Perimenopause: Cutting Through the Noise on Protein, Cardio & Supplements

[Music] There is so much nutrition information out there. Welcome to Diet Notes, the weekly podcast brought to you by Dietitian designed to make your diet a whole lot easier. Well, hi everybody! It's been a good few weeks since I've dropped an episode of Diet Notes. I was very lucky to spend a month over in the States a trip I'd been planning with my kids for a very long time and probably the longest period of time I've had off work since I can't even remember before, definitely before the twins were born and they're 10. So it's safe to say it was a much needed break and yeah, it's just taking me a few weeks to get my groove on with work to come back to Diet Notes and I've had quite a few messages asking me when it's coming back so I know that there's some listeners who enjoy getting this little update each Monday morning and from here for this school term, I think it's another sort of eight weeks I'll make sure I'm on track to drop an episode a week again to help you and of course we have our Wednesday episode of the Nutrition couch where Liam Ward and I cover current issues in nutrition or review supermarket products, take on listener questions. That is one of Australia's most downloaded, if not the most downloaded nutrition podcast. I think we've had over six million downloads in the past five years. It's a really good podcast so if you haven't listened to that, please give it a go. It's the Nutrition couch, COUCH and it drops every Wednesday morning and we've got a very active Instagram page where we take all of our requests for product reviews and listener questions. Whereas Diet Notes is sort of me having a little chat about topics that cross my path with my clinic and sort of deep diving some nutrition issues. The topic I'm going to talk about today, I don't want to say it's called a peri rant but I'm definitely feeling ranty because there's just a few things in the world of peri that are really bothering me and I've actually made a list that I'm going to work through it. Now I'm going to call it peri musings but it's a rant, let's be honest and I'm hoping that there'll be some information that's helpful because what my experience is at present is there are so many experts and people talking about peri, the information is so murky, you just actually come away with nothing helpful and I'll talk about in a minute why this has evolved but I just think it makes things really confused and saturated but not actually helpful to anyone and that's why in my clinic I'm seeing a lot of women who have got all this information on GLP1 medications and hormone replacement therapy and supplements and strength training and actually none of that's right for them. It's all this general advice that all these people just love to talk about now that peris become a buzzword but actually I'd argue there's very few clinicians who actually even should be talking about it because they're not working with women every day doing this work and they're probably in many cases not even qualified but I'll come to that. So I'll try and keep it as positive as I can and it's also helpful as I can. So the first thing I want to talk about is five years ago we never really heard about peri. You know it was sort of Mama Mia the women's media organization who really pushed that agenda when female journalists were going through this time in their life and and became aware that there was not a lot of information for women out there and you know fantastic for them they've really revolutionized and brought a lot more attention. The other key person in my mind is Mary Claire Harbour who is of course a gynecologist who has a very big profile in pushing the agenda for women to be looking after their health through their forties and beyond. And so the combination of that sort of group has really pushed for this idea of peri and I remember when Mama Mia rang the peri summit it was attended by so many people because people were just desperate for information and bringing it all together. Now fast forward five years and everyone's an expert in peri and anyone who is consulting or communicating online or in social media can see this is a great market for them let's be honest it's about business and work and there's a work opportunity for women who are desperate for information on their health weight the hormone supplements you know so it's just right for the taking but as I said there's there's some issues with that and I think the best thing I can leave you with is just be super careful who you're getting information from because some people I argue shouldn't necessarily be giving it or giving it skewed to selling something generally now yes I have a dietitian clinic yes I have a supplement line but ultimately I'm a clinician I'm a accredited healthcare professional who has worked with women for 25 years so you want people who are actually clinicians working with people to be giving you this information because often that otherwise it's nutrition or training in theory which is very very different from from practice so yes I'll be very clear I do have a supplement company I am a clinician who sells dark consults yes but I'm also an expert in this area and have worked in it for 25 years so that that is often the difference so I'll be transparent from the beginning that I have my position in in all of this or rash so the first thing I want to talk about is why diet I believe diet is the most important peri management strategy because it's the ultimate manager of inflammation and in the body and and we have to all eat and what we eat directly impacts our inflammatory pathways and ultimately our weight so whilst there's a lot of medical doctors and even exercise specialists talking about it really a lot of it I think 60 70% comes back to diet and as such dietitians are the ones who should be delivering this information because yes hormones are implicated and you may need medical support and management with those but