2017-11-04

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Nutrition Strategies to

Manage the Various Stages

of Menopause

in an Active Woman’s Life

Carla Coulson, BSc(Nutr), RD, CDE

Today’sOutline

ü  WeightManagementduringMenopause²  Calorierequirementsaswomenage²  Healthybalanceofcarbs,proteins&fats

ü  ReducingRisksfor:²  HeartDisease²  BreastCancer²  Osteoporosis

ü  OtherDietaryConsiderations²  MediterraneanDiet²  Antioxidants(Phytochemicals)

ü  Supplementsyoumayconsider

•  PeriMenopause“aroundmenopause”•  3-10yrsbeforemenopause•  Symptomsstarttooccurbutmonthly

periodstilloccurs(maybelighter,shorter,skipped,heavier)

•  Menopause•  ApproxageofCanadianwomanisearly50’s•  When12monthshavepassedsinceyourlastperiod•  Ovariesnolongerproducesignificantamountsofestrogen&

progesteroneanddon’treleaseeggs

•  PostMenopause•  Estrogenlevelsreduced–affectsenergylevel,bonedensity,

musclemass,sexdrive•  Increasedriskofdevelopingheartdisease,osteoporosis&breastCA

•  Eachpersonexperiencesitintheirownuniqueway

•  Anaturaleventthatoccursforeverywomanwhenherovariesproducelesssexhormonesandshemovesoutofherreproductivestage

•  Fluctuatinglevelsofestrogen&progesteronecause:•  Upto80%ofwomen-hotflashes,nightsweats•  Upto60%-sleepdisturbances•  Upto35%moodswings•  Upto39%vaginaldryness•  Headaches,forgetfulness•  Fluidretention•  Unwantedweightgain,changestobodyshape

StagesofMenopause

•  HormoneTherapy&otheroptionsavailableformenopausesymptoms.Speakwithyourdoctoraboutwhatisrightforyou.Learnabouttheevidence,thebeneficialeffects&thepossiblesideeffects

AroundMenopause-(reducedlevelsofestrogen&progesterone)

ü  Increasedweightgainpotential

ü  Lossofleanmuscletissue

ü  Bloodcholesterollevelsmaycreepup-Heartdiseaserisk

ü  IncreasedBreastCancerRisk–yearsofestrogenexposure

ü  Lossofbonedensity–Osteoporosisrisk

Protectingyourlong-termhealthProtectingyourlong-termhealth

Managingyourweight

•  “Iusedtobeabletojustaddalittleexerciseorcutbackabitto

managemyweight.”It’smoreofastrugglenow!!

•  “Shiftingbodyfat”…....Evenifthescaleweightdoesn’tchange,reducedlevelsofestrogenimpactyourbodyweight&shape

•  Estrogenmayhelptopreventbodyfataccumulationaroundthewaistline

•  ApplevsPearshape-Increaseshealthrisksforheartdisease,stroke, type2diabetes,sleepapnea

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Managingyourweight….cont’d

•  Ourmetabolismslowswithage/lossofleanmuscletissueStayingactive(weight/resistancetraining)helpstomaintain

musclemass&haveahighercalorie-burningbody

•  Asweage,weneedtoconsumefewercalories thanwedidwhenwewereyounger

EstimatedDailyEnergyRequirements HealthCanada

Age

Sedentary(Calories/day)

LowActivity(Calories/day)

Active

(Calories/day)

19-30 1900

2100 2350

31-50 1800 2000 2250

51-70 1650 1850 2100

71+ 1550 1750 2000

WannagotoEarls?

