Menopause missing links
Almost half of women are worried their diets aren't meeting their nutritional needs in menopause.
That's according to a research report by the Health & Food Supplements Information Service (HSIS, www.hsis.org).
Menopause Nutrition: Challenges and Opportunities also found that too few women are taking the simple step of bridging nutritional gaps with a dietary supplement.
HSIS dietitian Dr Carrie Ruxton says: "Around the menopause, women's nutrient intakes need to adapt to support their changing health status. It's more important than ever to have plenty of bone-strengthening vitamin D and calcium as well as heart-healthy omega-3 fats and B-vitamins, which also support cognition and mood. But too many are simply unaware."
The report shows that seven in 10 women realise a healthy diet can help ease menopause symptoms. But this awareness is not backed up with action as almost half (49%) are concerned their diets may not provide the nutritional support they need during the menopause.
Those in perimenopause and menopause – who are most likely to be experiencing symptoms – are understandably most likely to be worried. Two thirds of them felt this way.
The report, conducted among women aged 19 to 64 years, shows:
- Almost one in ten (9%) don't get enough calcium in the diet
- 15% are clinically deficient in vitamin D – vital for bone health and immunity
- A quarter (24%) don't achieve the target for potassium — a key nutrient for blood pressure control
More worryingly, one in five women (20%) are doing nothing to plug these nutrient gaps. Various reasons include simply not thinking about it (27%), believing they don't need a supplement (23%) or expecting to get all the nutrients they need from the diet (22%).
The report also highlights the dire consequences this level of complacency can have on key areas of women's health as they age.
Calcium and vitamin D
Calcium and vitamin D become increasingly important to slow the bone loss that typically occurs in the perimenopausal years. This is due to falling oestrogen levels, but vitamin D uptake is also dependent on vitamin K.
GP Dr Nisa Aslam says, "We actually absorb less than half the calcium in the food we ingest, and without sufficient vitamin D, this plunges to 10 to 15%. The effect is compounded by the lack of oestrogen seen during menopause since oestrogen boosts calcium uptake. So our ability to absorb calcium falls just when we need it most."
Reduced nutrient absorption
Nutrient absorption in the gut becomes less efficient as we age, and this inhibits uptake of a wide range of vitamins, minerals, the amino acids which make up proteins, and lipids, including cardio-kind omega-3 fatty acids.
Malabsorption increases the risk of shortfalls of B vitamins, particularly B2, B6 and B12, and this may contribute to the increased risk of cardiovascular disease and dementia seen in studies of menopausal women.
Lipid metabolism
Falling oestrogen impairs lipid metabolism which causes a surge in levels of unhealthy LDL cholesterol and is also thought to be one of a number of mechanisms driving the increased risk of heart disease and type 2 diabetes associated with menopause.
One study found there was also a significant increase in the proportion of LDL cholesterol particles that were very small and high-density — the most dangerous type — with this rising from 10-13% in premenopausal women to 30-49% after menopause. This underlines the importance of a diet rich in antioxidant vitamins and polyphenols and heart-healthy omega-3 fats.
Gut microbiome imbalance
During ageing, the gut microbiome becomes less balanced, with fewer 'friendly' bacteria and more species that promote inflammation. This escalates with falling oestrogen.
Dr Ruxton says, "The gut is the engine-room of nutrient absorption and we know that the microbiome influences the metabolism of a number of vitamins and minerals. Having a less balanced gut microbiome has also been linked with greater risk of obesity, type 2 diabetes and neurological problems in older adulthood.
Beneficial gut bacteria also play an important part in the production of body chemicals including serotonin, dopamine and tryptamine which help regulate mood and sleep. There is huge potential around the use of prebiotics and probiotics to rebalance gut bacteria and there is already evidence that probiotic supplements can ease some menopause symptoms."[13]
Nutrient disruption
The use of prescription medicines increases in the perimenopausal period, and many disrupt nutrient uptakes. Drugs which are known to impact nutrient status include metformin, commonly prescribed for type 2 diabetes, proton-pump inhibitors which reduce stomach acidity and are often used to protect against other medications such as NSAIDs, and diuretics used to treat heart failure.
Other factors
Ageing is associated with chronic inflammation, and there is emerging evidence that this spikes during perimenopause. Oestrogens are important for regulating immunity and inflammation, but the protection they provide ebbs away with menopause. This increases the need for antioxidants such as vitamins A and E and anti-inflammatory omega-3 fatty acids.
Lower oestrogen in the blood also increases the need for choline, a nutrient which the body converts into the messenger-chemical acetylcholine. This is important for memory, mood, muscle control and other brain and nervous system functions.
Studies confirm that post-menopausal women need higher intakes of choline and shortfalls of this nutrient increase the risk of non-alcoholic fatty liver.
Fertility & pregnancy
Folates are metabolites of folic acid (vitamin B9), found naturally in eggs, beef liver, dark leafy greens, broccoli, Brussels sprouts, asparagus, citrus fruits and beans. As with all B vitamins, folates are important for metabolism, cell growth, blood health and nervous system nourishment.
"This nutrient becomes particularly essential during pregnancy as studies show that it can reduce the risk for baby brain and spine malformations, especially if there is history in family," says Natures Plus nutritional advisor Martina Della Vedova.
"Doctors and midwifes always suggest taking it. Dosages normally are 400 to 800mcg, even if higher amounts can be recommended by doctors. And Folate is a very easily absorbed form of folic acid."
Vitamin B6, among the other B vitamins, contributes to the regulation of hormonal activity and in fertility. During pregnancy, blood volume increases drastically and it is a common issue for pregnant women to have lower iron levels. Iron is very important to oxygenate mother and baby tissues.
Chromium contributes to the maintenance of normal blood glucose levels. "This is a very important nutrient to look for in a multivitamin for pregnancy as it helps to keep energy levels and nausea under better control," adds Martina.
She points out that Source of Life Garden Prenatal combines these crucial nutrients to support all stages from fertility to pregnancy and breastfeeding with enhancing herbs such as ginger, fenugreek, flax, prune, and cranberry.
Bleak picture of nutrient levels in women
Recent National Diet and Nutrition Survey findings reveal just how nutrient-deficient many people are, especially women.
More than half (54%) of teenage girls are short of iron, which could in time lead to iron deficiency anaemia. More than a quarter are also low in riboflavin with potential impact on energy levels as B vitamins are required for energy release from food.
Inadequate intakes of selenium, zinc, iodine, calcium, potassium and magnesium are also common, particularly in women and teenagers.
Iodine is important for the normal function of the thyroid gland while calcium, vitamin D and magnesium are vital for normal bone health.
Potassium helps to regulate blood pressure – high blood pressure is a risk factor for stroke and heart attack. Iron and vitamin D are important for normal immune function.
One in six (16%) are short of calcium, and 10% lack folate (folic acid). Shortfalls in folate are serious for young women who might become pregnant and risk having a baby with a neural tube defect.
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