78: Navigating Perimenopause Nutrition with Ange Clark

Welcome to the Dear Menopause podcast, where we discuss the menopause transition to help make everyday life a little easier for women. Hey, this is Sonya, the host of Dear Menopause. I have a very juicy episode for you this week with Angie Clark, and it is all about perimenopausal nutrition. I'm giving you a warning you may want to split listening to this one up into two parts. I chose not to split it up because the info is so good I couldn't choose where to split it for you, so strap yourself in. This is a ride and it is jam packed with everything you could possibly want to know about what to eat, when to eat it and what causes some of that really annoying midlife middrift gain, and what you can do about it. Enjoy listening to Angie. Hey, angie, thank you so much for joining me today.

Thank you, Sonya. It's an absolute pleasure to be here.

I have been looking forward to this chat for a number of weeks, since we set it up, and I've had conversations with a few ladies as well that have come to me saying, hey, can you ask about this, hey, can you ask about that. So this is a really timely chat for us. So let's kick things off. How about you introduce yourself and tell us a little bit about who Angie Clark is?

Okay, well, I mean, it's a big question and I did want to know how far back we should go, but I think I'll keep it to what's relevant and how. I sort of started to come to work with the perimenopausal population and, to be honest, my first love has been always in exercise. So I graduated out of a human movement degree, majoring in exercise science, and I had this insane passion to figure out what I could eat and how I could train for the best body composition and the best type of health. So my entry into dietetics and food and nutrition because that's kind of where I sit now has really been led by a performance factor. So unfortunately, a lot of dietitians kind of enter the field in terms of wanting to figure out how they can help clients lose weight and unfortunately that's the societal message that we get, that as women in particular, we're always trying to make ourselves smaller and my angle was never that at all, which is probably what led me into falling into sports dietetics. So after I did my human movement degree, I was working with actually a musculoskeletal rehab center with pain management. I loved strength training. I thought that that was so empowering for women to the point where on the last day of high school I took a. I'm not sure if you're familiar with this book, but it was a. It was Bill Phillips was the author. It was called Body for Life. I'm very familiar with that. Yep, I thought you might because of your background of personal training. So I thought, oh gosh, like this is the book. That kind of was the catalyst to me, figuring out or wanting to know how to change a physique through exercise and through nutrition. And that was my first protocol. And, of course, me being 17 year old, small, thin, female with an endurance background, and you know, my dad's a French cyclist. So I had nothing, no ounce of muscle on me whatsoever. I walked into a female only gym in Cairns, mind you and they almost fell over backwards when I said I want to put on muscle. Can you help me do it? So I think all and to give you a perspective, it's probably at least 20 years ago now I was going to say that they would have fallen over backwards 20 years ago. Yeah, exactly right and now it's not the case, which I'm so passionate about. But and I'm excited as well but the whole purpose to my journey was that, unfortunately, when I was looking at the questions, I couldn't get them answered in relation to well, what do we do to make sure that we're in the most optimal physique state? So I first and foremost wanted to know what exercise should be done. So I went and did my human movement degree and graduated with exercise science underneath my belt and then all too quickly ended up asking more questions going well, training is one side of things. Well, what do we do about the food and nutrition to support that training, to change that physique? And so, whilst it sort of started out as something that was quite external like, I really just wanted to know how to change, how to get stronger, how to be an empowering female. It then sort of delved into listening to my clients over the years and, bit by bit, I ended up in the physique realm, as you do when you're focused on body composition. So I was working with a lot of physique-based sports women that were coming in wanting to change their physique for high-level competition. So we're talking, you know, competing and physique sculpting and things like that, and I, of course, myself and use myself as an experiment. Everyone loves an experiment.

Oh, we all do in this industry.

And so, you know, competed and dabbled in those types of things and learned a lot through the experience, I do have to say, because what was happening at the time unbeknown to me was I was just listening to these little stories about how female bodies were being affected with really low energy availability and so, as we sort of went on, I've been in practice now as a dietitian, a sports dietitian, for 15 years, so it's been a long time thereabouts in the industry. So prior to me being an actual sports dietitian and consultant, I was an exercise physiologist. I was doing a lot of personal training as well, again listening to my clients and then going through and seeing them on a perspective of how can I help you nutritionally to support your training, to get you where you want to go? And, sure enough, what I started to see was an effect in the menstrual cycle, and so a lot of these women were coming in with low energy available states and losing their periods, and that was probably the most red flag that I saw at the time and I went back into you need to try and find the answer to that question and nobody could really tell me otherwise that it was wrong and I just deep down. I kind of just knew. So I never really stopped at that. That was my first introduction to that and then, as I went into private practice, a lot of these people that I was seeing in their younger years when they were competing were coming back to me in their 40s and they're going Ang. My body has changed and I'm not doing anything differently. In fact, I'm training more and eating less. Why is my body not coming to the party? So this was a really interesting point as well, and I knew there was a gap in the research. And now, funnily enough, when we looked back at it, if you look at all the research that underpins exercise and nutrition science, a lot of these research papers were done on young, active men, and all we did and this is a disservice to me in terms of my profession and myself as a practitioner is that we just took that information, we learned it from our peers, university lecturers, and we just went and applied it to women. And of course we know that that shouldn't be the case, because we have this beautiful thing called a menstrual cycle and then, as we age, we lose that menstrual cycle. So it is time points in our lives. Our bodies are uniquely different. We are not small men, and so we shouldn't be treating ourselves like that when we're looking at nutrition and exercise interventions.