MenuItem CaloriesChicken&Wontons 850

DynamiteRoll 740

Calamari 890

CaesarSalad 570

WarmKaleSalad 790

JeeraChickenCurrywithNaan 1370

HunanKungPa0withChicken 1180

9ozglassofwine 210

EVERYTHINGyoudotolosetheweight…..mustbe

whatyouCONTINUEtodotokeepitoff!!(LeslieBeck)

•  Ifwanttoloseweight.....Setarealisticweightlossgoal Behappywith5-10lbslossvstoolarge/unrealisticloss

•  Thinklong-termchangesvsashort-term‘quickfix’goal. Don’ttry“diets”butratherchangebehaviorsthatyouknowwillmakeadifference

•  1-2lbslost/wk.Iffasterthanthat,youarelosingsomemuscle,fat&fluidandmusclelossisalreadyonthedecline.Lessmusclealsomeansreducedcalorieburning

WeightLossComparisonof12-36monthsonVariousStrategiestoLoseWeight Portions….Portions….Portions

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HealthyDailyEatingPractices toHelpManageWeight

ü  Eatatregularintervals–maxof4-5hrsbetweeneating topreventhunger

ü  Smallportions!Shrinkthesizeofyourplates, bowls,cupsyoueatfrom

ü  Snackwisely.Eatfillingfoods.Balanceyourplate

ü  Watchportionwithsupper&nighttime….lesscalories burnedintoeveninghours

ü  Watchalcoholfrequency&amount

HealthyDailyEatingPractices toHelpManageWeight

ü  Includeproteinsourcewitheachmealforsatiety&musclepreservation

ü  SmallinclusionofwholegrainswithmealsFistsizemax(1/2–1cupserving)

ü  InclusionofFruits,veggies,dairy/calciumsources

ü  Limitexcesssugars,refined/processedfoods.Keeptreatsoutofhouse

ü  Treatyourselfoccasionally.Dealwithlapses–weallhavethem!

ü  Positiveself-talkJ

Carbs 45–55%

Protein20-25%

Fat~30%

Carbs:WholegrainsFruitsMilk,Yogurt/AlternativesLegumes

LeanProteins:Beef,Pork,Fish,Poultry

EggsCheese,CottageCheeseNuts,NutButter,SeedsLegumesMilk&Yogurt

Fats:VegetableOilsOlivesAvocadoFlax/hempoilsNuts&SeedsLessfromAnimalSources

LimitEXTRASSweets,Treats,Wine,Fun

Foods

Carbs 45–55%

Protein20-25%

Fat~30%

Carbs:2000x45%=900calories/4calsperg=225g/d=2-3fruit/day 2-3dairy/alternative/day 5-6grain/day Lean

Proteins:1.5g/kgx75kg(165lbs)=112g/dor2000x20%=400cals/4calsperg25%=500cals/4calsperg =100-125g/day ~15-30g/meal ~5-10ginasnack

Fats:2000x30%=600cals/9calsperg=65g/day~18-20g/meal(moreemphasisonplantfats)

ExampleBasedona2000CalorieDiet

Limit

EXTRASSweets,Treats,Wine,Fun

Foods

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Proteincontentofameal

Meal: 2wholegrainbread =8g ½cansalmon =8g 175gGreekyogurt =15g 1apple =2g ¾sandbagofveggies =2g 35gprotein

- 

Include: 15-30g protein per meal

Proteincontentincommonfoods:Food Serving Protein (g) Food Serving Protein (g)

Chicken Breast 4 oz 27 Tofu, soft 1 cup 10

Fish 4 oz 23 Tofu, firm 1 cup 20

Egg/2 whites 1 7 Greek yogurt ¾ cup 15

Legumes 1 cup 14 Regular yogurt 1 cup 8

Beef 4 oz 19 1% cottage cheese ½ cup 15

Soy milk 1 cup 7 Almond butter 2 Tbsp 6

Skim milk 1 cup 8 Peanut butter 2 Tbsp 6 1oz/cheese string 1 6 Cooked veggies ½ cup 2-3

Brown rice 1 cup 5 Kashi cereal 1 cup 11

Oatmeal cooked 1 cup 6 Lara bar 48g 7

Nuts 2 Tbsp 7 Kashi granola bar 1 bar 6

Soybeans Sardines Can’d tuna/salmon

½ cup 2.6oz 30g

11 20 8

Quinoa Protein powder Protein bar

1 cup 1 scoop 1

8 20-30 8-25

Foods containing 15 grams of carbohydrate (Include 2-4 servings/meal)

