Everything NOBODY TOLD YOU About (Peri) Menopause (Weight Gain, Keto, Diabetes, Soy & More) with Dr. Jenn Huber, RD, ND

In today’s episode of Bite Back with Abbey Sharp, I will be chatting with Dr. Jenn Salib Huber about menopause and perimenopause signs and symptoms (and if you're in your 30s, it might already have started!!). We will chat about food cravings and how much weight you'll actually gain and where in your body. We will discuss the dangers of low carb, keto, eating disorders and weight loss during menopause. And we finish with the best foods to add to your diet. Language Note: I will be using exclusive woman-specific language, even though I fully acknowledge that not everyone who goes through menopause identifies as a woman. And we will be discussing disordered eating and weight loss themes. Also my general reminder that the information in this episode is for entertainment and educational purposes only and is never a replacement for personalized healthcare. Check in with today’s amazing guest: Dr. Jenn Huber Instagram: @menopause.nutritionist Website: www.jennsalibhuber.ca Podcast: themidlifefeast.buzzsprout.com References: https://pmc.ncbi.nlm.nih.gov/articles/PMC9974533/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6204950/ https://academic.oup.com/humrep/article/32/12/2522/4562350 https://pubmed.ncbi.nlm.nih.gov/32682573/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8308420/ https://pmc.ncbi.nlm.nih.gov/articles/PMC2200634/ https://pmc.ncbi.nlm.nih.gov/articles/PMC5770525/ https://oce.ovid.com/article/00005407-201606210-00022# https://pubmed.ncbi.nlm.nih.gov/34260478/ https://www.jognn.org/article/S0884-2175(15)30033-2/abstract Disclaimer: The content in this episode is for educational and entertainment purposes only and is never a substitute for medical advice. If you’re struggling with with your mental or physical health, please work one on one with a health care provider. If you have heard yourself in our discussion today, and are looking for support, contact the free NEDIC helpline at 1-866-NEDIC-20 or go to eatingdisorderhope.com. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •✨ Reach Your Weight & Health Goals — Without Dieting! Pre-order The Hunger Crushing Combo Method, Abbey’s revolutionary additive approach to eating well. Learn how to boost satiety, stabilize blood sugars, reduce disease risk, and improve your relationship with food — all while getting the best nutrient bang for your caloric buck. With 400+ research citations, cheat sheets, evidence-based actionable tips, meal plans, and adaptable recipes, The Hunger Crushing Combo Method is the only nutrition bible you’ll ever need. 👉 Pre-order today! 🛒 Where to Purchase: Amazon Barnes & Noble Amazon Kindle Apple Books Google Play Kobo Apple Books (Audiobook) Audible abbeyskitchen.com/hunger-crushing-combo • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •✉️ Subscribe to My Newsletters: Abbey’s Kitchen Newsletter 📘 Check out my FREE E-Books: Hunger Crushing Combo™ E-Book Protein 101 E-Book 👋 Follow me! Instagram: @abbeyskitchen TikTok: @abbeyskitchen YouTube: @AbbeysKitchen Blog: abbeyskitchen.com Book: The Mindful Glow Cookbook • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 🎧 Don’t forget to subscribe on Apple Podcasts, Spotify, or wherever you listen — and leave us a review! It really helps support the show ❤️ 💬 If you liked this podcast, please like, follow, and leave a review — and let me know who you’d love to hear about next! ⭐ ⭐ ⭐⭐ ⭐ Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  Because I was also 37 when I went into perimenopause and I was fully postmenopausal by 45. And I wasn't expecting perimenopause at 37.

• 0:13Abbey Sharp?

  Welcome to another episode of Bite Back with Abbey Sharp, where I dismantle diet culture rules, call out the charlatans spinning the pseudoscience, and help you achieve food freedom for good. We are here celebrating Nutrition Month and Registered Dietitians with a highly requested episode on perimenopause and menopause. I don't know about you guys, but as a woman, I feel like I can confidently say that mainstream science has really done us dirty by not investing more money, time, and influence into understanding how to help

• 0:52Abbey Sharp?

  us through our distinct seasons of life. And as a result, menopause has become a particularly vulnerable time for women to be sucked into grifty pseudoscience territory as we find ourselves desperately seeking out solutions for our uncomfortable symptoms. You know, it's like the alkaline diet detoxes and the hormone resets and the energy healing, like, really, anything goes. And while these alternative remedies may seem benign, they can become particularly dangerous when they distract us from accessing evidence-based strategies that actually work. They can also be the force behind our heightened risk of disordered

• 1:35Abbey Sharp?