ultimately when it comes to body composition inflammation complementing training gaining muscle mass preventing muscle mass loss a significant part of that comes from our diet and as such I believe there should be much greater focus given to that and when there are experts called to panel they should be dietitians who are working with women and have a deep interest in that and I have a bias I like it to come from women I think women are in a very strong position to be advising other women in this space so the first topic I want to talk about in it is why weight and calorie is so tricky because I think there's sometimes diet resentment I've talked about diet resentment in my e-books about having to fine-tune things so much and I wanted to give you a little bit of a reference as to why it's it's a big issue pardon the pump I want you to think back to when you grew up with your grandma I was born in 1978 so keeping my grandmother if she had been alive would have been 1900 now anyone in this sort of age group you probably love lost your grandparents by now they'd be sort of in their 90s or beyond but they were generally smaller humans think back to the 50s 60s I've just had a whole Kennedy focus in my reading and you know people like Jaheo Narcissan they were tiny women you know they probably weighed 45 50 kilos certainly my grandmother was very small I reckon she would have weighed 50 kilos her whole life she took great pride in in controlling her weight that was small one now they weren't stronger they didn't live as long and someone argue they're not as healthy because they didn't have the range of diet and the information we have access to now generally humans live longer because we're stronger fit our healthier we live longer but we're certainly not 50 kilos anymore I think the average Australian woman is like 75 78 we're bigger bigger humans we know that we're taller but I want you to think back then to what people of those generations age and not only with the foods they had access to much much smaller they didn't have the range of snack foods etc they ate three meals a day there was no milk based coffees you know they were fundamental differences in the way they ate the foods they had access to food technology hadn't developed so they didn't have access to process snacks in general that all happened in the 80s and 90s but my grandmother would eat a bowl of nutragrain in the morning I'm not saying it was healthy this is just as a calorie example if she'd drink tea you know with a dash of milk they're gonna capacinos or anything then at lunch she would have a small multi-grain sandwich usually with something like ham and an apple so probably three four hundred calories if she snacks very rarely she would have a few nuts in a scotch in the afternoon and then at dinner she would have two of those kind of lamb loin chops and with all the fat on them potato peas again three four hundred calorie meals she weighed 50 kilos because she ate about a thousand twelve hundred calories a day she didn't do any structured exercise and hadn't her whole life so as such her bone density was probably in her pants and she wasn't very strong but she did a housework herself she did all the gardening herself she washed her car herself so she was not my active as well so of course there's different body sizes and frames but just as a comparison you can't compare that life to ours where we eat non-stop the average calorie intake is closer to two thousand and as such we're seventy eighty kilos plus on top of that of course we're deeply sedentary I'm going to come to a movement in a minute so I think that we have to be realistic in these key changes so when I have a client who comes and this happens all the time these are the most common clients that actually come they might be sixty five kilos and they want to be sixty or fifty eight again and it's an interesting conversation because women of these generations were programmed to be smaller lighter you know it's less now with the girls they tend to be more embracing of more curvy figures and stronger bodies and you know muscle mass which of course weighs more but when they come wanting to be light and lean again it's really difficult because we live in a world where we don't eat a thousand calories a day we're eating easy easily 2000. So I thought it was just interesting to look at the difference and we've really got to make sure that when we're giving advice or setting even dietary goals, you've got to be in line with where we sit now and it's hard. It's hard because there's food around all the time. It's hard because we just naturally eat everything's bigger, dense, are a lot more calories all the time. We sit down a lot more, we're just not as active and often don't have capacity to be. I'll talk about the pile on of peri information as well and the effect of that. So that's where this huge differential comes from. It's that we in our heads, particularly women in our 50s and beyond, think it's nice to be 50 kilos, but our lifestyle naturally is predicting us at 70s. And hence, focusing on functional fitness, leanness, waist measurement are all very, very important rather than weight, because weight is almost irrelevant when we get to sort of a bigger lifestyle. So that's the first thing I want to talk about. The average calorie intake of the average Australian is much, much higher than anyone. And that's why it's also hard to reprogram and reprogramming metabolism takes a lot of work and a lot of time, particularly if you do want to get back down that light and lean and hold it there, it's really, really hard. And these are generally goals that are self driven as opposed to being driven by professionals. I really am only focusing now with my girls on waist and I have this conversation when I have someone who comes and says I want to be 60 kilos or 58 unless they're a very, very small human. But she leads me to protein and protein is a whole nother kettle of fish because I think it's overdone and I think protein