Peri - Its all about DIET

[Music] There is so much nutrition information out there. So welcome to Diet Notes. The weekly podcast hosted by Dietitians, Susie Bowle, designed to make your diet a whole lot easier. Well hello everyone and first of all thank you for everyone who listened to last week's episode, chatting all things diet reset. I've got some good feedback so we'll continue the press on this January with some special edition podcasts and see how we go. And a topic that has been on my mind for quite some time I wanted to deep dive today was all about the idea of Kerry Menopause and Diet. Because if you are a woman in your 30s, 40s, 50s, you will have, I'm sure, been aware in recent years that every second personal trainer, nutritionist, doctor is now an expert on Perry Menopause and it's not by chance really because really I guess the guru journalist Mia Friedman from Mamma Mia kicked off sort of a huge interest in Perry when she came and one of the first sort of very vocal leaders in women's media around hormonal changes that we impacting her and those around her in this period of their life. And I guess it was sort of the first time through our history where women in their 40s, 50s who were working pretty big jobs also had a voice. You know, if you think about 20, 30 years to when we started or when our mums were going through this phase, you know, there was a lot of primarily males in mainstream media. There wasn't podcasts. There wasn't, you know, online media organizations at all. It was all print and that was heavily controlled by men. And, you know, in recent, more recent years women are in a lot more power. They have a lot more of a voice. There's a lot more social media and an opportunity for women to share in these significant changes that affect metabolism, body composition, well-being, mood, you know, the vast array of symptoms and signs that can precede the menopausal time in a female's life. And that's good, you know, the more information out there, the better. Ideally, it will come from a strong evidence base, people who have qualifications to be talking about it. But I guess the thing that I always find super interesting is that whilst there's plenty of talk about parry and menopause and health, you know, I would say and people would disagree with me, but I would say at least 50% of the shift in body composition, weight, hormones and even symptoms are diet related, if not more, if not more. And if you need any further assurance of that or evidence to support that, there'll be plenty of you listening who have indeed started to investigate hormonal changes. You might be working with a GP or gynecologist or endocrinologist on hormonal shifts. You may have started HRT, which might be the pill. It might be estrogen, testosterone, cream, gel, tablet, all different ranges. You might have spent a significant amount of time and money investigating and looking deeply at your bloods and working with a doctor to help relieve symptoms, things like sleep disturbance, mood disturbance, weight gain. You might have started a GLP medication, waggogi, ozampic, mongaro because of weight gain related to parry and menopause. All those things are all linked. But one of the most powerful things you can do is change your diet because ultimately parry, menopause and menopause will is linked to inflammatory processes in the body. So declining estrogen over time means that the body is not protected from weight gain centrally and it means that a number of pathways will be promoting inflammatory pathways in the body. And that's why your joints might be full sore. That's why you might get a frozen shoulder. That's why you might not be sleeping very well. Your hypothalamus is being impacted. That's why you might have dry eyes as I do or very itchy skin which is really upsetting. You might be noticing changes in your skin, how you're looking in the mirror. Your cholesterol may have increased. In fact, menopause guru, Dr. Merit Claire has of course said what are the first signs from a blood perspective is when your LDL cholesterol starts to creep up over time, which can happen as early as 10 years before full menopause or in our early 40s. These are all things that can be heavily managed with diet. And I really don't think enough of that is focused on. We have a lot of people talking about HRT and getting the right medical advice, which of course, an imperative. But in many cases, once you've started the HRT or even once you've been prescribed a medication like metformin or a GLP1 to help control appetite and prevent weight gain, ultimately it comes down to some powerful dietary changes. And the best place to get those is from a dietitian and not any dietitian. You need a dietitian who is qualified and heavily experienced in the hormonal changes of women through the lifespan. And as such, we'll know how to complement any HRT regime that you've been given with a good GP or endo, but really work in conjunction. And if you, as I said, if you need further evidence of that for everyone listening, who has started HRT and not lost weight or and/or started a weight loss medication, and also not lost weight, that is because without the diet to go with those things, nothing will change. Because whilst menopause and perimenopause is indirectly, and I say indirectly because it's not a direct relationship, that's why you start these medications and your weight doesn't change. Whilst they are indirectly related to weight, just because you bump your estrogen up means you will not necessarily lose weight, it doesn't work like that. It's a much more complicated relationship, which is what I wanted to go through today and go through while you need the dietary changes to go alongside a hormonal replacement or estrogen therapy or changes, physiological changes and symptoms and signs and amenables. So the first misconception that's out there is that estrogen