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Diet and the Menopause: What Makes a Healthy Menopause?

A healthy diet is one of the cornerstones of optimizing health across the menopause continuum, and yet less than 20 percent of women in the United States maintain a healthy diet during their menopause transition and beyond.

This is unfortunate, especially considering that a healthy diet has many benefits, from lowering the risk of heart disease (the number one cause of death for women), reducing the risk of type 2 dia­betes, preventing constipation and hemorrhoids, lowering the risk of colon cancer, and reducing the risk of Alzheimer’s disease to name a few.

A healthy diet is an important foundation and should be thought of as preventative care. Despite this medical truth, discussions about diets often fall by the wayside in favor of interventions, such as menopausal hormone therapy (MHT) or supplements. The reasons are multiple and sometimes complex. While it’s true many health care providers receive little to no training in nutrition, many are equipped to have these conver­sations but they don’t have the time in a twenty-minute (or less) office visit to discuss changes of menopause and menopausal hormone therapy, never mind diet unless they can bend time to their will. It can also be difficult for people to access the real experts on nutrition—registered dietitians or appropriately credentialed nutritionists.

The Challenges of Food Science

In addition to communication and access issues for nutrition, food science is challenging. Studies can have bias due to funding, in the same way that Big Pharma influences studies on medications. Then there’s the sheer volume of data produced, and much of it is contradictory. Almost every day it seems as if there is a new dietary do or don’t. Are eggs good now or are they bad? It’s easy to lose track as the consensus seems to change as often as hemlines.

What we eat and how our body uses that fuel is very complex and can rarely be boiled down to a single ingredient. Observational studies can generate interesting information and trigger hypotheses, but the data is rarely clean enough to make definitive conclusions.

Basically, the science of nutrition is challenging, and sometimes studies raise more questions than they answer, but that is also the meandering path of science. The problem is most of us—doctors in­cluded—want a nice, tidy answer about food.

Eating Plans and Menopause

With this in mind, what are the best dietary plans for the menopause continuum, if any?

The healthiest diet for menopause will typically be the one that’s heart healthy, as heart disease is the number one cause of death for women. Ideally, this diet should also include special attention to prevention of os­teoporosis, Alzheimer’s disease, and breast and endometrial cancer.

It’s easy to cherry-pick data from studies and weave a compelling tale about the supposed superiority of one diet over another, but many diets have both pluses and minuses, and the reality of food science means there are a lot of “well, maybes” and “it depends.” There’s also context. For example, it’s best to limit saturated fats to less than 10 percent of your daily calories and down to 5 percent or 6 percent for a heart-healthy diet.

And yet if someone loses and maintains a 25 kg weight loss following a low carbohydrate diet that is high in animal fat (which is saturated fat), as long as their triglycerides and LDL are in the normal range, then that diet is likely healthy for that person. Any negative effect on triglycerides and LDL is offset by the health benefits of the weight loss. Perspective here is important.

It’s also important to remember humans are creative omnivores. Be­fore mass migration and emigration were possible, humans thrived in wildly diverse sources of food, so there seems to be significant adaptabil­ity. This means there are many ways to eat healthy.

There are three diet plans that appear to be beneficial for heart and brain health as well as lowering the risk of diabetes, which are three of the biggest health concerns for women as they age. The DASH diet (di­etary approaches to stop hypertension), the Mediterranean diet (based on traditional diets in Greece, Southern Italy, and other Mediterranean regions), and the MIND diet (Mediterranean-DASH Intervention for Neu­rodegenerative Delay), which combines aspects of DASH and the Mediterranean diet with an emphasis on foods that have been shown to be neuroprotective or brain healthy. All three diets focus on lean meats, fish, whole grains, fruits and vegetables, and olive oil, and they limit salt, sweets, and eliminate ultra-processed foods and sugar-sweetened bever­ages. Women interested in learning more about these diets can find quality information at the American Heart Association (go to heart.org) and the National Institute of Aging (go to nia.nih.gov/health) and search internally on the sites.

Plant-based diets (vegetarian and vegan) can also be very heart healthy and are good options, but will require supplementation with omega-3 fatty acids and vitamin B12, and possibly with other micronu­trients such as iron.

The Bottom Line

  • The foundation for healthy eating is whole grains, plenty of vege­tables, and fruit.
  • Women should have 25g of dietary fiber a day.
  • Ultra-processed foods are associated with many negative health outcomes, so reducing or eliminating these foods can be very beneficial.
  • Fish and seafood are the only source of the essential omega-3 fatty acids.
  • The DASH, Mediterranean, and MIND diets are three excellent plans for overall nutritional health during the menopause con­tinuum.