  eating and eating disorders at this time, where one study found that 3.5% of women experience midlife eating disorders, with some eating disorders having prevalences as high as 30%. My guest today is Jen Salib Huber, a fellow dietitian who specializes in debunking menopause misinformation and helping women learn gentle nutrition strategies to support them through the big M. A quick note on language, I will be using exclusive women-specific language, even though I fully acknowledge that not everyone who goes through menopause identifies as a woman. And we will be discussing disordered eating and weight loss themes. So if that is not supportive to your journey, absolutely feel free to

• 2:20Abbey Sharp?

  skip this one. Also, my general reminder that the information in this episode is for entertainment and educational purposes only and is never a replacement for personalized healthcare. Finally, please don't forget to hit that subscribe button. It really does help me out so much. And I would also love if you would leave me a nice little five star review on this episode. Even just like a few little kind words will really, really make my day. All right, folks, let's get into it.

• 2:56Abbey Sharp?

  Fight Back with Abby Sharp is proudly sponsored by Tena Sensitive Care Incontinence Pads for Women. Seventy-seven percent of women with bladder weakness experience skin irritation while wearing incontinence protection. Tena Sensitive Care Pads are enriched with skin comfort formula to help protect intimate skin from irritation while providing triple protection against leaks, odor, and moisture. Sleep tight, wake up bright with Tena Sensitive Care Pads. Learn more at tena.ca, T E N A dot C A.

• 3:34Abbey Sharp?

  Hi Jen, thank you so much for joining me. I'm so excited to learn from you.

• 3:38Speaker 00

  Thanks, Abby. I'm really excited to be here.

• 3:41Abbey Sharp?

  Okay, so like, no joke, in preparation for this interview, I went down a perimenopause rabbit hole and I went to see my doctor on Friday and I was like, I know I'm 37, but can I get a bone mineral density scan now? And I want to get all this blood work done. And anyways, I just know this interview is going to be so helpful for so many people listening. So thank you again for doing it.

• 4:04Speaker 00

  No problem. Let's get started. I'm excited.

• 4:06Abbey Sharp?

  Yes. Okay, so I think a lot of, you know, women go through all of these unique stages of life just woefully unprepared. We either have not been told anything at all of what to expect, or we get fed all this like misinformation and like insignificant details. And I, in my experience at least, like, I feel like with menopause, it's like, up until at least a few years ago, all I really knew about it was that, A, I wouldn't need to buy tampons anymore, and B, I might gain weight. And that was like the extent of what I knew about menopause. Um, can we, we'll talk about the weight gain thing in a second, but I was hoping you could kind of speak to some of the other important roles of estrogen and what is kind of happening in the body when estrogen levels decline as we see in menopause.

• 4:50Speaker 00

  Yeah, absolutely. And I think that your experience of only thinking about, you know, the, the benefits to our period, or some people will have that stereotypical hot flash in mind.

• 5:01Abbey Sharp?

  Right.

• 5:01Speaker 00

  Anybody who watched The Golden Girls would be shocked to learn that, you know, most of the characters on that show were in their mid 50s to early 60s. And, but in our minds, we thought that that was what the typical midlife, older woman looked like.

• 5:17Abbey Sharp?

  Right. Oh, yeah.

• 5:18Speaker 00

  So we have, right? So we have estrogen and progesterone receptors in pretty much every cell in our body. And as we go through perimenopause, which is the transition from our peak reproductive years to menopause, which is when we stop having periods altogether, it's a little bit like a roller coaster and it's a ride that we don't know when it's going to end. There's lots of ups and downs. And as we go through that transition, we can go through pockets or periods of time where there's going to be a lot of symptoms. This could be related to period changes, heavy periods, I call them crime scene periods. We might experience mood changes, sleep changes, along with the stereotypical hot flashes,

• 6:01Speaker 00

  night sweats, vaginal dryness. But because we have these estrogen receptors and progesterone receptors everywhere in our body, once we cross that threshold and aren't having periods anymore, those changes can still be having an impact on our health, both in the short term and the long term. So we tend to see this increase in the risk of heart disease. So by the time that we enter our 60s, heart disease risk for women is kind of caught up to where men is. And like you were mentioning about bone density, we will also see increased risks with osteoporosis, osteopenia, and increasing the risk of breaking a bone. So the changes that are happening aren't just happening below the waist, below the belly button. These are changes that are happening everywhere.

• 6:45Abbey Sharp?

  Super helpful kind of overview there. And I'm 37, so I don't know if I'm in my head now, but I feel like, you know, a lot of these, so many of the symptoms that we associate with perimenopause, menopause, like I kind of experienced a lot of those things now, not sleeping, gray, moody, fatigued. But I chalk it up to like motherhood and just like being just hugely overworked. But I'm also, yeah, I'm 37, so I'm coming into those pre-menopausal years. Is there anything that us 30, 40 year olds can realistically do to delay the onset of full-blown menopause?