Yeah, and it's interesting. What you say about how we and I go through a similar conversation with my clients and with every woman that I come into contact with, to have this conversation with, is that we do ourselves a disservice when we do just take what we're told and what we're taught as on face value and we implement it and we don't ask questions and we don't advocate for whether that actually feels right for us or not. And the common conversation for me is for women with their GP. When it comes to going into their GP or their health practitioner and saying, hey, you know what, I'm not really kind of feeling like myself. My body shape has changed. I haven't done anything differently. In fact, I've been training more, eating less, my periods are a bit all over the place, and a common response is yeah, but you're busy. You're just a woman, you're a mom and you're running a business and you're busy and maybe you should take a holiday and it. You know, it's that same dichotomy of not taking that on face value and doing a little bit more research and delving into what actually is right for you, as opposed to what we're being taught and told.

Oh, completely. And I think that that word, that dismissive, is so, so important because we go to our general practitioners, probably at first protocol, like when we don't feel well in our bodies, we generally will go to a doctor and say, can you please help me? But unfortunately what we don't have is the language and the understanding and probably the education is where I felt like there was a massive lack, particularly with myself growing up, like we didn't get taught how our bodies worked. I've done two science degrees and I still didn't understand the connection with physiology and relating it back to how I make better informed evidence, informed decisions when it comes to what I'm eating and how I'm exercising. And I think also this is hustle mentality in our culture, in our lifestyle, that you know, that perpetuates that narrative that we're constantly bombarded with all the time Like you don't complain. Like you know, pick yourself up. I mean, how many times have we been told women, do we multitask? We totally multitask and, like I know for a fact, your brain hates multitasking, you know. And why shouldn't we have the permission and the luxury to be able to go? Actually, don't dismiss what I'm trying to say. And I just listened. That's the biggest thing you need to listen to your body. It's in innately. It knows exactly what it needs to do. But also find a practitioner that's going to listen to you as well, because I think that's just don't stop there. You can actually find people and obviously, with what you're doing, you know raising that awareness and getting women on board with actually knowing where and how to ask the questions, having low language to do that and then benefiting from the education. Now, once they learn about their bodies, they can actually start working with them rather than against it.

Yeah, brilliant advice. So let's move into something that you touched on a little minute ago, which was the clients that were coming back to you in their 40s saying, hey, my body's changed. We talked about low energy availability, which I would be good if we can actually explain that for my listeners or for our audience, because that's a term that I'm familiar with as a term you're familiar with, but it might kind of not be making sense to the average woman that's listening in. So I'd like to delve a little bit into what low energy availability is. So let's start with that, and then we'll segue into the next question I had for you.

Yeah, so low energy availability. It's really just describing a position in your life where you're not actually giving yourself enough nutrition, so we don't have enough energy and we can talk about calories or kilojoules of energy unit measures of where we get that from as food and drink. So what we eat and how we drink is going to contribute to us surviving. Now, of course, we need to eat to live. So to be human, to be functioning, we all need a level of nutrition. How best we do that nutrition is going to relate to how optimally we're going to be functioning, and I will often, you know, I've sat in many, you know client meetings where my client is active. So I work with an active population, but that doesn't mean they're elite. I have worked with the elites but I've worked across a broad spectrum of what I call every day, weekend warriors or just lifestyle athletes, and I always say you are an athlete and you need to start thinking about yourself as an athlete if you train with intention, if you train with purpose and you're consistent in what you're doing. So that might mean you're training Zumba three times a week. You're an athlete, you know, you've got the intention. You don't necessarily need to enjoy it all the time, I would argue that you should be doing exercise that you enjoy. But if you're really, you know, devoted to your health, if you've got a health value, if you are training and exercising and just moving in general, then if you start to then coin just a perspective or a lens of treating yourself like an athlete those small little principles that I've learned over the course of my working with the elites once they filter down to the everyday population, they can have the most profound impact. And that's what I was finding with a lot of the scenarios where low energy availability was there. It was just because they weren't feeding themselves a enough to just cover what we call your basal metabolic rate. So this is just the energy that your body requires you to get up, function, beat your heart, work your lungs, breathe, do all these sorts of things. That is just a normal part of human behavior and movement. So that requires a certain amount of energy. So, first and foremost, we need to let women know that they have to have permission to eat. We cannot survive on literally nothing. So the second to that is when you're adding that exercise on top of that, because if you do have a health value we're trying to look for ways to move. That then increases your energy expenditure, and so it's a formal way of doing it, but you're burning more energy in a way that you are exercising and that's using up a little bit more energy. We also have incidental activity, so you just might find that just because you live in a house that has stairs, and that you're actually burning more calories going up and down those stairs every day compared to somebody that lives on a low level house. So all these factors are combined. And then there's another factor in terms of energy expenditure with what you eat. So the more you eat, the more you burn calories for digestion and eating as well. So all these factors involve, if you add that now to the basal rate of what you need energy wise, then you add your activity factors and all the stuff that you're doing day to day, and then, of course, you end up with a certain amount of energy that you should be required to eat. Now what happens with women is they perpetually and chronically under eat and unfortunately they end up in a scenario where they can go for so long, but their hormones will then override that and it will become basically a fight or flight survival system, we'll create really high stress levels or cortisol, in our body, and you will tend to probably what we call overeat or binge eat at certain times. And I have lots of women come to me and say, and I don't eat bad, and I was like, yeah, that's fine, there's no judgment here. I don't eat bad, I don't eat KFC, I don't eat McDonald's and I can't lose weight. Well, first and foremost, you're not in a deficit, so we need to figure out what that deficit is. But unfortunately most women sorry, they lie in a low energy available state for maybe five days of the week and then their weekends they go into two bigger surplus, which then chronically does this yo-yo pattern of dieting and then you go straight back again, start back at Monday, start the diet again and then start to then chronically under fuel. So, if you can think about it, most of my women come in and they're not eating A properly enough to support their day to day what I call fundamental nutrition, which is their health. B they're not supporting their training nutrition, so they're starving their training, so they want to lose more fat, so they don't eat around training, which is counterintuitive at its best. And as a sports dietitian, that was one of my major things to be able to be giving people fuel to support the training that they're doing. So if we can do that, you're not going to be in a state where you're not having the energy that's required for your body to utilize when it needs it. Long periods of fasting, intermittent fasting, and then we could talk about all the different diets out there. But particularly fasting, I find for women, particularly active women, is so, so detrimental because it doesn't give our body the available energy that it needs, a to function, b to support your exercise and, like nobody really likes to be hungry a long, long period of time. So at some point, like I said, you'll probably over-consume your some other aspect of the day and then you'll blow out your deficit anyway. So this is the perpetual cycle I see women in Take into its chronic level if you do that for a long period of time. In the sporting realm we term that red-ass. So that becomes the syndrome of relative energy deficiency in sport. And that's obviously then looking at the disparity between that bigger gap of low energy availability, between what you need to survive and then adding exercise on top of that. So if you are training pretty consistently and you're always after more fuel. Your body, at some point, is going to reduce, or what I call it. I call it like put yourself on low power mode when it comes to your endocrine system, obviously, your menstrual cycle is going to get affected, so your hypothalamic pituitary axis is going to be down-regulated. Your whole metabolism is going to drop. You're probably likely to lose muscle. Your functionality is going to go down the gurglar. And then you look at all the reasons why you want to be training to get stronger, to get fitter, and you're not doing any of those, any of those things, because you're just not fueling.

