health. But more than two drinks a day may increase breast cancer risk. If you like to have a drink, be moderate, and keep in mind that the calories in alcohol can add up. For example, a regular beer has 150 calories in a 12-ounce serving, most spirits have 60 to 70 calories in a 1-ounce serving, wines range from 80 to 10 calories a glass, and margaritas and other sweet drinks can have 200 or more calories per glass.
If you are having night sweats, consider eliminating alcohol entirely. Tucson, Arizona–based holistic physician Molly Roberts has found that, for her patients who are experiencing night sweats, eliminating all alcohol frequently lessens the frequency and severity of night sweats or eliminates them completely.
Go Japanese
Nutritionist Dr. Annemarie Colbin believes that it’s not as much the soy, but rather the seaweed and fish in the Japanese diet, that may play a role in minimizing menopausal symptoms for Japanese women. There’s the additional benefit of these foods helping thyroid function, due to their natural iodine content.
Dr. Colbin recommends we eat incorporate more Japanese-style cooking, and, as Colbin told me, “eat a Japanese meal twice a week—some sushi, miso soup, and seaweed salad.”
As a sushi lover myself, I have no problem incorporating this recommendation into my diet. If you don’t have time to go to a Japanese restaurant or can’t cook Japanese-style meals, Dr. Colbin recommends you add a bit of nori to your diet. Nori is a dried seaweed that comes in thin sheets; according to Dr. Colbin, you can add it to soup or even eat it plain as a snack.
(Note: Dr. Colbin has a wonderful video, The Basics of Healthy Cooking, that in less than two hours teaches you about healthy cooking, even how to roll sushi. I highly recommend it if you want to try incorporating Japanese cooking at home.)
Eat More High-Fiber Foods
Aim to get 25 to 30 grams of fiber every day, ideally from foods. High-fiber foods include bran cereals like All-Bran, Bran Buds, 100% Bran, and Raisin Bran, whole grain breads, lentils, lima beans and other beans, and most nuts.
High-fiber vegetables:
High-fiber fruits:
Note: While they are rich in fiber and nutrients, avocados and dried fruits are not low-calorie foods.
Remember that if you are taking thyroid medication, fiber-rich foods can interfere with the effective absorption of your thyroid medication. So if you start a high-fiber diet, you should have your thyroid rechecked eight to twelve weeks after making this change, to assess whether you need a dosage readjustment.
Calcium (and Calcium-rich Foods)
Many experts recommend that after menopause, a woman should be getting at least 1,500 mg of calcium daily, to help prevent loss of bone mineral density. Perimenopausal women should be getting 1,000 to 1,200 mg of calcium daily. Ideally, calcium should be obtained from food. The following are some guidelines to calcium content:
Other foods high in calcium are
It can be hard to eat enough calcium-rich foods to get sufficient amounts of calcium, so many women need supplements. You can use something as simple and inexpensive as calcium carbonate (for example, Tums) or calcium citrate supplements. Many practitioners suggest you avoid calcium products made from bone meal, dolomite, or oyster shells, as these products may contain unnecessary lead.
Since you can’t absorb more than around 500 mg of calcium, spread out calcium supplementation throughout the day. It’s best absorbed when taken with food.
Important note: If you are taking Synthroid, Armour, or any other thyroid hormone replacement drug, calcium supplements and calcium-fortified products can interfere with absorption of these drugs, so allow at least four hours between taking your thyroid hormone drug and calcium-rich foods or supplements.
Watch Goitrogens and Soy
While making sure we get more vegetables in the diet can be healthy, we also need to be careful about the effect these foods can have on the thyroid when consumed improperly or in too large a quantity.
Goitrogens are chemicals found in certain foods that promote formation of goiters and can slow down the thyroid, causing hypothyroidism. Specifically, goitrogens inhibit the body’s ability to use iodine, blocking the process by which iodine becomes the thyroid hormones thyroxine (T4) and triiodothyronine (T3).
If you don’t have a thyroid gland due to surgery, or if you’ve had radioactive iodine treatment, you don’t have to be particularly concerned about goitrogens. If you still have a functional thyroid, however, you need to be more concerned and careful not to eat goitrogens uncooked in large quantities. The enzymes involved in the formation of goitrogenic materials in plants can be partially destroyed by cooking. Eating moderate amounts of goitrogenic foods, raw or cooked, is usually not a problem for most women.
A list of common and potent goitrogens is featured in Chapter 2.
Soy, in addition to being a goitrogen, is a plant estrogen—or phytoestrogen—which means that soy can act as a weak hormone, operating like estrogen in the body. I’ve discussed soy at greater length in Chapter 6.