Food Serving Food Serving fruit Tennis ball size slice bread/medium muffin 1

banana 1 small bun/English muffin ½

melon or blueberries 1cup rice/sweet potato 1/3 cup raspberries/strawberries 2 cups potato/pasta/corn/quinoa/barley ½ cup

kiwi or plum 2 pieces of sushi/nigiri roll 3 grapes or cherries 12-15 pita / 6”naan bread tortilla ½

grapefruit/mango ½ cup oatmeal /cold cereal ½ - ¾ cup fruit juice ½ c Triscuits/rectangle Melba 4-5

raisins or dried cranberries 2 Tbsp waffle/pancake (4 inch) 1

milk/soy/almond chocolate/flavored milks

1cup ½ cup

popped popcorn

3 cup

no sugar added yogurt regular yogurt/Greek yogurt

¾ cup ½ cup

plain granola bar medium bagel

1 ½

milk/cream/pasta/rice soup hummus legumes (chickpeas, lentils, black beans, etc)

1cup 2/3 cup 1cup

soda/Ritz crackers Graham crackers “Treats”: tortilla chips

small cookies stick of licorice ice cream

7 3 12 2 1 ½ cup

Protectingyourlong-termhealth–

ReducingHeartDiseaseRisk

•  Men10-15yrsearlierriskthanwomen

•  Protective/delayedriskisduetoestrogensowithestrogenloss,woman’sriskofgettingheartdiseaseincreases4-foldaftermenopause

•  Withaging/lessestrogen,bodylessefficientatclearingcholesterolfromblood&vesselsbecomelessflexible

•  CellsinliningofbloodvesselscontainLDLreceptorsthatremovecholesterol.Bodyproducesfewerreceptorswithlessestrogen.LDLcholesterollevelsthenrise

•  Agingalsoincreasesweightgainrisk&highbloodpressure–alsoriskfactorsforheartdisease&damagetothevessels

Are you at risk of heart disease?

Non-ModifiableRiskFactors ModifiableRiskFactors

50+yearsold Highcholesterol(LDL)levels

Atorpastmenopause LowHDLcholesterol

Familyhistory(parent)ofCVDbefore55yrsforfather&65yrsformother

Highbloodtriglyceridelevels

Poordiet–higherprotein,fat,sodiumHigherprocessedfoods

Smoking

Highbloodpressure

Lowexercise

Overweight/Obese/BMI>25

Diabetes

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ReducingHeartDiseaseRisk

•  RegularexercisecanboostHDL,reduceLDL&strengthentheheart

•  Antioxidants(fromplantfoods)-reducesLDLfromstickingtoarterywalls&causingdamagefromfreeradicals(highlyreactiveoxygenmoleculesproducedbynormalbodyprocesses,smoking,pollution)

•  Antioxidantenzymesproducedbybody,howeverlevelsdeclinewithage

The colorful world of Phytochemicals

Carotenes (DEEP ORANGE)

Reduce free radicals & cancer promoters

Squash, pumpkin, mango sweet potato, carrots, cantaloupe

Lycopene (RED)

Inhibit cancer cell growth Stimulates immunity Blocks free radicals

Tomato/tomato prod’ts watermelon, grapefruit

Anthocyanins (PURPLE)

Heart health influences Blueberries,beets, grapes, cherries, cabbage

Cryptoxanthin (ORANGE)

Antioxidant & tumour suppression

Peach, carrots, nectarines tangerines, papaya

Lutein Zeaxanthin (DARK GREENS)

Free radical effect especially for eye health

Green beans, peas, peppers, spinach, romaine, kiwi, honeydew

DietaryFats&Cholesterol

ü  Unsaturated,Saturated&Transfats

ü  Cholesterol

•  Goodforyou…unsaturatedfats(plants)

