Your diet and the menopause

Hot flushes

The Japanese have lots of bright ideas where diet is concerned. Obesity and heart disease levels are low in Japan, and much of the credit has been given to their diet. The average Japanese diet is high in soya in the form of tofu, soya beans, soya milk and other products.

They also have large quantities of oily fish and low levels of saturated fat and refined, sugary foods. Japanese women are much less likely to be troubled by hot flushes than their Western counterparts, and increasing your soya intake may help relieve you of them too².

Seeds - such as linseed, pumpkin, sesame, sunflower seeds - and red clover isoflavones, available as capsules from pharmacists (60-80 mg a day) have a similar effect. At the opposite end of the spectrum, spicy foods, coffee and alcohol may trigger hot flushes, so are worth avoiding.

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The breast cancer conundrum

Soya contains isoflavones, which mimic the effect of oestrogens. Importantly, concerns that this might make them unsafe for women with, or at high risk of breast cancer, have largely been allayed³. In fact, one study suggested they might even slightly reduce the risk of dying in breast cancer patients⁴.

It's important to note that there are several different types of breast cancer, some of which are 'oestrogen receptor positive' - meaning oestrogen may stimulate the cancer to grow. So while women with breast cancer are may benefit from being wary about their soya intake, healthy women should be assured that soya is safe.

It's also important to keep an eye on your alcohol intake, as research suggests alcohol can increase the risk of breast cancer after the menopause⁵. A diet high in red - particularly processed - meat and saturated fat may also increase your risk.

Mood swings and tiredness

Previously, there was controversy about how much the mood swings, often seen around the menopause, were due to hormone changes, and how much were down to other life stresses seen around this age. But there's no doubt now that mood swings can be part of menopause and keeping your blood glucose (sugar) stable can reduce irritability and counter sudden tiredness⁶.

Keep chocolate and sugary foods for occasional treats and eat 'slow-burn' foods to avoid sudden spikes and dips in your blood sugar. Go for unrefined carbohydrates - wholegrain and wholemeal - nuts and seeds, and whole fruit rather than fruit juice can help keep blood sugar steady.

Foods high in tryptophans can make it easier for your body to manufacture serotonin - a brain chemical linked to protection from depression. Turkey is the classic source, but if you don't want Christmas dinner every day, try oats, root vegetables and cottage cheese.

Weight gain

Piling on the pounds isn't inevitable around the menopause, but sadly you are likely to struggle with weight gain⁷. Being overweight can increase the risk of type 2 diabetes and increases your risk of breast cancer.

The key to avoiding weight gain isn't crash diets - it's sustainable changes to your diet. Key elements include:

• Managing your portion sizes. Eating from smaller plates, not eating on the go, drinking a glass or two of water and eating 'mindfully' can all help.
• Filling your plate with vegetables before you add more calorie-loaded foods.
• Eating wholegrain and wholemeal 'complex carbohydrates' as well as proteins - from lean white meat, tofu, eggs, seeds - which help keep you full and prevent food cravings from sudden drops in blood sugar.
• Limiting sugary and processed foods.

Heart disease

Your risk of heart disease goes up after the menopause, which may be linked to lower levels of the female hormone oestrogen⁸. A Mediterranean-style diet has been shown time and again to protect you.

Thinning bones

Menopause significantly speeds bone loss and increases the risk of osteoporosis⁹. Vitamin D is vital for bone health, and up to 90% of our vitamin D is made in our skins when we're exposed to sun. Oily fish, eggs and fortified cereals can help increase your vitamin D intake. An alternative is a 10 microgram (400 units) daily supplement.

Calcium is also a key building block for bones and you should try to up your intake after the menopause. Aim for three portions a day of dairy, from cow's milk or alternatives with added calcium, cottage cheese, yoghurt, tinned fish, tofu and seeds.

Further reading

1. Fait et al: Menopause hormone therapy: Latest developments and clinical practice.

2. Nagata et al: Soy product intake and hot flashes in Japanese women: Results from a community-based prospective study.

3. Breast Cancer Now: Are soya foods safe for women with breast cancer?

4. Nechuta et al: Soy food intake after diagnosis of breast cancer and survival: an in-depth analysis of combined evidence from cohort studies of US and Chinese women.

5. Dam et al: Five year change in alcohol intake and risk of breast cancer and coronary heart disease among postmenopausal women: prospective cohort study.

6. Penckofer et al: Does glycemic variability impact mood and quality of life?

7. Zoe: Diet may counteract menopause metabolism change, ZOE study shows.

8. British Heart Foundation: Menopause and heart disease.

9. Endocrine Society: Menopause and bone loss.