Yeah, yeah, I know it's a fascinating subject and I think the biggest takeaway there that I feel would be relevant to the everyday woman that is listening is that, yes, we all acknowledge and know that we need to be in a deficit if losing weight is our goal, but what I think the most important message that we can get across is that that deficit is personalized and individual for every single person. So when you come across these weight loss programs that they provide you with a set amount of calories, kilojoules per day, they're horrifying because they are not personalized to what your like you said, your basal needs are, let alone what your everyday incidental exercise and then your intentional exercises on top of that. Yeah, we could talk about this for hours, but I think that that is such a key takeaway for women, particularly women over 40 who are experiencing changes to their body shape that they haven't perhaps tried to achieve. It just is naturally happening, and then they start seeking out ways to make that change and they get into all sorts of trouble. So, okay, cool, hopefully we've got a really good understanding now of what low energy availability is and the impacts of that on our body as a woman. So when your clients come back to you. They're 40 plus. They're starting to see these changes. Can you explain to us a little bit about why those changes are happening from a hormonal perspective and different ways that a woman leads to look at her nutritional intake? As a result, yeah, absolutely.

So. Here we start to see and now you know we talk about paramedic pauses being this kind of five to 10 year. I call it a shit show roller coaster of hormones where they're kind of going up and down. You don't know what the hell's going on. Again, you know you added the very valid point of it being personalized and individual to you, so your experience is not going to be I mean, it's very similar because we see a lot of women reporting the symptomology of going through paramedic pauses and the reason for that we believe we don't exactly know for sure. But what we believe is that because of that decline in female sex hormones estrogen, progesterone, testosterone in there as well, throw that into the mix, but obviously a major two hormones and in particular estrogen. When I'm looking at this from a perspective of why it becomes more important that we have to be doing nutrition and exercise a little bit differently to mitigate the loss of the decline in that estrogen as we age. So we know that this happens past 35. You know, when we talk about paramedic pauses this kind of maybe in your 40s ish thereabouts, we talk about menopause being mid 50s. But you know everyone's different and, as you can attest, you were pushed into menopause probably a lot earlier than what an age related normal woman should be pushed into it. So there's many different reasons that we can end up in a situation where we have low estrogen. And so, as a result of low estrogen, what do we see happen to the female body? Now it's very interesting. When I looked at this, I look at it from a physiology perspective. So we have less lean muscle mass, so we tend to lose muscle, which of course then includes strength and functionality. So if you think about one of the key factors in terms of aging and the female aging is independence, right. So if we lose our independence now, functionality, that becomes completely debilitating. And then, of course, we end up older, but not necessarily living out our best years, and that's something that I'm really passionate and have always been passionate about doing resistance training to counteract that loss, particularly of estrogen. So estrogen, we know as a hormone, a female hormone, is anabolic. It helps us lay down more muscle, but it also helps us lay down more bone, and so when we're looking at bone mineral density, the risk of osteoporosis is going to increase as we start to age because that estrogen is starting to lower. The other thing we see physiologically is that there's an increase in what we call visceral abdominal fat, so just the belly fat gain around the midsection. Right, we go from being this beautiful pear shaped now being a bit more of an apple shape. So this is what women do report and all of these have been absolutely. There's a paper that just got released this year that validates the physiological changes that happen in perimenopause compared to for the rich menopause, the humanoric women compared to post menopausal women as well. So we actually now have this beautiful opportunity to A recognize, not dismiss, women that are coming and going. There is something going on with my body and I don't know what the hell is happening. That is the reason why. Lowering of estrogen, all those effects now in terms of the muscle mass loss, the increase in belly fat, and then, as a result of this as well, what happens is because we've got more fat around the midsection increases our risk of insulin resistance. So we can't clear that blood glucose as effectively, which means we can't use it as effectively, which means we're constantly hungry all the time. We've got too much sugar running around our system but we don't actually know how to tap in and utilize it. We also feel like absolute shit. So I don't know about you, but like when you train, you feel like you want to eat better, right? So when you're in this sort of routine and zone, you're like I've got it, you know everything's working really well. Well, let's have a look at the other aspects, not just the physiological aspects of low estrogen, and I'm sure you would have covered this at some point in your podcast anxiety, depressed mood, obviously, sleep disturbances. Now let's go back to physiology. We have temperature changes, so regulations, as hot flashes that happen, that's going to affect our sleep and that's when we get a crap night's sleep. Our appetite hormones are affected, so we get hungry. The next day is the roller coaster of just emotions and then we end up feeling like we are so freaking crazy. I've had women walking and go. You have just given me the reason to understand my body that I'm not actually crazy, because the next step that they do and if that's what they're complaining about is they go to their GPM. The GP puts them on an antidepressant and I'm like, no, it's your hormone. So you are totally validated and we can do things through our nutrition and exercise to help with it. But we have to remember that we can't stop the decline in estrogen unless we're looking at things to help ease that roller coaster shit show, which might be things like menopause therapy, hrt, you know things like that. So I would warrant that it's an absolutely pristine time to be having beautiful discussions with your GP and someone that understands what the female is going through, because if they don't understand that, then guess what? You end up in a dietician's office and you've got increased risk of cholesterol, increased heart rate sorry increased high blood pressure, which then increases your risk of cardiovascular disease. I've already talked about your increased risk of osteoporosis and now you're looking at this and it's just everything that's associated with central abdominal obesity. So we look at this as like metabolic syndrome, or it's termed metabolic syndrome in the in the. You know the clinical space. Your risk has automatically just elevated because your estrogen has dropped. Now, if I'm coming and in dietetics world, we learn how to clinically treat these conditions. I never once thought to ask at what stage of your menstrual cycle are you at? At what stage of your life cycle are you at? Because if I understand that, that estrogen is in a lower point. There's nothing I'm going to do too effectively well to help you reduce that risk factor other than try to help you get that estrogen back up and running in the best way that we know how. So it's a combined effect. You know nothing I'm going to say, unfortunately, in relation to nutrition and exercise is going to be going to fix everything.