•  Lesshealthyforyou…..saturated(animals)

•  Worstforyou…….trans(hydrogenated,processed)

•  Mayaffectsomeofyou……Cholesterol(animals)

Sources of Dietary Fat Choosehealthierfats“thatgiveback”......butwatchamounts

(unsaturated)

Nutsandseeds

Fish&FishOil

OliveOil,Olives

GroundFlax&FlaxseedOil

Chia&Hempseeds

Non-hydrogenatedmargarine

Avocado

(saturated&trans)

Meat,pork,poultry

Dairy

Butter&hardmargarine

Coconutoil

HydrogenatedFoods

FriedFoods

Pastries

Baking&desserts

BeneficialFatSources LessHealthyFatSources

BestOmega3Food

SourcesDietaryCholesterolsources

n  Animalfoods

(anythingthathasalivertoproduceit):n  OrganMeatsn  Beefn  Poultryn  Porkn  Buttern  Shellfishn  Eggs

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Nutrition Facts Table Theinforma5onisbasedona

specificamountoffood

The%DailyValue(DV)showsifthereisaliFleoralotofanutrient.Basedon2000caloriediet&%ofmax100%limit

A%DVof5%orlesswouldbelowinthesenutrientsanda15%ormoreishighinthesenutrients.

AdditionalDietaryConsiderationsto

ReduceHeartDiseaseRisk

ü  DASHdiet–DietaryApproachestoStopHypertension8-10fruits/veg,2lowfatdairy, <2300mgsodiumperday

ü  Fibre~25-35g/d–Removescholesterolfromblood(oatmeal,oatbran, AllBranBuds,psyllium,legumes/beans,fruits,veg)

ü  Wholegrains–vitE&mineralsactasantioxidantsagainstLDLoxidation

ü  Nuts¼cup/d–reduceLDL&improvebloodvesselfunction

ü  Tea–1-2cups/d–antioxidantagainstarteryhardening

ü  Garlic–Useincooking;roasted-antioxidant,bloodthinner

AdditionalDietaryConsiderationsto

ReduceHeartDiseaseRisk

ü  PlantSterols–2gdaily–Plantsterolmargarine/yogurtwithaddedplant sterols/milkalternatives

Naturallyinsoybean,corn,squash,vegoils&wholegrainsinsmalleramounts

ü  Soyprotein~15-25g/d-lowersriskbyincreasingHDL,lowersBP, preventsoxidation,keepsvesselshealthy

ü  Alcohol–0-1/d–antioxidantsinwine(5oz=1svg)&mayincreaseHDL cholesterol,reducebloodclottingBUTincreasestriglycerides,weightgain,hotflashes,insomnia,breastCArelationship

IfwomencontrolledmedicineJProtectingyourlong-termhealth

ReducingBreastCancerRisk

v  1 in 8 chance of diagnosis in a woman’s lifetime

IncreasesriskFirst-degreefamilyhistory

Longerestrogenexposure–menstrualcyclebeforeage12-menstruationfor40+yrs-neverpregnant

Weightgain–Estrogenproducedinfatcells-Increasesinsulinrequirements-agrowthhormone

Alcohol–higherintake,higherrisk

*Saturated(animal)&transfatintake.Higherfatintakeoverall

*Redmeatintake.Limitprocessedmeats,smoked/curedmeats*Highheatcookingofmeats(BBQ,broil,fry).Don’tchar/blackenmeat

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Protectingyourlong-termhealth

ReducingBreastCancerRisk

Considerenhancingintakeof:Mediterranean-stylediet-Recentstudytracked60,000womenx2decades.Excludedalcoholinanalysis.40%reductioninbreastcancerdiagnosisrisk

Fish(omega3)&Unsaturated(plant)fatintake.Lowerfatintakeoverall.

