WOMAN FOOD — start by ditching the rice cakes
The clinical nutritionist and research scientist Federica Amati is a busy woman — working with the health science company Zoe, teaching nutrition to medical students at Imperial College and seeing clients at a London clinic. Yet, fortunately, she has found time to write Recipes for a Better Menopause. Amati explains the science of the transition, and how to prepare for it. She also includes a guest chapter on hormone replacement therapy (HRT) from the menopause specialist Dr Sam Brown.
Amati devised the cookbook section with the chef Jane Baxter, formerly of the River Café, who runs the Wild Artichokes restaurant in Devon. Baxter, guided by evidence on what ingredients ease menopause symptoms, says: “I tried to add nuts and seeds, without it feeling like you’re at a hippy festival.” She created dishes that were exciting — such as miso cod with braised greens, buckwheat and sauerkraut pancakes — not “worthy, brown” ones. Dessert-wise, Amati said she was having none of the “whipped egg whites and stevia” nonsense.
She says that studies show we can decrease our risk of “cognitive decline, depression, cancer, hot flushes and heart disease” by eating solid nutritious meals — not a pale salad and grilled chicken — including more than 30 plants a week, which reduce inflammation and blood sugar spikes and nurture a beneficial gut microbiome.
Equally important is respecting our circadian rhythm, which loves regular habits and a 12-hour overnight fast, and keeping active, especially after meals, which helps our middle-aged metabolism. “Going for a sprightly ten-minute walk helps to use that blood glucose as it goes straight into your muscles, bringing levels back to baseline fast,” she says.
How diet can affect the onset of the menopause
Entering the menopause between the ages of 45 and 51 is the “sweet spot,” Amati says. “Nature has given us that time.” Because oestrogen has a protective effect on, for example, bone density and cardiovascular health, if women reach the menopause too early — it’s estimated that between 5 and 10 per cent of women now reach menopause before 45 — “the increased risk of disease is quite marked,” she says. But later than 51 isn’t ideal either, she says. “You have an increased risk of breast cancer, womb cancers, because too much oestrogen for too long is not great.”
Forty-five per cent of the variability is genetic. Several studies link diets high in UPFs, and in meat, to entering menopause earlier, she says, while having excess body fat can delay it to between 52 and 55. Studies show that women who ate a Mediterranean diet high in oily fish and legumes tended to reach the menopause around 51 — whereas those favouring white rice and refined carbs tended to reach it between 46 and 49.
Where does HRT fit in, if too much oestrogen isn’t healthy? “The studies we have for HRT show that it is safe to take,” she says. Also, “HRT is supposed to be lower than physiological levels, so you take just enough to get rid of the symptoms.”
The menopause affects blood sugar control
Women’s metabolism starts changing in their thirties. For many, “by the time they’re 45, they’ve gained about 10kg without having done anything differently,” Amati says. Higher blood glucose is part of the picture. At 36, she already has poor blood sugar control. “Blood glucose has become a bit of a thing,” she says.
But actually, it’s your insulin that’s important here. Oestrogen improves insulin sensitivity, so we become more insulin-resistant post-menopause, and over time chronic insulin resistance can make you more prone to weight gain, and developing high blood pressure and high cholesterol. And, Amati warns, “If you’re insulin-resistant, even if you have fairly low or normal blood glucose, you’re still insulin-resistant.”
Other factors — like how efficiently fats are cleared from your blood — also contribute to the ideal of “metabolic flexibility”, where your biology works as well as age allows because you’re not taking liberties like nibbling on sugary snacks day and night.
Meanwhile, we can also lower blood sugar by maintaining muscle, as muscle tissue takes glucose from our blood and stores it as glycogen. “Our muscle is the most active tissue that we have metabolically. The more muscle you have, the more it stores, because the more energy it needs to function,” Amati says. You must be active to use it up and make space for more, “but it’s a much quicker input-outtake”.
Eating your first and last meal at roughly the same time daily also helps to regulate blood sugar. “When there’s a set mealtime, our body will expect that and insulin will spike before we even eat,” she says. “Your body’s primed to efficiently remove that glucose from your blood into tissues.”
Defend your microbiome with extra virgin olive oil
Part of why the menopause directly affects a woman’s ability to respond to glucose and blood fat clearance is because there’s an “overhaul in microbiome species” during these years, Amati says. Post-menopause, the gut’s bugs are “more similar to a man’s than to a premenopausal woman’s”. She adds: “As our oestrogen starts declining, the species of bacteria that are oestrogen sensitive — the estrobolome — start dying off.”
If our diet doesn’t contain polyphenols from colourful plants (eg berries, beetroot, spinach), fibre (nuts, pulses, seeds) and probiotic (fermented) foods, unhelpful bacteria fill the gap. “But if we have a diet higher in plants — which basically means higher in fibre — the changes are mitigated,” she says. Eat wholegrains, mushrooms, pulses, nuts and seeds to support gut microbiome, estrobolome and metabolic health, she says. “And extra virgin olive oil — all day every day!”
Eat healthy fat to combat midlife spread
In midlife our body recognises that oestrogen is declining and, meaning well, tries to combat this by storing more fat, as fat tissue produces oestrogen. “Often ‘midlife spread’ — horrid term! — is your body’s attempt to get oestrogen back into the system,” Amati says. Declining oestrogen also allows more pro-inflammatory gut microbes to thrive in the gut. Some make it into the bloodstream, increasing cortisol levels, leading to higher blood sugar and more fat storage.