Yeah, there's no silver bullet.

There's no silver bullet, but what it can do is maybe help those changes and help reduce the changes and the frequency of the changes that are happening in that perimenopausal state. So I can definitely talk to that and, finally, enough, a lot of the sports nutrition principles that we've learned can actually apply really, really well to the perimenopausal woman. So, yeah, I mean, where do we start with that?

Oh, let's start at the very beginning. So what would be your top if you had top three tips that you could give a woman from a nutritional point of view and I love the way that you've talked about it's about improving your quality of life as opposed to a silver bullet. So what are your top three tips that you would give?

Okay. So with my dietitian hat on the first thing I would do, most women really tend to lack, and this could make a significant difference not only to your muscle loss, or what we term sarcopenia, that age-related muscle decline, but of course we know that that's happening at a faster rate with women because our estrogen is dropping. So I would look at the quality of protein that you are getting in your diet. So what we need is we need HBV, or high biologically valuable protein. So this is a protein that has all the essential amino acids that we cannot assimilate in our body. We need to get it from our diet and from the foods that we eat. It also, in particular, has a high amount of one certain amino acid, which I call light bulb, lucy, or it's called lucine, and this and I say it- like this.

As soon as you said it, I knew you were talking about lucine, but I was like light bulb, lucy, I love that.

Light bulb lucy, light bulb lucy, like so light bulb lucy switches everything on. And so we thought when we're looking at muscle, so when we've looked at muscle physiology, we always try and look at the muscle level. No, women, we need to look at the brain. So what happens with lucine is it was very much the what we call the trigger for what we would term muscle protein synthesis. So we would need a certain amounts between three and four grams of lucine to actually engage the muscle to start accruing more muscle mass when we're training. So it's in combination with doing some strength for resistance training. So this is really, really important. But what we failed to miss in the menopausal woman is that the effect it had on the brain. So by eating these high, biologically valuable foods and if you drip, feed them in over the day, we keep a beautiful what we call nitrogen balance. So instead of really depleting yourself, not having those beautiful amino acids present that your body can pull from and utilize to build everything it needs to build, the other thing we forgot to mention and we just weren't looking at it from a research perspective was its function and cognition. So when I talked about, you know, the symptoms, we also missed brain fog, you know. So this is, if anything, probably one of the most significant factors that you can do with your nutrition is to get some more HBV protein in your diet and to drip feed it at least at four occasions over the day. So that's going to be breakfast, lunch, dinner and post training, and we can talk to resistance training. But you definitely need to start doing some resistance training because that's the other thing that's going to help mitigate that loss of estrogen and the loss of muscle that goes with it and functionality that goes with it. So if we can do those two things in combination and be consistent with that, we stand a fighting chance to actually diminish the rate of decline and we can slow that process down a little bit. So what is HBV protein and where do we get it from? From a food perspective, these are things such as our animal meats and products. So I'm thinking my favorite is probably eggs, and for another reason, because I think that vitamin D is also contained in eggs and that's wonderfully beneficial for our bone health, but also for everything in general. Vitamin D is a precursor for oil at home loans. So when we aren't getting enough of it, if we're particularly low in vitamin D if we cover up. Even I'm in Queensland, so we are often told to cover up and put sunscreen on. We avoid the sun when in actual fact there are some. There's a small amount of foods that we can get vitamin D from, but we still also need that sunlight and possibly supplementation if you're living in certain parts of the world. So going back to our HBV protein, so eggs are fantastic. I'm going to talk about the whole egg, because that's where the vitamin D is contained in, not just the egg whites, which is kind of a fitness industry thing. So, very good, very good for leucine. Egg whites are fantastic for leucine in terms of protein, but you're missing out on all those vital nutrients that's contained in the egg yolk itself. So please have the whole egg. The quality of the egg does matter. So if you can get fresh, or at least chooks that you know that you know what they've been eating it does make a difference to the quality of the egg and the nutrients that you get. Consequently, fish is my other next one. I absolutely love fish, in particular the high omega three fishes. So helps with reducing inflammation or the precursors for those disease states that we just mentioned, as the issue starts to decline. So salmon is wonderful. If you can get like tin salmon with the bones, you're going to get an extra calcium boost there. It's going to help that vitamin D and help that bone to make sure it's really strong in the integrity of the bone itself. And resistance training is also going to help you with that resistance to actually lay down more bone as well. So you know combined dual effects, but we're still talking things such as chicken. You know meat of any description. I'd probably always go the lower lean cuts because again, what we're trying to do is increase the unsaturated fats that we're having, as opposed to the saturated fats, because that's the ones that really help calm all that inflammation down. So, yeah, fish, like I said, oily fish, tuna as well. It doesn't have to be fancy, just tuna, it's actually tuna that has high calcium. Now John West has come out with a tuna that's got extra calcium in there. All they've done is just ground up those bones and just whack them back in there. So really, really fun fact. And then, of course, anything to do with animal products. So I love the high protein strained yogurts that are available at the moment, and there's so many available now. So many, so many. So, yes, and I mean the market is a little bit crazy to try and flick through, but if you're just looking for ones that are like high protein, low in fat and less added sugars, so I would just always go with a natural one, because you can always add the sweetness from fresh fruit, you know those types of things as opposed to kind of getting one that's really really late and with lots of sugar from you know added sugars and things like that. So, yeah, the strained yogurts, for instance, brand-wise Ciggies I love is a great brand, very high in calcium as well Trivani, gopro, those types of things. Farmers Union has a version as well, yeah, but there's plenty out there. It's just always kind of start with a natural one, and then milk, of course, is a wonderful form of, you know, hpv protein. It also has some good calcium in there as well. So, yeah, we're kind of covering all aspects. But the other thing not to forget also is the plant-based proteins?