levels are directly linked to metabolism, body composition and weight, it's not the case. Estrogen at a molecular level helps to direct where fat is deposited. So that means that if your estrogen has been declining, you're feeling tired, run down, emotions are all over the place, you're not sleeping well, you've got all the signs, your eyes are dry, you've got dry skin, you don't have a lot of lubrication in the body, all signs that your estrogen is declining over time, irregular periods of course. Now that molecule is complex and as you may have read targets a lot of different body receptors, you know linked to pain in the body, hips, but it doesn't link directly to how fat is metabolized. It doesn't mean that you metabolize more fat just because your estrogen is higher. Rather, it's simply involved in where fat is deposited. So when we're young and our estrogen is at an optimal level, is it sort of protective around reproduction, the hip, the bum, but it keeps the heart healthy in that sort of high abdominal area and that's why we pay a lot of attention to where weight is depositing. It's not about weight on the scales, it's about waist measurement. So if you don't know what your waist is, that is the number one variable to be keeping an eye on in your 40s and 50s and you don't want your waist to be increasing and there's usually two points I measure a waist with any female in their 40s, 50s and beyond. I'll do the highest point, which is sometimes a belly button, particularly if you're a high waisted or you haven't had kids. A belly button waist, but then a lower waist because in the case of having pregnancies, you know, the body changes in size and shape and you might find that even though your upper waist is still quite lean, you're carrying around that lower waist hip bone area and the numbers I'm looking for, I want the high waist, the leanest part of you to be less than 80 centimeters and then the low waist depending, you know, if you're a hundred, I want it to be sort of closer to 90 and that is sort of describing where your body's depositing fat and that's where estrogen comes in. So in the past when you're younger, you might have found that if you gave weight, it might be on your bum, but it would or your legs, but it wasn't on that waist as much whereas now you're probably finding it's creeping up over time. And like monitoring blood test changes so your LDL cholesterol creeping up, it's the waist that you don't want to creep up or in the case of proactively trying to lose body fat, it's the waist measurement we want to be going down, not the weight on the scales because the weight on the scales could be suggested that you're just losing muscle mass and wasting metabolically active tissue, which is the issue with GLP medications like Benjarro, if you're not exercising and burning fat, you'll be wasting muscle and getting lighter but not leaner so you're not improving or protecting body composition. So that's why the waist is so so important. So just because you're on HRT doesn't mean you're going to lose weight rather it should hold or help prevent further abdominal fat. But ultimately if you're gaining weight it's just that your lifestyle habits have caught up with you and that's a harsh reality but it's ultimately true. It means that you are not eating and exercising in a way that allows you to control a certain weight and it really kicks in in our 40s and 50s but not only for hormonal changes, it's our lifestyle and I see it all the time and that is not clearly chatted about. So the first thing, I'm going to talk about three second but I'm going to talk about activity first because I actually think that's the most powerful thing and you'll notice with friends, you'll have friends who go through their mental pauses or years and if they exercise a lot and not not just move but exercise effectively. they won't have the weight gain that other women do. So because it's not about movement, it's about efficient exercise. And in my clinical experience, this is what is missing. Now, it's relatively easy to change your diet. You can eat more protein, you can eat more fresh food, you can lower the calorie load. But if you don't get the right mix of exercise, you will not change body composition and you will not lose body fat. And that's why we're constantly chasing our tails. So the first thing is, it is not enough just to move in particular your 40s and 50s. What may have got you through in your 20s and 30s and flogging yourself at the gym or doing a run once a week or lots of walking in steps will not get you through the menopause of years. And that's because of these changes in hormones and the waist fat wants to deposit around your body. And if you don't have good muscle mass and haven't trained for your entire adult life, you don't have that protective effect which is fending it off. Remember, muscle mass is the metabolically active tissue that burns through glucose and carbohydrates and fats. So if you don't have well functioning muscle, it's going to be pretty tricky and that's where the weight conversation comes in but again, it's quite specific. So the first thing is, it won't be enough just to move. The body needs to move. So if you're someone who sits down a lot through the day, you don't have little kids anymore, you sit in an office job, you're tired a lot, so you tend to sit, you might go to the gym once a day but you sit the rest, that's probably the problem. You've got to be off to move and move a lot. The human body is programmed to move. So if you're getting 10,000 steps and that's it, it won't be enough, but you should be aiming for that anyway, just for mobility. So that's the first thing, won't be enough just to be getting steps. Second, if walking is your choice of exercise, I guarantee you it's just movement, it's not exercise because for it to be exercise and it's similar to Pilates, Pilates is