Antioxidants-Fruits&veggies–2-3fruit&1.5-2.5cupsveg/day++colorandvariety-Green&blackteas

Healthfuleating(minimizeprocessedfoods&sweets/pastries/sugardrinks)Regularactivity

Dietaryfibre–25+g/day–Replace/reduceanimalsourceswithplantfoodsmoreoften

Soy–Upto1food(notsupplements)/day.Speakwithyouroncologist/doctorifokforyou

ReducingBreastCancerRisk

²  BenefitsofPhytoestrogens(isoflavones-estrogen-likeeffectsplusantiestrogenproperties)

-Blocksnaturalestrogensfrombindingtoestrogenreceptor-reducesrisk-Antioxidant&anti-inflammatoryproperties

²  Soy(Isoflavones)–Wasconcerninbreastcancersurvivors,especiallyER+.

Nowseveralstudiesconsistentlyshowbenefitswithmoderatesoyamounts.ImprovedoutcomeswithwholesoyfoodNOTsupplementconsumption.

-“Moderate”=1-2servings/d-20-60mgisoflavonesdaily&regularintervalsneeded–foodsourcessafe-50timeslesspotentthanregularestrogen

²  Adietrichinphytoestrogens…..alsofullof:>Phytochemicals(antioxidants),vitamins,minerals,fibre,omega3>Include-soy/legumes,wholegrains,flaxseed,nuts/seeds,veg,fruits

IsoflavoneContentinSoyfoods

SoyFoods ServingSize Isoflavonecontent(mg)

Roastedsoynuts ¼cup 40-60

Soybeans(inshell) ½cup 14

Soyflour ¼cup 28

Soybeverage(mostbrands) 1cup 20-25

Soybeverage(SoNice) 1cup 60

Soyhotdog 1 15

Soyproisolate(waterextract’n) 2roundedTbsp(30g) 30

Tempeh,cooked 3oz(90g) 48

Tofu,firm 3oz(90g) 22

Soyoil,lecithin,sauce Poorsources

Isoflavonesalsoinflaxseed, greentea,broccoli,whole grains

Protecting your long-term health Reducing Osteoporosis Risk

•  Osteoporosis–lowbonedensity(mass)&deteriorationofexisting

bonetissue

•  Hormones–Estrogen&calcitonindecreaseasweage Thyroidhormonealsoinfluential.Allimportantforbonehealth

•  Early20’s–boneshavereachedpeakbonemass–stopincreasingindensity

•  Afterreachbonemasspeak–naturalbonelossoccursslowlythereafter

•  Beforemenopause,womenlosebone@1%/yr(sameasmen)

•  Within1st5yrsaftermenopause,womenlosebone2-6xfasterSomehavemorerapidlossthanothers

•  By10yrsafter,rateofbonelossreturnsto1%/yr

ü  Affects1in3women&1in5menintheirlifetime

ü  Genetics–parentsearlyfracture/hipfracture

ü  Stayactive.Weight-bearingactivitystimulatesbonetoincreaseinstrength&densityduringperi&post-menopausalyears

ü  Weighttrainingalsohasprotectiveeffectonbonedensity

ü  Calcium,vitaminD(increaseintestinalabsorption)&magnesium(tomake parathyroidhormone)worktogethertomaintainstrongbones

ü  Calciumcitratebetterabsorbedthancarbonate.Splitdosesoverday (500mgmaxinonetab)

ü  Magnesium–“Typical”NorthAmericandietlowd/thighlyprocessedchoices. Choosewhgrains,legumes/soy,nuts/seeds,dairy,darkgrveg

ü  Smoking-Negativeaffectonbonehealth Smokershaveearlynaturalmenopause&increasedriskoffractures

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Calcium & Vitamin D Recommendations (referenced from Dietitians of Canada & Osteoporosis Canada)

AGE

Calcium

VitaminD

Adults19-50yrs51-70yrs

1000mg

Men1000mgWomen1200mg

(Max1500mginsupp)

600-1000IU

(Max2000IU/d)

