As life expectancy increases, the number of women experiencing menopause is also on the rise. By 2030, it is estimated that there will be 1.2 billion menopausal women worldwide. Menopause, typically occurring between the ages of 45 and 55, is defined as the cessation of menstruation for a year. The period leading up to menopause, known as perimenopause, can involve menstrual irregularities such as amenorrhea, potentially lasting for years. This transition brings about significant hormonal changes, particularly a decline in estradiol, a hormone with extensive metabolic effects. This can lead to a cascade of physiological changes that impact a woman's health and well-being.
This article explores the dietary considerations and nutritional needs of women over 40, particularly those navigating perimenopause and menopause. It will cover strategies for maintaining a healthy weight, preventing chronic diseases, and managing menopausal symptoms through balanced nutrition, key nutrients, and lifestyle modifications.
Understanding the Physiological Changes of Menopause
The decline in estradiol during menopause has far-reaching effects. Estradiol influences the central nervous system, impacting food intake and basal energy consumption (basal metabolism). It also plays a role in glucose metabolism, increasing gluconeogenesis in the liver and enhancing insulin sensitivity in skeletal muscles. With the onset of menopause and the reduction in estrogen levels, basal metabolism significantly decreases. This, coupled with a reduced hunger-suppressing effect of estrogen, can lead to increased calorie intake and subsequent weight gain.
Body composition also undergoes changes during this period, with an increase in body weight and a shift in fat distribution towards increased visceral fat. This excess fat storage can trigger local and systemic inflammation, contributing to vascular damage and increasing the risk of chronic diseases.
The Increased Health Risks During Menopause
The decrease in estrogen levels during menopause is associated with an increased risk of several chronic diseases, including cardiovascular diseases, hormone-sensitive breast cancer, insulin resistance, type 2 diabetes (T2DM), and osteoporosis. These risks can be mitigated through lifestyle modifications, including dietary changes.
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Hormonal changes during perimenopause and menopause also cause several characteristic symptoms, such as hot flashes, night sweats, headaches, and joint pains. Lifestyle choices can impact the severity and frequency of these symptoms. For instance, hormone-sensitive breast cancer is more common in women who started menstruating earlier and ended later.
The Importance of Lifestyle Modification
Even if lifestyle changes do not eliminate symptoms and associated diseases entirely, they can delay their development, make them more bearable, and improve overall quality of life. For example, losing just 5 kg of weight can improve the tolerability of hot flashes by 30%. Regular exercise promotes metabolic health and reduces the frequency and intensity of hot flashes.
A holistic approach to menopause involves integrating changes in diet to address the physiological processes resulting from declining estrogen levels. Given that the nutrition of many people in developed countries falls short of food-based dietary guidelines (FBDG), and the prevalence of obesity is increasing, dietary interventions led by dietitians are crucial for women experiencing menopause and perimenopause.
The Role of Diet in Managing Menopause
Dietitians play a vital role in helping women navigate the nutritional challenges of menopause. They can provide personalized guidance to eliminate and reduce dietary risk factors, which can significantly improve unfavorable laboratory values and reduce the risk of chronic diseases. The European Menopause and Andropause Society (EMAS) emphasizes the importance of lifestyle factors, including diet, physical activity, smoking, and alcohol consumption, in managing health and menopausal symptoms.
Regardless of menopause, women tend to gain an average of 10 kg between the ages of 40 and 60. EMAS recommends supporting women in regular exercise and creating a diet in accordance with national nutritional guidelines to manage health risks and prevent excessive weight gain.
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Balanced Diet and Fluid Intake
The quality of the diet is a determining element of an individual's health at every stage of life. A healthy diet can help counter the symptoms of perimenopause and menopause and prevent many chronic diseases, such as cardiovascular disease, diabetes, and different types of malignancies.
Recommendations for a balanced healthy diet are described in the Food-Based Dietary Guidelines (FBDGs) in Europe. Several diets have a positive effect on chronic non-infectious diseases and weight management, such as the Mediterranean diet and very low-calorie diet (VLCD-1200 kcal/day). However, diets providing less than 1200 kcal/day may yield micronutrient deficiencies. Low-calorie diets (LCDs) and VLCDs are used only in clinical practice, while balanced hypocaloric diets can be managed to individuals and may, therefore, have a better chance for long-term success.