is being considered as a one size fits all model. You need more protein. You need to be having 1.5 to grams per kilo. Now I would say out of the 10 say women I've seen in the last week, they're all eating now too much protein because they're small. They're small women. Now if you're 5, 8, 5, 10 and 70, 80 kilos you might need 100 kilograms of protein. But if you like many, including myself, are 5 foot nothing, 158 cm, 160 cm, you don't need that much. At an upper limit you might need 80. So I've seen repeatedly clients coming in and they're adding all this protein in, proteins, eggs for breakfast, cottage cheese, protein shakes, high protein lunches, high protein snacks and they're coming in at 80, 90, 100 plus grams, 120 grams per day and then they're wondering why they can't lose weight. It's too much. If you want to be a small female or are a small female and a small female is a 4, 4, 8, 5, 5 foot one female, you're probably having too much because of the way we eat which I've described as dense, everything's big. And even if you control it you go to the pub and the stakes 300 grams. Well that's like 80 grams of protein. That's the problem. So keep in mind that this blanket protein messaging is deeply misinformed for the average female because it's targeting a certain body shape type, training goal. If you're a 55 year old woman who sits down most of the day, does Pilates twice a week is trying to do a gym session once you probably don't need more than 80, 90 grams of protein. Check your amounts, stick it in my fitness pal, guarantee you you're having too much and probably at night time. That's when we have 150, 200 grams and we think more is better. We grab a protein pudding which is another 20 grams. This is all extras we don't need and it's programming us to be bigger and that's potentially preventing your goals because there's this message that more is bigger, bigger, stronger. It's not if you're out weighing and out sizing your natural small body shape and size. Keep in mind that there's plenty of women out there who went through paramedics for 20 years ago with no drama. They did very little strength training and they didn't eat that much protein and they're still probably doing okay. I think it's overemphasized the impact on your health. I think it's always relevant to an individual which is why it comes down to seeing a person who is qualified to be giving this advice rather than listening to people online who are giving all these blanket diet recommendations and you don't even know what their background is. Number three, I wanted to talk about movement and strength training. If I could have a dollar for every client in the last year who's come to me and he's very proud to inform me they're doing strength training and have dropped all cardio, I would be wealthy because everyone's doing this and this is again getting exercise advice, prescriptive exercise advice from influencers and even experts online who are not clinicians sitting with people each and every day. So because women are so pushed for time and this is my other issue with giving all these to-dos, I do this, cook this, eat more protein, get to the gym, do strength, it's too much. The women I see are working, they're caring for aging parents, they've got little kids themselves, they've got hard relationships at home and then we're telling them to do more. This is the worst thing for women of these generations to do, we're exhausted already. No wonder everyone's got low eye and that's a whole different podcast. So in this very limited amount of time that busy working women in their late 30s, 40s, 50s have to exercise, given all the other demands on their time and they're not getting up at four o'clock in the morning because they're already exhausted, big mistake, if you're already tired, don't get up at four o'clock. To then use the one, two, three hours a week they've got to exercise and take out an hour and a half of that for strength training because let's be honest, strength training means going to the gym, getting changed, getting there after work, doing a class, you're looking at an hour at least, probably an hour and a half and not doing any cardio. Walking doesn't count, walking is movement, it is good for us but it is not true exercise unless your heart rate is significantly elevated. I know it hurts, I hate it too. If you walk the dough gets not exercised, they stop all the time. But focusing just on strength and letting cardio completely fall off the wagon is why you're losing your metabolism. Yes, part of it's muscle mass loss but part of it is because you are not training your body to burn calories efficiently. To do that you've got to have high heart rate, 70% VO2 max. That's going to be at least 131.40 even up to 150, 160 for some women. Some of the time, people don't want to do it. It hurts. It's much easier to get to the gym, lift a few weights, check your phone in between, do a Pilates class and I do exercise, you're not doing hardly any. I know it hurts to say, strength training is hard and Leanne and I are actually going to do an episode on this because strength training really hurts. It makes you sore, it's uncomfortable, you're hurting the next day. But even if you do that two, three times a week with very little cardio, it will not be enough to add some cardio back in and get your heart rate up and be smart with the time you have. If you've only got an hour a week to exercise, you're much better to do half an hour cardio, half an hour weight. If you've got three hours, you're much better to do half cardio, half weights and I would argue with that with anyone because you can't burn calories efficiently just from lifting weights. Yes, it helps with muscle mass, absolutely. But not if you sit down the rest of the time, your muscles are not burning enough calories to remain efficient. So put some high intensity cardio back in their small amounts, you don't need huge amounts, you don't need an hour a day like the old 80s cardio, but you need some and