amazing for strength, a long line of the muscle relaxation, but again, you've got to check your heart rate. These are physiological variables we can't change. It's your heart rate is not getting 140, 150, even 160, at some point in a workout. It's not exercise, you're not getting the cardiovascular benefits, you are not training the body cell to burn fat more effectively, you are not improving blood glucose control, you're just in this no man's land and that is where most women I see initially in my practice of sitting. In their head, they're doing a lot, but I have to tell them physiologically they're not because they're not training the cell. Now, what the research shows is that we don't need to do a lot of that. You don't need to do, as we did in the 80s and 90s, an hour of cardio a day, you just need to do some of it, which could be as simple as 20 minutes of hit training or some running as part of your walking or some heel walking, so your heart rate peaks, but you've got to do some of it. Now, some of my clients, I'll say you can go and have a rot your night with your husband and get your heart rate up that way, but trust me, no one I speak to wants to do that, they would rather go to the gym. So whatever your choice is, you've got to get some high intensity training and at a minimum, just roughly, I'd say 20 minutes where your heart rate's getting right up there, 140, 150, of course, if you've got cardiovascular risk, always check with your doctor, but as a general thumb, it has to be getting out there some of the time, at least three times a week briefly, even if it's a bit of running, a bit of interval at the gym, you might do a sort of cycle class at the gym, you might have a sex with your husband or someone else, but you've got to get it up there, that's really, really important. Then the third component is the rate weight training. Now, the muscle mass is important, but you again can't get away with just doing the weights without the cardio. So what I'm seeing is all these women who are getting a little bit of information about parry and menopause and they're eating a little bit more protein here and they're going and doing some weights. And they're then wondering, why am I not losing weight? Because I'm doing everything I'm being told to, but they're actually not, because they're not doing the movement, they're not doing the little bits of high intensity cardio and they're just doing the weights. And when they go to the gym, they might do an hour, they stand around a bit, talk to the trainer, once or twice a week. Serious weight training, you've got to get in there, 20, 30 minutes, do proper training where your heart rate's elevated. Once, twice, however many times you can manage, but it can't be in replace of the cardio stock. You've got to do all three, because one, the basic movements, what human beings need to do, just for a basic calorie load and movement, we need to be cardio vascular training to improve the cell's ability to burn over time. That's exercise, not movement. And third, if you're someone who particularly lacks muscle mass and has never lifted, you need to do some weights, but proper weights. And that might be a pump class, it might be saying a trainer three times a week, but again, if you're not losing body fat, if your waist is not decreasing, if you've got a waist over 90, I would argue that the training really needs to be deeply looked at. It's not enough just to do something, you've got to do the right mix. If your goal is to lose body fat and change body composition. And if you need any sort of feedback, if it's working, it's not working, it's not working. If you've been going to the gym, doing weights, doing all the things that it's not working, it's got to be one of those things. So always check, am I getting enough steps? Am I doing some proper cardio training, at least two, three times a week? And then am I lifting, and if I'm lifting, am I doing it the right way? In many cases, you'd better to do a home based program that you're doing regularly, than going to the gym occasionally, which is also what I see. As people going and they might go once or twice a week, but not consistently, because there's school holidays, and then I was sick, and then I missed that session. Well, you're not doing it. And that's actually why, personally, I've always been a massive fan of pump classes, the good old Les Mills, because it's the mix of cardio and weights. It's progressive, so you train the body to put more weight on over time, which is proper weight training. And it's something that you can do in a class style, so you can even get your equipment into a home or video. You can sign up and do it at gym, so it's there. You don't have to go and sit in the machines, try and get the right machine, sit around while you're waiting for someone else. There's a lot of downtime I find in weight-based workout. So that's something I really want to talk about, because I see it all the time. Now, of course, the third component is diet, and of course, I'm a dietitian. I have vast interest in this. Now, again, it's not about hitting a protein target. Any way you look at the moment, there's a million protein-based foods, women need this much protein. It's like calorie prescription, that's a guide. Someone who's five foot nothing, who doesn't do a lot of exercise, doesn't need as much protein as someone who's five foot 10, doing an hour or two of training a day. It's a guide protein, it's not an absolute prescription. So in many cases, I'm seeing small women eat way too much protein, and they're not actually getting enough good fat and enough carbohydrate. Now, this is not a one-size-fits-all model. I can't tell you how much protein or carb to eat everyone's different, but I can tell you that it is often we're having too much protein at the expense of carbohydrate, or we're not getting our protein from the right sources, because