We can help ourselves by eating more healthy fats (nuts, extra virgin olive oil, salmon, avocado). “A nice piece of fatty salmon will nourish your gut microbiome and help increase the anti-inflammatory species,” Amati says. “Omega-3 fatty acids also make up the nice helpful HDL [high-density lipoprotein] cholesterol that’s released into the blood and helps decrease the risk of heart disease.” Fermented foods (miso, kimchi, kefir, natural yoghurt), herbs and spices also help reduce inflammation.
Do eat proper meals — and ditch the rice cakes
“I tell my clients they must eat more to lose weight,” Amati says. Too many over-45s eat a biscuit instead of a meal. “They think one small biscuit at 50 calories will help them lose weight.” Other culprits include fruit juice, rice cakes and dates, eaten at random times on an empty stomach. “So you have these random rapid spikes of blood glucose and random peaks of insulin which are outside any circadian rhythm the body’s trying to establish.” Lunch is often “a salad and no carbs, and a little grilled chicken”.
She advises against this. “It doesn’t provide enough plants, diversity of fibre, it’s not satiating, there aren’t enough complex carbs. They’ll be hungry again in two hours and have the one biscuit.” The meal and snack each create an insulin response, “so blood glucose levels don’t come down”. (When glucose is present in the blood, you can’t burn fat. You’re “eating and storing” energy not “fasting and releasing” it.) If you snack, have something nutritious. “Yoghurt with fruits and nuts, or hummus with vegetables is much better metabolically than a rice cake.”
There’s no point fasting for 16 hours
Especially from our mid-thirties onwards, we need to support our biology, and it thrives on having a regular daily rhythm and a solid break from digesting food. “Zoe’s snacking study showed that eating after 9pm tends to have a negative metabolic impact on anyone,” Amati says. “Sensibly and logically, night-time is not for eating.” For most people, research shows that a 12 to 14-hour fast seems beneficial. Amati notes that this window gives the gut microbes time to break down prebiotic fibres and produce something useful, eg vitamin K, neurotransmitters, butyrate (a short-chain fatty acid that helps to keep the gut lining intact) — she doesn’t eat between 7pm and 9am. But there’s no need to punish yourself: “I don’t think a 16-hour fast is sustainable long term,” she says. The good news? A splash of milk in your morning coffee won’t “break” the fast.
Leave out the protein shakes
As we reach midlife, we become less efficient at absorbing protein, Amati says. We must work harder at building muscle and need protein for that. But she says: “In the UK the average person gets roughly twice the protein they need from food alone.” For example, a bowl of natural Greek yoghurt, a splash of kefir, with a handful of nuts and seeds provides 30g protein, more than half of your daily intake if you weigh 72kg (the UK average for women.) A daily protein shake isn’t necessary or beneficial. “There’s about 20g of liquid protein in these shakes. The absorption rate is really quick — we don’t think that is good for your liver.”
It is far healthier to absorb protein at a normal rate, through food. “Focus on nuts, legumes, beans and wholegrains, then oily fish, shellfish, tofu and chicken occasionally. Meat and animal products don’t need to be consumed that often to get the maximum benefit from them.” It’s a misconception that we can’t get all 20 amino acids from plants. While it’s harder to get all the essential amino acids from a single plant (apart from quinoa), she says, “if we combine plants, eg corn, black beans and squash, we do”. Eating this way, “You’re hitting the gut microbiome, high plant fibre and protein targets” — improving health and contributing to an easier menopause transition.
10 healthy swaps
• Rice — pearled barley
• White pasta — spelt pasta
• Couscous — buckwheat
• Iceberg lettuce — rocket
• Mincemeat bolognese — black bean and mushroom bolognese
• White bread — seeded rye sourdough
• Cereal or muesli — oats soaked overnight with kefir and nuts
• Flavoured low-fat dessert — fruit with natural yoghurt
• Milk chocolate — dark chocolate, 70 per cent+ cocoa solids
• Shop-bought vinaigrette — homemade extra virgin olive oil and apple cider vinegar dressing
Menopause-friendly foods for eight common symptoms
• Hot flushes — blueberries, beetroot, cavolo nero, cauliflower
• Anxiety — salmon, mackerel, wholegrains, seasonal vegetables, mushrooms
• Hormonal weight gain — dark leafy greens, beans, legumes, chicken, tofu, mushrooms
• Vaginal dryness — extra virgin olive oil
• Poor sleep and night sweats — natural yoghurt, kiwi fruit, plums, blackberries, blueberries
• Stiff joints — fresh spices, oily fish, extra virgin olive oil
• Brain fog — beetroot, dark chocolate, mushrooms, cherries, raspberries
• Change in frequency and urgency of urination — dark leafy greens, dark berries, red cabbage
Recipes for a Better Menopause: A Life-Changing, Positive Approach to Nutrition for Pre, Peri & Post Menopause by Dr Federica Amati and Jane Baxter (Octopus Books £25). To order a copy go to timesbookshop.co.uk or call 020 3176 2935. Free UK standard P&P on online orders over £25. Special discount available for Times+ members
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