you're probably not doing very much. So check your walking, check your heart rate, but if you're not losing body fat around your abdominal area, probably one of the missing links is cardio, the other will be eating too many calories. For some people you might not be eating enough calories, but you're eating too much protein. And this is how technical it is and this is where I get frustrated seeing every expert out there giving this advice, but none of it's overly helpful. Or Ash, another rant, supplements. Now, yes, there are some supplements, including creatine, fatty magnesium, including collagen for joint health in particular, that can be particularly beneficial in perimenopause and beyond, because there is evidence to support their use if they're used in the right way. The same for a good quality protein powder. It's just just an efficient way to get protein, particularly for people who might not eat a lot of meat or don't like a lot of dairy. But should X, TV stars, beauty queens, supermodels, influencers be selling, formulated dietary supplements to the average woman? Absolutely not. Because these people generally have very few qualifications and let's be honest, a lot of nutritionists out there don't have many qualifications either. Some may have a university degree, fantastic in science, others have just done a course. This is your health. Should you be buying dietary supplements from people who are not qualified nutritionally? Absolutely not. Because ultimately it's a business for them and it's a business that it's really easy to get into. Anyone can, white label, protein powder, magnesium, you could do it, put some profit margins on it, sell hot chocolates for 80 bucks a pop and make some money. But should they be doing it? I don't think so. You should be buying dietary supplements and taking dietary advice from those who are qualified to be giving it. So just be mindful that it's a very easy business on the side for influencers, television stars, celebrities who need to make a quick buck as their career winds up. But whether you should be throwing your money at them, at least throw it at a reputable group who is qualified to be formulating nutritional supplements. And that is like crazy to me that it's even allowed. But it's hard to even regulate food labeling in Australia, a little low and put a limit on who can make and sell supplements. But particularly when it comes to giving women, prescriptive dietary and health advice for television celebrities and influencers to be on Instagram and TikTok telling you what to do. Come on, you're smarter than that. They're selling you and flogging your product to make some money. Now we all want to make some money, but at least some of us are qualified to be doing it. So just be aware that is right out there horrifying. And these are also the products that are sold at two, three times the markup, which means that basically if you're paying for five grams of collagen, there's no benefit to paying double, same with creatin. In the case of creatinine, you're often paying for German sauce, which is more expensive, but unless that person is qualified, stop being reptiles. So what are my positives, I can say? I can say that there is a lot of noise out there, and I can say that a lot of people are trying to get a position in the market based off Perry, but in my clinical experience, the best thing you can do is work with professionals, whether it is a dietitian, whether it is a qualified personal trainer, exercise physiologist, and you'll notice those people are a lot quieter online because we don't want to get up there and claim that we can solve the world with our diet or with our exercise. It's good to work like that. It's a lot more complicated, but just taking random pieces of advice from a wide range of people is something to be keeping in mind. That can be same if you said the GPs who are very quickly prescribing GLP1 medications for people who need to lose less than 5 or 10 kilos without any risk of diabetes in the family. This is completely inappropriate as well. There's a lot of that going on. So basically my end point in this rant about Perry is get your information from people who work with people every day in this space. Get your supplements from people who are qualified to be formulating them. If you're not getting the results you're looking for, check things like how many calories are you actually having? You can do this online. How much protein is it too much for you? You probably haven't a bit too much. Are you doing some cardio? Are you doing too much strength when you should be doing cardio and getting a reduction in waist measurement? All of those things are relevant. If you've only got a handful of kilos to lose, you probably don't need a GLP1 medication and they stop working because they're not right for those people. All of these factors are at play and why there's a lot of misinformation about Perry out there and quietening the noise and getting it just from a small group of qualified people is a pretty good place to start. I have put it in an ebook. As I said I am qualified to be writing and selling these things which has as four weeks of diets, calorie controlled recipes and a lot more in-depth information on some of these areas. You can find that at my website. A lot of the information we give myself, Leanne, ward my business partner, we give it for free because we're qualified professionals and this is part of our stick is to be sharing evidence-based nutrition information for busy women. So that's enough of a rant. I'll be back next week with a topic. I'm about to put together my topics and one of the ones that has been requested is getting off a weight loss plateau and how to stop weight regain when you have lost it. That will be the topic that I talk about next Monday. And in the meantime, have a good week, keep active, get your heart rate up with some cardio and I'm Susie Burrell and I'll see you next week for our regular episode of Diet Notes. Thanks for listening.