September 2000

Menopause and Diet
By: Andrea Platzman, R.D.
Contributing Editor

Each year, approximately 1.25 million American women between the ages of 45 and 54 enter menopause, the cessation of menstrual periods and the associated decline in estrogen secretion. Menopause often is accompanied by uncomfortable side effects, which may include hot flashes, night sweats, memory problems, depression, weight gain, insomnia, incontinence and anxiety. It has also been linked to an increased risk for heart disease and osteoporosis. Hormone replacement therapy (HRT), a combination of estrogen and progesterone, reduces side effects. However, HRTs safety is controversial, so many women are looking for natural alternatives.

Heart risks
Heart disease is the leading killer of American women, affecting more than 245,000 annually. The Framingham Heart Study, an ongoing study under the direction of the National Heart, Lung and Blood Institute in Framingham, MA, found that menopausal women experience a shift in the high-density lipoprotein (HDL):low-density lipoprotein (LDL), where the LDL level usually increases. Elevated LDL levels have been linked to a higher incidence of heart disease.

Menopausal women tend to have higher waist-to-hip ratios in comparison to premenopausal women due to a redistribution of body fat. This increase also has been linked to a higher incidence of heart disease. The metabolic rate decreases by 2% every decade, which means women need to consume approximately 100 calories less per day every 10 years to maintain a healthy body weight.

Soy power
A healthy diet is essential, says Marsha Hudnall, MS, RD, director, nutrition programs, Green Mountain at Fox Run, Ludlow, VT. "I recommend a plant-based diet including soy as an alternative to protein."

Consumer and industry interest in soy is rising. "Soy has numerous health benefits especially for the menopausal woman by lowering cholesterol levels, which usually elevate menopausally, reducing hot flashes and preventing bone loss," says Laurent Leduc, marketing manager, Schouten USA/ SoyLife, Minneapolis.

"Although the actual mechanism by which soy protein lowers lipid profiles remains unclear, it is likely that both soy protein and soy isoflavones play complex roles. One hypothesis is that soy isoflavones act as antioxidants by neutralizing or slowing the rate of oxidation of LDL cholesterol. Soy genistein binds to estrogen-receptor-beta (ER-beta) cells, which may contribute to the attenuation of plaque formation, as well as increase arterial elasticity, allowing blood to flow more easily through the arteries," explains Leduc.

Menopauses estrogen reduction results in hot flashes, night sweats, headaches and irritability. Paola Albertazzi, et al. , The University of Ferrara and The University of Bologna, Italy, conducted a study of 104 post-menopausal women. Fifty-one patients took 60 grams of isolated soy protein daily and 53 patients took a casein placebo. At the end of the 12th week of the study, patients taking the soy had a 45% reduction in their hot flashes versus a 30% reduction obtained from the placebo group.

Boning up
Approximately 16 million American women suffer from osteoporosis annually. A decrease in circulating estrogens causes post-menopausal bone loss between the ages of 42 and 58. In fact, bone loss during the immediate post-menopausal period can be as high as 2% annually.

"Some studies have shown that soy helps with osteoporosis and there may be several mechanisms of action that involve isoflavones binding to ER-beta cells as well as inhibiting the activity of bone cell tryosine kinases," says Leduc.

At the University of Illinois, Urbana-Champaign, Susan Potter et al. studied 66 post-menopausal women for six months with three interventions. All subjects were randomly assigned to one of three groups: 40 grams of casein protein per day; 40 grams soy protein with 56 mg soy isoflavones per day and 40 grams soy protein with 90 mg soy isoflavones per day. The latter group gained significant increases in the bone density of the lumbar spine as compared to the other two groups.

Consume calcium
Post-menopausal women require 1200 to 1500 mg of calcium per day. This not only prevents bone loss, but may reduce the incidence of hypertension according to the Dietary Approaches to Stop Hypertension (DASH) study. Researchers found that a high-calcium, low-fat diet rich in fruits, vegetables, and dairy products significantly reduced blood pressure without weight loss or sodium restriction.

The best way to obtain adequate calcium levels is by eating foods such as low-fat dairy products, kidney beans, white beans, soy beans, almonds, brazil nuts, canned salmon, sardines, Chinese cabbage, broccoli, spinach and calcium-fortified foods, such as orange juice. Additional vitamin D may be needed to aid calcium absorption.

Herbs that may help
"Many women are trying alternative treatments for menopausal symptoms including black cohosh, chasteberry, kava and red clover," says Hudnall. Black cohosh, cimicifuga racemosa, has long been used to treat symptoms of menopause. "Studies indicate that 40 mg a day of black cohosh relieves hot flashes and vaginal atrophy as well as reducing night sweats, nervousness, heart palpitations, headaches and some depression by having an estrogen-like effect," explains Kara Dinda, MS, education director, American Botanical Council, Austin, TX.

"Chasteberry (Vitex agnus-castus) may help with irregular bleeding since it has a progesterone-like effect; however, there hasnt been strong evidence with its use. Kava (Piper methysticum) can help with anxiety. Red clover (Trifolium pratense), a member of the legume family, is high in isoflavones, similar to soy, and is being studied for its effect on hot flashes, but the supporting evidence so far is not strong enough to make any conclusions or recommendations," says Dinda.

Consuming enough calcium, adding soy, maintaining a healthy weight and trying herbs can help make menopause merely a rite of passage instead of a time of suffering.

Andrea D. Platzman, a registered dietitian, writes regularly for nutrition publications. She earned a master's degree in nutrition from New York University, and has a culinary and business background.

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