The Mediterranean Diet
The Mediterranean diet, characterized by foods with anti-inflammatory and antioxidant action, has shown promise in weight management, blood sugar control, and cardiovascular disease prevention. However, its sustainability may vary across different European countries.
During perimenopause and menopause, the basal metabolism of the female body decreases significantly, potentially reducing the basal metabolic rate (BMR) by up to 250-300 kcal per day. This can lead to an annual weight gain of 2 kg if lifestyle remains unchanged. Weight gain often manifests as an increase in abdominal (visceral) fat mass.
According to 2016 WHO data, 55% of women are overweight or obese. In menopause, body mass index (BMI) combined with waist circumference measurement may not be sufficient. Body composition analyzers based on bioelectrical impedance (bioelectrical impedance analysis, BIA) are suitable for measuring body composition and determining daily energy requirements and nutrient ratios.
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Achieving and Maintaining a Healthy Nutritional Status
Achieving and maintaining a healthy nutritional status can significantly reduce and make tolerable the symptoms of perimenopause and menopause. There is no single, ideal way to achieve a healthy nutritional status. An option must be chosen that allows the individual to change lifestyle in the long term and form a new system of habits.
In reducing body weight, the energy requirement, including the energy requirement of basal metabolism (basal metabolic rate, BMR), is a determining factor. Energy intake below BMR does not lead to weight loss in the long term and is more difficult to maintain on a daily basis. Diets with an energy content of less than 1200 kcal/day are associated with a higher risk of micronutrient deficiency. During the dietary treatment of obesity, achieving a negative energy balance is of greatest importance.
The ideal rate of weight loss is 0.5-1 kg of body weight loss per week, which occurs from fat body mass while maintaining muscle mass. This means a 15-30% or 500-1000 kcal lower energy intake than the current energy requirement. It approximately corresponds to an energy intake of 25 kcal/kg/day. To maintain or increase fat-free body weight and skeletal muscle mass, the daily protein intake should be 1-1.2 g/kg body weight (20% of energy), with regular exercise with free weights or against resistance. Body weight loss usually slows down after 12 weeks, in which case the goal is to maintain the body weight achieved.
Reducing energy by 500-700 kcal per day can be achieved primarily by omitting snacks between meals, incorporating small meals but reducing portion sizes, and avoiding sugar-containing liquids and alcoholic beverages.
The Importance of Hydration
Adequate fluid intake is also extremely important during menopause, especially concerning cellular metabolism and maintaining the optimal functioning of hemostasis. It has an important role in regulating heat balance, detoxification, maintaining the proper functioning of the gastrointestinal tract and moisture of the mucous membranes, as well as turgor of the skin. Adequate daily fluid intake is important in the transport of nutrients and oxygen and contributes to the health of the skeletal system.
Key Nutrients for Women Over 40
As women transition through their 40s and beyond, their nutritional needs evolve. While the principles of a healthy diet remain consistent, some key nutrients become even more critical.
Iron-Rich Foods
Iron is crucial for maintaining energy levels and preventing anemia. Women in their 40s may start experiencing hormonal shifts that can impact iron levels. Good sources of iron include:
- Liver and lean red meat (consume in moderation)
- Fortified breakfast cereals
- Lentils
- Green leafy vegetables (chard, spinach, green beans, asparagus, broccoli)
- Dried fruit (apricots)
Calcium
Bone health becomes increasingly important as women approach middle age. Ensuring adequate calcium intake is essential for preventing osteoporosis. Good sources of calcium include:
- Low-fat cottage cheese
- Greek yogurt
- Low-fat milk
- Kale
- Broccoli
- Spinach
- Canned fish with bones (salmon, sardines)
- Fortified plant-based milk alternatives
Vitamin D
Vitamin D works synergistically with calcium to maintain bone health. It also plays a role in immune function and mood regulation. Good sources of Vitamin D include:
- Egg yolks
- Salmon
- Fortified foods (milk, cereals)
- Supplements (especially during winter months or for those with limited sun exposure)
Vitamin B-12
Vitamin B-12 is essential for brain function and red blood cell production. Women over 40 may experience difficulty absorbing this nutrient. Good sources of Vitamin B-12 include:
- Leaner meat
- Fish
- Milk
- Eggs
- Fortified cereals
Omega-3 Fatty Acids
Omega-3 fatty acids are beneficial for heart health, brain function, and hormone balance. Good sources of omega-3 fatty acids include:
- Fatty fish (salmon, trout, sardines, mackerel)
- Flaxseeds
- Chia seeds
- Walnuts
- Omega-3 enriched eggs
Fiber
Fiber is important for digestive health, blood sugar control, and weight management. It also helps promote satiety. Good sources of fiber include:
- Fruits
- Vegetables
- Whole grains
- Legumes
Practical Dietary Recommendations for Women in Their 40s
- Focus on Vegetables: Fill the bulk of your plate with non-starchy vegetables like spinach, cucumbers, onions, and cabbage. Include starchy vegetables like black beans, peas, and lentils in moderation.