because, yeah, I was going to ask about that because obviously there might be people listening that don't eat or consume animal products. So what are their options?

And that's going to lead into my number two for the things that we need to do for nutrition, because we want to increase our fiber, and when we choose plant-based proteins, we automatically increase our fiber. So what I love about plant-based proteins. So we're talking things like tofu, tempeh, edamame, any sort of beans or legumes or lentils. All of those are considered a fantastic source of protein from a plant-based source. And now we talked about skeletal muscle declining and, you know, sarcopenia and reducing that as we age. Well, so too does our smooth muscle of our intestine, so this starts to slow down and also our digestion becomes impacted. So when we're talking about gut health and, in particular, fiber, we really need to be looking at the variety of fiber that we're consuming, how much we're consuming, but also where it's coming from and how we can build more plant-based foods into our diet, and plant-based proteins are a really fantastic place to start. So the other thing and the really cool thing about soy and soy products is that they contain what we call phytoestrogens, which are a week sort of illicit, a week sort of estrogenic effect, which might help to raise estrogen in our bodies if we are on that decline. They also have been linked to some studies in Japan looking at, obviously, you know a population that consumes a lot of soy-based products. They reported the lowest levels of hot flashes when it comes to them and apposal women. So there's definitely some evidence around that and particularly, I think we also need to dispel the myth that it causes breast cancer Cancer. Yep, yeah, yeah. So there is some element of link with, I believe, the brachygine, but if that's not, you know, part of your clinical history, then of course we really want to be going. Can we get these soy foods into our life? And I would always go whole being first, as opposed to like the processed version of that. So you know tempeh is a fermented soy bean. Miso is another really good way of getting it into. But, yeah, if you didn't want to do like the soy milks, you can definitely go with the whole bean or edamame, like everyone loves edamame in Japanese, they sure do, yeah, so you know the fiber is very, very important. And then you know I think was there anything else that you wanted to know in terms of fiber? Sonia, is that okay to cover that? We've covered that something, yeah.

No, I was really interested. Actually, if we can just step back a little bit, you talked about the changes to the smooth muscle, which obviously impacts your digestive system, and one of the symptoms of perimenopause for some women is constipation or an increase in constipation. Now, obviously that is going to potentially be a result of the changes to the smooth muscle, but also perhaps a lack of fiber in the diet, so the two are kind of not working together as well as they should. Is that a fair assumption?

Absolutely, and I'm going to layer that as well with another sports nutrition hot topic hydration, yes. So when we also increase our fiber, if we do not do that with the right amount of fluid, it's a bit like cement. We're going to get more constipated, so it's not pleasant. So if I'm going to go in and go, yeah, let's jack up your fiber, lots of colorful fruit and veg and lots of plant-based proteins, and you go oh my God, I've done that and I haven't increased my fluid intake. With that I'm actually going to be more bloated, more constipated and feel worse, because there's going to be a lot of gut fermentation happening, which we know is not a bad thing. But when you do too much all at once, it's going to not be that fantastically comfortable for you. So the other thing, as well as we age and we see this also in and the luteal phase of the menstrual cycle is the high hormone phase. When we look at menopausal women, they don't tend to engage in their femo regulation as quickly as what we need to. So I often find that thirst is actually not a great indicator to actually increase your fluid intake, and so we have to continually be looking for other ways in which to kind of just encourage sip, sip, sip, and you know at least nine glasses of water in the day.

I experienced that actually myself, and it took me ages to actually come to the conclusion that my thirst had changed and I realized that I wasn't hydrated, that I wasn't drinking enough water. It was impacted me cognitively and you know, there were a few other symptoms that I recognized and I was like man, why am I not drinking as much water as I used to? And I've been always someone that drank. You know my two litres of plus of water a day, and what I did was I'm going to show you which nobody else would be able to see this but I actually went and got myself a bottle that has incremented, like by 8am. You should have drunk this by 9am. You should have drunk that because I needed that external reminder to drink. And now that you've said that, totally makes sense.

