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Healthy eating through the menopause: where does soya fit in?

Over two million women in the UK are between 45 and 51 years of age. This is the age at which most women undergo a change of life and begin the menopause. It is a time when many women seek help and advice from their GP and practice nurse about diet and lifestyle

Nigel Denby
Women's Health Dietitian
Hammersmith and Queen Charlotte's Hospital Menopause Clinic
London

Menopausal symptoms are primarily due to falling oestrogen levels, and may last for just a few months or linger for several years. Symptoms differ in frequency and severity between women, but can include:

  • Hot flushes.
  • Night sweats.
  • Irritability and mood changes.
  • Poor concentration.
  • More frequent headaches and joint pains.
  • Reduced sex drive.
  • Vaginal dryness and irregular or heavy periods.

Over the long term, loss of oestrogen significantly increases cholesterol levels and the risk of coronary heart disease. Diet and lifestyle advice can significantly help maintain healthy cholesterol levels. Similarly ensuring adequate calcium intake can help to maintain bone density, while keeping physically active is an important element in weight control and protection from weight-related disease. The important message for women is that a balanced diet and healthy lifestyle is the cornerstone of a healthy menopause.

What diet and lifestlye advice can you give?
1. A healthy balanced diet and lifestlye
A varied diet including foods from all of the food groups can provide all the nutrients the body needs. Many women may experiment with "special" diets, which are not always nutritionally adequate. For the vast majority of women, a healthy balanced diet and an active lifestyle is the best foundation for long-term health and wellbeing.

2. Healthy weight
Being overweight increases a woman's risk of heart disease, diabetes and some cancers. Some women find it more difficult to control their weight during and after the menopause. However, this is not the time for "quick-fix" diets. A balanced diet combined with around 30 minutes of brisk daily physical activity is the healthiest combination to achieve and maintain a healthy weight. Weight loss of just 10% can bring significant improvements to raised blood pressure and cholesterol levels, and reduce risk of heart disease and diabetes.

3. Bone health
During menopause it is important to include foods that will help maintain bone health. Calcium is an important mineral and dairy foods and calcium-enriched soya alternatives are rich calcium sources. Vitamin D, which is synthesised skin via sunlight and magnesium found in a wide range of foods, is also important. Three servings of dairy foods or soya alternatives will provide the 700 mg recommended daily allowance (RDA) for calcium. Women with existing osteoporosis may benefit from taking a daily vitamin D supplement providing 10-20 mcg.

4. Heart health
Seven out of 10 menopausal women have high blood cholesterol, which is a risk factor for heart disease. A heart-friendly diet should include at least five fruits and vegetables a day. Encourage plenty of wholegrains and soluble fibre from foods, such as beans, pulses and oats, as well as a portion of oily fish (salmon, mackerel, herring, sardines) each week. Keeping saturated fat intake down and being physically active is also important.

Soya foods lower blood cholesterol levels
Enjoying soya foods as part of a healthy balanced diet can have an important role in helping to reduce cholesterol levels.(1) It is the soya protein in soya foods that lowers the cholesterol.(2) It is possible to obtain 25 g of soya protein per day by consuming the equivalent of two to four servings of soya foods each day.

5. Sleep
Keeping a healthy weight and taking regular physical activity can help improve the quality of sleep and wellbeing. Women who complain of night sweats should find that diet and lifestyle steps to reduce the frequency and severity of their sweats will significantly improve their quality of sleep. Keeping the bedroom well-ventilated and choosing cotton nightwear can also help, as well as limiting caffeine intake to just two to three cups of tea, coffee or cola drinks per day.

6. Benefits of exercise
The emphasis should be placed on activity rather than exercise. Simple, brisk walking for 30 minutes a day can help improve overall fitness and wellbeing. Studies have shown that daily activity can be more beneficial than occasional bouts of strenuous exercise.(3) The benefits are equal whether the activity is taken in small 10-minute segments or all in one go, which can be helpful when motivating women.