- Prioritize Protein: Include lean sources of protein in your diet, such as lean meats, poultry, seafood, tofu, and eggs. Aim for 1-1.2 g/kg body weight per day.
- Embrace Healthy Fats: Incorporate sources of healthy fats like avocados, nut butter, olive oil, and fatty fish into your diet.
- Choose Healthy Carbs: Opt for healthy carbohydrates like fruits, vegetables, nuts, and whole grains.
- Limit Processed Foods: Minimize your intake of processed foods, sugary drinks, and fried foods.
- Stay Hydrated: Drink plenty of water throughout the day to support cellular metabolism and overall health.
The Importance of Exercise
The best diet is only as strong as the exercise you get. Regular physical activity is important for maintaining weight, building muscle, and preventing chronic diseases.
- Cardio: Aim for at least 2 1/2 hours of moderate physical activity per week, such as brisk walking or light yard work.
- Strength Training: Incorporate strength-training exercises at least twice a week to help maintain muscle mass.
Addressing Common Challenges
- Weight Gain: As metabolism slows down, it can be easier to gain weight. Focus on portion control, healthy eating habits, and regular exercise.
- Stress: Stress can lead to unhealthy eating habits and make it harder to lose weight. Practice stress-reducing activities like yoga, meditation, or spending time in nature.
- Sleep Problems: Lack of sleep can disrupt hormone levels and increase the risk of weight gain. Establish a regular sleep routine and create a relaxing bedtime environment.
The Importance of Professional Guidance
Navigating the nutritional challenges of menopause can be complex. Consulting with a registered dietitian can provide personalized guidance and support to help women achieve their health goals. Dietitians can assess individual needs, develop tailored meal plans, and provide ongoing support to promote long-term success.
The Mayo Clinic Diet
The Mayo Clinic Diet is an official weight-loss program developed by Mayo Clinic experts. The program focuses on eating delicious healthy foods and increasing physical activity. It emphasizes that the best way to keep weight off for good is to change your lifestyle and adopt new habits that you enjoy and can stick with.
- Lose It!: This two-week phase is designed to jump-start your weight loss, so you may lose up to 6 to 10 pounds (2.7 to 4.5 kilograms) in a safe and healthy way. In this phase, you focus on lifestyle habits that are associated with weight. You learn how to add five healthy habits, break five unhealthy habits and adopt another five bonus healthy habits.
- Live It!: This phase is a lifelong approach to health. In this phase, you learn more about food choices, portion sizes, menu planning, physical activity, exercise and sticking to healthy habits. You may continue to see a steady weight loss of 1 to 2 pounds (0.5 to 1 kilograms) a week until you reach your goal weight.
Harvard Study on Midlife Diet and Healthy Aging
A recent Harvard study found that adhering to a healthy diet in midlife could significantly increase the chance of achieving healthy aging. The research, based on data from over 100,000 people spanning 30 years, revealed that people who followed a healthy diet from their 40s onward were 43-84% more likely to be well-functioning physically and mentally at age 70 compared with those who did not.
The researchers found that higher intakes of fruits, vegetables, whole grains, unsaturated fats, nuts, legumes, and low-fat dairy were associated with greater odds of healthy aging, while higher intakes of trans fat, sodium, total meats, red and processed meats were associated with a lower odds of healthy aging.