there's a lot of protein-rich foods out there, but very few of them are good quality. So for example, if you have 100 grams of white fish or chicken breast, you'll be getting, say, 100, 150 calories, maybe a little bit more for chicken breast, and then you'll be getting, so, say, two, three grams of fat, and you'll be getting at least 20 grams of good quality protein. If you do that in, say, a protein bar, so say you pay four or five dollars for a protein bar, you might get a very similar number of calories, but only 10 grams of protein. So what's going on out there is we're getting protein, but we're getting a lot of fat and other calories with it. So you have to remember that protein has to be lean. Things like chicken thigh are not lean. Things like a processed high protein pizza are not lean. You're getting a lot of calories for the protein load. So often it's getting back to basics and eating plain protein that's high quality. So another example just come to my mind is, you know, there's a lot of protein-based milk drinks out there, but they're like 300, 400 calories for 20, 30 grams of protein, whereas I can get 20 grams of protein in 100 calorie yogurt. So for small women, it's often being smart with the choices, not just ticking the box on protein. And then just to finish where it goes wrong. And this is not a criticism. This is purely an observation. I am 47. I live this life too. I know the challenges it presents. It's not coming from judgment. It's coming from what I routinely see in practice. What I see is women who are trying very hard, but they do their version of my diet or they do it some of the time. So for example, they might do really well, Monday to Wednesday, Monday to Thursday, where they're eating protein-rich meals, they're having like dinners, they're getting their movement, they're going to the gym, and then it gets to Friday and they're exhausted, and then they might have a dinner out, maybe a takeaway, couple of bottles of wine with friends, and unfortunately we just in this life tend to have too many extras, because at that phase of life, 40s, 50s and beyond, we often have a little bit more time. We love to go out to dinner. We love to entertain. We love to indulge ourselves and treat ourselves because of the pressure. And again, no one is judging that. You know, life is tricky, and if you need a glass of wine or a meal with your friends to relax and indulge, no judgment. But what happens is, in the regular days, there's extras that go in. There's a treat here, an extra glass of wine here, coffee here, and then the weekend starts on a Thursday night and continues to Monday morning. So it goes from having 12, 1400 calories, two or three days to 2000 calories on three or four days. And that's why you're not losing body fat. There's just too many extras going in and the baseline is not low enough, which is why with the programs I work on with women, I like to have lighter days and heavier days because that then allows for more weekend indulgence. But if I'm completely honest, that often does not. need to be pulled back because we indulge way too much and then we're also having treats et cetera through the week. So you've got to create a lower baseline. If you are 80 or 90 or 100 kilos, ultimately your lifestyle habits are supporting that. You are eating in a way that is allowing you to maintain that even though you might have good days. So keep in mind, long term we have to lower it down, shave off calories so you can learn to eat in a way that is fueling you at 60, 70 kilos, not 90 or 100 kilos. So I guess that the thing I would say in summary is it's complicated. It's not as simple as just doing more weights, eating more protein or cherry picking what we like to do. If your ultimate goal is to get your weight, your health under control in your 40s and beyond and you're carrying 5, 10 kilos, you may even just want to halt weight gain. These are the steps to work through it at takes time. One, you've got to get your blood on track, two, you've got to get the right mix of training, exercise, movement and then third, you've got to create the diet that has the light and shade that's required to get you into consistent fat loss considering you also want to have a life, eat out and enjoy alcohol. It's very, very specific but it is manageable and if you're not getting results, I guarantee you one of those things is not coming together whether it's the exercise, the weights, the movement or your diet might be healthy but you're having too much bigger size or you're indulging too much daily or all the time and these are all areas that we work on regularly in getting people to where they want to be with their health and their diet. So I hope for anyone listening in your 40s and 50s that's given you something, a little tidbit that might be helpful in your journey to take control of your health. These generations of women, our generations, touch wood will hopefully live long lives. If you're 40 or 50, you might get to 80/90 with the right steps and genetics. Let's be honest, a lot of it's genetic but these are the steps to set you up to that and rather than feel overwhelmed, just take one area at a time, it might be working on increasing your steps or it might be really looking at your protein quality and then just small steps add up over time and hopefully in six, 12 months if weight losses your goal, we've achieved it almost specifically fat loss but ultimately getting your body healthy or for the journey through the midlife. Next week I'm going to cover GOP medications who therefore what they are, how they work and how if you're using them you can make sure that you're getting the most out of them. Thank you for listening, I look forward to your feedback on this episode and I look forward to seeing you next Monday for the next episode drop of Diet Notes. It's Susie Bowle. Have a great week. [BLANK_AUDIO]