Yeah, look, and I think the other thing to remember is sometimes like we're told to avoid consuming fluid with meals, but I actually do the opposite, and the reason why I do that is sometimes, you know, we could guzzle water, but if we're just going to the toilet and dumping it all out, it's not really effectively hydrating us. It's kind of just going in and coming out the other end. What we want to do is look at the sodium content of our food. So sodium is contained in salt and our food will have a natural element of sodium in it anyway. Irrespective of, you know, whether you're eating processed foods or whether you add salt to your meals, it's going to have a natural element of sodium. So when you combine having water, it's another good trigger as well. So every time you eat, are you having a glass of water at the start of the meal and at the end of the meal? So that's another good way to at least get six cups in a day. Yeah, if breakfast, lunch, dinner, you know, and add that to your snacks as well. So then you can easily find another trigger for that. It'll also help the absorption of that. So we talk about hydration as being, you know, weeing about four, maybe six times a day. So if you're less than that, you need a bit more, a few more than that you probably don't need as much. You need to maybe just drink strategically, which means pairing that with something that contains a little element of sodium in there as well, and, of course, you know, don't rely on your thirst. You kind of always need to be on top of this. Make it a habit, put it into your lifestyle and, exactly as you said, what's your cognition? You know change from that aspect too. But yeah, it's definitely something from a gut health perspective. You know we talked about stress as well. So the idea with this is it's sometimes when we're in a really particularly stressful state from the environmental factor. If I look at most perementapals of women, they have a lot of shit going on. Like you know, we are really. We're truly at an age where you know we've got kids. We might have young kids, depending on how late you leave your kids to have. So you know you've got young kids on one hand, you've got aging parents on the other, you've got probably you at the height of your career. You know trying to. You know make those inroads as well. You're probably more gished up to the eyeballs. You know, there's so many things that I feel like my women when I talk about food. Sometimes it's not even about food. So sometimes we talk about nourishing other aspects of their life to help calm their stress levels down, because that vagus nerve connects the gut and the brain and when we are particularly stressed, when we short breathe sorry, when we short breathe, in terms of our breath, our diaphragms connected to the vagus nerve as well. So when we're you think about it, when your stress anxieties through the roof, you don't tend to sit and breathe really, really deeply, right? So you're on this heart and alert system. Your diaphragm's not actually engaging properly. And then what happens is there's a massive flow and effect. You know, with everything that happens, the cortisol raises, insulin resistance happens, our body pumps out more glucose from our liver and our muscles to go oh, you're particularly stressed, maybe there's going to be a sabertooth tiger you need to run away from and that that tiger doesn't happen or doesn't come across your pathway. And yet we're chronically in this stressful state. Long periods of fasting is going to add to that stressful state. Not exercise, I'm sorry, exercising without eating is going to lead to that stressful state as well. We can couple so many other things, we can lay all that sort of stuff off on top of it, but yeah, that would be my top three and I'm going to add to the last one, if I can resistance training.

Yeah, yeah, I'm glad that you added that in, for sure.

Yeah, yeah, and it's not just resistance training, it's possibly looking at that, but also having enough recovery. So this is what I see. Most of my 40 year old women come in. They're like, okay, I've noticed that my body's changing. So what did I do? Well, the fitness industry told me that I'm putting on weight. I need to eat less, do fasting and then increase my activity. And it's the most worst thing that you can do because, of course, we've just explained, the cortisol is going to go through the roof as well, so which then leads to more weight gain. And you know, I'd really depressed mood state as well. So nobody wants to be starving forever. It is not a pleasant state. So when we're looking at types of training, I also need you to put in perspective of quality versus quantity. So I actually reduce all my women. I don't let them do anything over 60 minutes, like 90 minutes at worst, if they're training for a marathon or something like that which most women do when they turn 40, the amount of people that get into. I come into my clinic and go hey, I'm, it's my 40th, I want to do, you know, go cross marathon. And I was like really. I was like what do you really do you like running? Why running? No, I don't really like it. That is so funny. What happens with women? We, literally, because we, we enter possibly I'm not going to say a midlife crisis, because again, that's perpetuated by the notion that, you know, statistics tell us we live to 84.5 years as females. But it's almost a position in their life where they notice things are changing and it's a reason to take care of themselves. That is like the intention behind that is so wrong so they kind of needed permission so they'll go and put an event on and they'll go. If I've worked towards that, if I look at my nutrition, if I force myself to exercise, even though I'm bloody hated, I'm going to, you know, have this massive accomplishment that I'm going to get to at my 40th, I was like that is the wrong intention. And then they are miserable every step of the way and the year that they are going to turn 40, it's probably the worst year of their life and they'll get to their birthday and be like oh my God and fall in a heap.

So they blame it on turning 40.

100%, 100%, so yeah, so this is where we need to be a bit more smarter from this perspective. So resistance training is a consistent for every single woman. I feel like it has to be in there. So, from a perspective of frequency, I'm going to suggest about four to five times over 10 days. So as we age, we need more recovery. So I'm not looking just a week in view, I'm looking now at 10 days so you can actually get enough recovery over that period of time, because your body needs the extra time to fill it up with good nutrition, to repair, to recover better for the next time. And the reason for this is because I want you to start pushing your intensity. So I need you to lift heavy shit. I need you to then go. It's the stimulus that's required, because that estrogen isn't there to help you now to actually then do your muscle protein synthesis, so we need that in there. We also, as I mentioned, need to fuel your amino acid availability around that. We also need to periodize our carbohydrates, so we're going to put them at a time where our body is likely to help utilize them, and that includes higher intensity workouts, maybe threshold training, but no more than sort of 30 seconds sprint based intervals. Anything longer than that, 60 seconds longer, cortisol goes through the roof. So you know, break that sort of stuff down. And the other thing which I feel like women need to start thinking about putting into their training is plyometric training, because what that does is it wakes up those satellite cells, you know, that sit and orbit around the muscle belly. That gets you primed to actually then do the heavy lifting as well. So, all of that involves.

Well, we're talking about that because that's a really valid point and I think it's a piece of research that's actually only recent is the benefits of plyometrics for women into their menopausal kind of years. But can you explain for us what that actually means, because that's a term, again, that you and I are familiar with? But I'm sure there's women out there scratching their heads going, oh, a play or what.