Where does soya fit in?
Many women are now including soya foods in their diet to help with the menopause. Soya fits very well with a healthy balanced diet as many soya foods are low in fat (particularly saturated fat), a source of the essential omega-3 and omega-6 fatty acids and soluble fibre, and contain soya protein, which actively lowers cholesterol. The calcium-enriched varieties of soya yoghurt and milk alternatives are also an excellent source of calcium, equivalent to that of dairy. Soya also contains isoflavones. Recent research suggests that isoflavones found in soya may help to lower the number of hot flushes in some women.(2)

Some facts about isoflavones

  • Isoflavones are a group of substances naturally found in plants.
  • Soya is the richest source of isoflavones.
  • If eaten regularly, isoflavones have been shown to have a weak oestrogenic effect. The strength of isoflavones in the human body is much weaker than oestrogen.(4)
  • Epidemiological studies from China and Japan show that the intake of soya isoflavones is high. Only one to two out of 10 Chinese and Japanese menopausal women complain of hot flushes and sweats. In addition they are less likely to suffer from heart disease.(5)

Women who are most likely to benefit:(4)

  • Women who are suffering from severe hot flushes (ie, five or more hot flushes a day).
  • Women who are taking soya foods containing soya isoflavones throughout the day rather than one large serving per day.
  • Women who are incorporating soya, containing isoflavones, in the diet for approximately 12 weeks.

How much does a woman need to consume?
Studies have used a broad range of isoflavones from 30-100 mg/day. It has been suggested that around 50 mg of isoflavones per day can help with hot flushes.(4) This would equate to two to three servings of soya foods a day.

Diet and lifestyle
The top tips in Table 1 can be used to help guide women towards the key dietary and lifestyle factors to help manage their menopause more effectively. Any changes to diet and lifestyle may take up to three months to take full effect. Keeping a food and activity diary for a few days can help identify specific areas for change. Patients may find it useful to work on just two to three changes at a time.

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Frequently asked questions
Q. Will I gain weight during the menopause?
Unfortunately many women gain weight around the time of the menopause and the reasons are multifactoral. Attention to physical activity levels and a healthy diet are essential for effective weight control. Women may benefit from a referral to a registered dietitian. The British Dietetic Association Weight Wise campaign has some useful resources (see www.bdaweightwise.com).

Q. Are there any natural options to HRT?
The most supportive evidence for natural oestrogenic activity focuses on phytoestrogens. Herbal remedies such as don quai, Ginseng, St John's wort and black cohosh have also been used for menopausal symptom control, but information about their specific effects is lacking.

Q. Should menopausal women take a calcium supplement?
Current evidence suggests that menopausal women who have been diagnosed with osteoporosis may need to boost their calcium intake to around 1,200 mg/day and a calcium supplement may be necessary to achieve this. Nonosteoporotic, menopausal women require approximately 700 mg calcium per day. Three portions of low-fat dairy foods or calcium-enriched soya alternatives should be sufficient to achieve this.

Q. Are essential fatty acids useful?
Essential fatty acids (EFAs) such as those found in soya, nuts, seeds and oily fish can be useful if skin becomes dry and may be helpful in relieving joint pain. The best EFAs are those from the omega-3 and omega-6 families, which are found in soya and soya products, pumpkin seeds, oily fish, such as herring, sardines, salmon and mackerel, walnuts, dark green vegetables and oils such as sesame, walnut, soya and sunflower. EFAs may also help relieve vaginal dryness and improve mental and physical energy. Adding seeds to cereals and salads, using EFA-rich oils for dressings and eating oily fish at least once a week will all increase EFA intake.

Q. Are complementary therapies useful?
Complementary therapies including acupressure, acupuncture, Alexander Technique, hypnotherapy, reflexology, reiki and T'ai chi are reported to be helpful by some women. The evidence to support these treatments is, however, slight.

References

  1. Anderson JW, Johnstone BM, Cook-Newall ME. Meta-analysis of the effects of soy protein intake on serum lipids. N Engl J Med 1995;333:276-82.
  2. Zhan S, Ho SC. Meta-analysis of the effects of soy protein containing isoflavones on the lipid profile. Am J Clin Nutr 2005;81:397-408.
  3. Department of Health. At least five a week. Evidence on the impact of physical activity and its relationship to health. London: DH; 2004.
  4. North American Menopause Society. Role of isoflavones in menopausal health; a consensus opinion of the North American Menopause Society. Menopause 2000;7:215-29.
  5. Messina M, Hughs C. Efficacy of soyfoods and soybean isoflavone supplements for alleviating menopausal symptoms is positively related to initial hot flush frequency. J Med Food 2003;6:1-11.