Adults>70yrs

1200mg

800-1000IU

HighCalciumContainingFoods

CalciumSource Serving CalciumContent(mg)

Milk 1cup 300

Calciumfortifiedsoy,almondmilk

1cup 300

Yogurt ¾cup 300

Cheese,hard 1.5oz 300

Tofu,firm(wcasulphate) 4oz(120g) 260

Blackstrapmolasses 2Tbsp 290

Collardgreens,cookedKale,cooked

1cup1cup

350175

Spinach/SwissChard,cooked 1cup 150

Broccoli,cooked 1cup 95

Soybeans,cooked 1cup 175

Blackbeans,cooked 1cup 100

Salmonwithbones ½tin(45g) 200-300

Nuts ¼cup 70-100

OsteoporosisRisk

DietaryConsiderations

ü  Adequateintakeimportanttomaintainstrongbones&strongmuscles

ü  Protein–highproteinintakecancausecalciumtobeexcretedbykidneys ratherthanreabsorbed&depositedinbone

ü  Caffeine(coffee,tea,colas)–max400mg/d-coffee,tea,cola–likelymost detrimentalifnotmeetingcalciumneeds

ü  Sodium–toomuchcauseskidneystoexcretecalciumKeepmaxto2000-2500mg/d(tablesalt&packagedfoods)

AMultivit/Mineraltabtopsupahealthydietwithoutcreatingexcessesthatcanbeharmful

Supplementtoconsider

Goal/AmounttoTake AdditionalComments

Women’sAdultMultivitamin/MineralTablet

Takewithfoodforbetterabsorption

Don’tneed“natural”or“slow-release”Toprovidevitamins:folicacid,A(max2500IU),D,betacarotene,B1,B2,B6,B12&minerals:iron,zinc,copper,magnesium,iodine,selenium

Iron

Menstruating18mg/dAfter8mg/d

LossofironthroughmonthlybloodlossDon’tdrinkteaorcoffee1hrbefore/2hrsaftereating(iflowironlevelssobetterabsorption)IncludevitCsourcewith(fruits&veg)Youcanfindthisinthecorrectmultivit/mintab

VitaminB12 2.4mcg/d LessstomachacidasweagetoabsorbB12.Advisedif50+yrs.Youcangetthisinamultivittab

CalciumCitrate 300mgforeveryservingnotconsumed/day

Splitdosesoverday(500mgmaxinonetab)Swallowedorchewable.Worw/outfood

VitaminD3 600-1000IU/dayyear-roundoratleastallwinter

Max2000IU/daySeparatesuppneededtoprovide600-1000IU

Plantsterols 2g/day Margarine,yogurt&milkalternativeswithaddedplantsterols

Probioticsfromfood1stchoicebutsuppanoption

>1(to30)billionCFU’s/d Eatyogurts,kefir,fermentedfoods

CredibleMenopause&NutritionWebsites(somestatistics&informationusedfrommanyofthesesites)

•  menopause.org–NorthAmericanMenopauseSociety

•  healthywomen.org–NationalWomen’sHeathResourceCentre

•  osteoporosis.ca–OsteoporosisCanada

•  oncologynutrition.org–AcademyofNutrition&Dietetics

•  cancer.ca–CanadianCancerSociety cancer.org–AmericanCancerSociety

•  todaysdietitian.com–ResourceforDietitians–publicaccess

•  nih.gov–NationalInstituteofHealth

•  lesliebeck.com–Canada’sLeadingProfessionalDietitian&Author(sometables&information forthispresentationweretakenfromherbook….anexcellentread!)

•  myfitnesspal.com–Food&activitylog

•  supertracker.usda.gov–“MyWeightManager”-Personalizednutritionandphysicalactivityplan/log

•  eattracker.ca eatingwell.com cleaneating.com eatrightontario.ca

“Wearewhatwerepeatedlydo.

Excellence,therefore,isnotanact,

butahabit.”

Aristotle

Questions?