I'm so sorry. I know I do this all the time. I just assumed that everyone's got the same language that's going around in my head. Yeah, so plyometric training is looking at movements with velocity, not necessarily with weight, and I probably would advocate not to put weight or like hold dumbbells or do it too intensely. From that aspect it's just looking at body weight exercises that you do with a little bit more movement. So, for an example, I can give you maybe a box squat, a jump squat, maybe a lunge turning into a split lunge. What else? Throwing, like throwing a ball really quickly against a wall.

Mountain climbers.

Mountain climbers? Yes, you're probably one hates.

The trainers love modified burpees. I am not a fan of every woman doing burpees because they can be so problematic, but there are some beautiful ways to modify burpees to actually make them available for everybody and also, I think, for me. When I think of plyometric movements, it's something where the feet are moving, are leaving the ground at some point during the exercise beautiful way to describe it.

You should have led with that. I'm the nutrition person, remember. Sorry, but this is the thing. I come with that background of understanding exercise and physiology and once I put the two together I was like, oh, like. I constantly just looked at things separately or parallel and I thought, oh gosh, you know, and with sports diatetics, what I loved about it was that it merged the two. So, with the understanding of your physiology, of what's going on, then we learned, okay, how do you fuel that? So if you're going to be changing your training, then of course, as you mentioned, like everyone's individual, they're not going to be doing as much training as somebody else. Somebody might love hot yoga versus something else and I advocate for that as well, doing exercise that isn't necessarily always intense. So I say that because that's the best types of exercise to reduce or remove that sort of sarcopenia effect when our muscles do decline. But if you are in a position where you've had a terrible night's sleep, stress is going on, you know you've had an argument with your partner, whatever that may be, sometimes it's totally okay to just do a walk or, you know, like a yoga session, because that's going to help reduce that cortisol that's really, really high at this moment in time. So not all stress is bad stress and we understand that because there's so many beautiful aspects of exercise that does contribute to our longevity and our health. But if we're doing that constantly without the recovery in between and without the intuition of knowing when I need to back that off, then that becomes problematic and then it forces you and urges you to eat more. You know you might overdo it. And then, of course, you know we haven't even talked about anything related to mood and emotional eating.

There is definitely a few episodes, I think, in this conversation we're having, so I'd love to invite you back at this point, ang, to really delve into some future topics as well. I think that would be amazing and so beneficial to the amazing women that are listening in. So, if we can just to wrap things up a little bit, I got a couple of questions in from followers across some you know my audience, across different platforms, and both of them tied into the one topic which I thought was really interesting. So it was obviously a message from the universe that we were meant to talk about this. I had a question around calcium and I had a question around vitamin D. So I think I know, and you know, that they actually work together and that they're really important. How can we just in a really kind of pop it into a nice little box with a bow on it? Why are calcium and vitamin D important? Why are they problematic for some women in there from a nutritional standpoint, and what can somebody do to bring both of those into their diet or through supplementation as well, obviously?

Yes, well, I love a food first approach and I always say food first, supplement second. But in times of extra need, which is clearly when we are starting to look at that aging female again, this is what happens when estrogen starts to lower. Is it now calcium needs to actually go up? So, as a you know, pre menopausal female, we are looking at about achieving about 1000 milligrams of calcium a day dietary. So what that is is the RDI, the recommended dietary intake guideline guideline. But then when we look at menopausal women, it actually goes up to 1300 milligrams a day. So it's an extra 300 milligrams of calcium to achieve. Now if, in particular, a you don't have a great appetite because remember that smooth muscle isn't doing it, then you might be constipated, you don't really feel like you're going to eat much. And B we tend to also get another fitness industry message that might mean that dairy is removed in terms of foods in our diet, and dairy, I mean, it's not the only form of calcium, but it really is an easy, a quick and easy form of calcium and, as I mentioned, it's a great form of HPV protein as well. So if we're removing these types of things in our diet, we don't have the appetite for it. Issue is now starting to lower and then, of course, our needs go up. We find ourselves in a bit of a pickle if we're not looking at foods to help supplement that or get those nutrients from, and that's when supplementation does come in. So the idea behind Y-calcium in combination with vitamin D, and also magnesium and K2. So these are the beautiful nutrients that we termed the bone metabolism nutrients, and so they help to keep that bone integrity really, really good. So, unfortunately, as we age, like I said, if we lose muscle, we're not going to be as functioning or as functionable as we probably could be. We're probably not doing the resistance training because we don't have the mojo or the motivation to want to do it. Again, maybe the estrogen is playing effective. That lowering of estrogen just reduces our motivation to do anything, low libido included, like everything. Like that, our motivation and our drive and our zest for life is actually diminished. So these are the important factors that we forget about estrogen and when we don't get enough of it, and so that in combination, when we're looking at that bone mineral density and that bone health, it takes a massive toll. So if we can look at a, like I said, if it's necessary and you do have a blood or clinical report and a blood value that suggests that you are low in those micronutrients, then I would probably be supplementing straight away. But it's a conversation definitely to have A with your GP and then B with your dietitian as well, to make sure that you can't get all these nutrients from your food, because the assimilation is a lot better from our food and, of course, all the other nutrients that go in the food matrix itself. So if we can look to doing that, that strained high protein yogurt that I mentioned is actually really really high in calcium because what happens in the straining of that process is that it increases the calcium content, so it removes the water, gets the protein nice and high and in the sporting realm it's been touted as like the best thing to eat for gains from that perspective. But it's also ridiculously high in calcium, to the point. Where I looked at it was double. It was at 600 milligrams, I think for one of the yogurts that I was looking at and I emailed the company and said has there been a mistake on this nutrition label? Like I had to double check because I just was gobsmacked and they said no, it's actually the amount of calcium that's contained in it, because we've strained it so much that that's what ends up happening, wow. So yeah, and remember as well, like it's not about getting it all in the one meal. We can drip feed that over the day, but in total, we want to be at least achieving, you know, three serves of any form of calcium containing foods. So there's one that I've mentioned with the yogurt. So if you're not eating yogurt, that's probably that's a problem. Milk's obviously the other one as well. We get about 300 milligrams in a cup of milk. If you're lactose free like you can't do lactose, and that's totally okay there's also lactose free alternatives. The soy based products are often fortified and sometimes I would just get you to have a look at if you are going to do a plant based milk or a dairy free beverage of some description, just make sure it's fortified. So you'll look on the label at the back and it'll say calcium carbonate and they've actually then fortified that so it will contain the calcium in there, which most of them do, but not all of them do. So just double check the brand and then the next thing is to look at, you know, salmon with bones. Again another beautiful way of getting that calcium up in there, because there's because you're eating the bones, the bones contain calcium. So, you know, hopefully that makes a good assimilation. So yeah, so that's another good way of getting it in. Obviously, the yolks of the eggs. Funnily enough, aged cheese is actually high in K2. So, you know, if you don't mind a bit of, you know, extra aged cheese in your diet, then that might be something that you know you might enjoy because it's the other things on you is that I tend to feel like most women forget that they can actually enjoy food, like there is more to food than just nutrients. And yeah, you really need to make sure that you're part of that process. Like you've got it, like I'm working with your preferences and if you say to me I eat this but I don't like that, no problem, we can make anything work. Like I'll be, I'll do my best in terms of getting your nutrition up to a level where it can have a really good foundation. But there's so much individualized preference within that that we can actually work with as well, rather than just say here's what you need to eat. Go and do it. You know like it's very difficult from that aspect and that's kind of, I guess my point of difference is to engage you in the process to really nurture that and actually get you excited about food again, because we're often bombarded with. You know, you've got to get calcium in, you've got to get this in, or you've got to remove, you know, fat or whatever it is which, again, from a perspective of vitamin D, you need fat in your diet to absorb vitamin D. So if we're not, you know it's a fat soluble vitamin. So if we're not getting enough fat in our diet, our hormones aren't going to be operating effectively well and B we're not going to be absorbing those nutrients as well. So you know again, vitamin D will come through. Sun-baked mushrooms is another unique way of getting vitamin D in. So just pop your mushes on the windowsill, let them absorb that sunlight and then whack a minister fry.

Oh, really so it can be that simple. Get your mushes that you might buy at the markets or the supermarket, bring them home, pop them in the sun, let them absorb the vitamin D for you oh, that's awesome. And then consume it yeah, love that.

There's not a huge amount of other forms of vitamin D, unfortunately, unless, like I said, it's fortified dairy egg yolks and the sun-baked mushrooms. So yeah, so supplementation with vitamin D in particular I am quite aggressive with. So I do really look at that and you know there's a series of questions.

We'll think about your symptomology and I think the other thing to note there, too sorry before we move off this topic is that there's actually a high percentage of Australian women that are low in vitamin D. So they get their blood work done, it comes back showing that they're low in vitamin D. And then I know there are women that naturally go oh, but hey, I go out in the sun and you know I spend time in the daylight every day. Why is my vitamin D low? But it's actually very common. It's not as unusual as some people think it might be.

Absolutely. I think it's one of the most undervalued nutrients that we really really do need to make sure that, as particularly Aussie women, are getting enough for sure. I think that's huge, it's very problematic and if we actually if I give you a reference point, if I look at the most successful, you know, healthiest accomplished athletes probably not physique athletes, I'm talking more other spectrum of athletes their vitamin D status is through the roof off the charts and it helps to know that the people that are performing at high level, if they're doing well, their vitamin D is high. So it was something that was really brought up with a lot of the early athletes that I was working with because, yeah, they were really. Maybe they're training in confined spaces other hours of the day, those sorts of things as well. So if your vitamin D is low, your performance is going to be low, and that's obviously on a training front, but also I talk about performance being life performance.

Yeah, getting up every morning and getting on with your day, yeah.

Exactly, exactly so, yeah, so, as I said, there's supplementation for that. You can actually obviously get a calcium and a vitamin D supplementation together and they might have little traces of other micronutrients in there as well. But again, just assess. Firstly, you got to assess if you're getting enough nutrition in your day to day diet. So take a dietary inventory of what you are consuming, add up the amount of milligrams of calcium that you are obtaining and you don't need to hit that every day. I think most people go, oh my gosh, I've got to get that in every single day. Your body is beautiful in terms of, you know, breaking things down and assimilating those types of things, but you really kind of want to be diligent with it. And same with things such as gut health. You know it takes about 48 hours for your gut microbiome. So you know the beautiful environment where your gut bugs, your good, healthy gut bugs, are protecting you. If you remove a lot of your plant based material, a lot of your fiber, it'll take about 48 hours before it'll affect the microbiome of your gut. So you know, we know, that these sorts of things need to be looked at. You know, probably every second day, if not, it's just consistently. You know, having a good foundational based diet, having room to play with and then accommodating that to upscale it when you do increase your training, is very, very important.

Amazing and we have covered so so much in this episode. I'm going to wrap things up here. It has been an absolute pleasure getting into the minute details that you have stored away in your brain, that about nutrition, that it's just such a fascinating topic. Thank you so much for your time. Oh, thank you for having me Sonia. Thank you for listening today. I am so grateful to have these conversations with incredible women and experts and I'm grateful that you chose to hit play on this episode of Dare Menopause. If you have a minute of time today, please leave a rating or a review. I would love to hear from you, because you are my biggest driver for doing this work If this chat went way too fast for you and you want more, head over to stellarwomencomau slash podcast for the show notes. And, while you're there, take my midlife quiz to see why it feels like midlife is messing with your head.