• 7:20Speaker 00

  It's such a great question, and it's great that you mentioned being 37, because I was also 37 when I went into perimenopause and I was fully post-menopausal by 45, essentially. And I wasn't expecting perimenopause at 37, like you. I was in the throes of motherhood, I had young kids, I was running a business. And when I went to my doctor and my other healthcare team members and I said, I'm tired, I'm not sleeping, I'm moody, I'm cranky, I'm losing patience. Nobody was telling me that perimenopause is on my radar. And I was working already as a healthcare professional and it wasn't on my radar. And so much of that is because, you know, this patriarchal medical complex that we, that we live under and work under tells us that these are normal symptoms.

• 8:04Speaker 00

  And it's not to say that they can't be, but to assume that they are isn't helping anyone. Because 20% of people will meet the clinical criteria for perimenopause by the age of 40. So one in five, that's not a small number. And so I think that the most important thing that anybody can do is to educate themselves and to learn, maybe review, maybe just take a little refresher of, you know, biology, public health, whatever it is, to be able to say, okay, what happens after I stop having kids? Or what happens after I turn 40? Because we tend to think of puberty as, you know, kind of the biggest milestone in our reproductive lives and maybe pregnancy if people choose to become pregnant.

• 8:45Speaker 00

  But menopause is a pretty big one and we're going to spend 30 to 40% of our lives in post-menopause. So educating yourself, understanding what the symptoms are, what the ages and stages are. So that you are prepared to maybe bring those conversations to your healthcare providers.

• 9:02Abbey Sharp?

  That is really helpful. And just so people know, I mean, can you list off a few of those early symptoms of perimenopause?

• 9:09Speaker 00

  Maybe it helps to back up a little bit and say, what happens after puberty? So after puberty, you start having regular cycles and that's going to happen for 20 or 30 years. And there are kind of medically defined stages of reproduction, but essentially when you start to get to the end of your reproductive years, there's a big overlap between late reproductive and early perimenopause. But clinically speaking, the criteria for early perimenopause are that your cycles are still regular, but they're now not as regular. You can't set your clock by them anymore and they're probably off by six or seven days fairly consistently. You may start to notice that your PMS has gotten worse, so worsening PMS. So instead

• 9:52Speaker 00

  of two days, it's now lasting a week. Maybe you're having some of those crime scene periods. Maybe you've now gone from your regular tampons to your super plus and have them in every purse in your head, you know, around. And maybe you're starting to notice that the week before your period, you're not sleeping as well. These can all be some of the subtle symptoms that meet the criteria for early perimenopause. When you start skipping periods, when you've gone 60 days for at least two cycles, you're technically in late perimenopause. And this can actually bring a little bit of relief because it takes the ambiguity out of it. If you are over the age of 35 and you've had some of these symptoms and you're starting

• 10:34Speaker 00

  to skip periods, clinically speaking, you're definitely in perimenopause and you're getting a little bit closer to that waiting room where you have to spend 12 months without a period before you can say, okay, that's it. I'm not having any more periods and I'm now entered that postmenopausal phase. But there isn't a, other than your symptoms, and that's why I think it's so important to track not only your periods, but also these symptoms that can seem really normal. Having a bad night's sleep for a few nights, maybe feeling a little bit more irritable, or maybe just having a heavy period that seems to come out of nowhere. If those things start to happen more often, that's a pattern. And patterns are really helpful with perimenopause because we don't have a blood test. We don't have a urine test. We don't have a saliva test. We have no test that can say definitively,

• 11:19Speaker 00

  this is perimenopause and nothing else. So we have to rely on your age, your family history, and some of the symptoms that are happening.

• 11:25Abbey Sharp?

  That was so helpful. And now I'm like, oh, my God, I, I'm there. Uh, I'm, I'm not, that's, that's me. Uh, okay. Uh, right. Okay. So I'm curious because, I mean, again, bringing it back to me and my own experience. I had an eating disorder as a late teen, young adult. How, if at all, can that affect how things shake out in our 40s, 50s in this trajectory?

• 11:54Speaker 00

  Yeah. And that's a great question. And we know that a lot of people do experience eating disorders, especially in those teen years. And probably the biggest impact is potentially to bone density.

• 12:05Abbey Sharp?

  Right.

• 12:05Speaker 00

  Uh, so we know that having a history of an eating disorder increases the risk that there was less bone laid down, potentially more loss happening. So anybody who has that in their medical history will want to bring that up, like you did with your healthcare provider and say, hey, even though I'm not 55 or 65 or whatever it is where you live, I have this in my history. And so I think that that's an important thing to bring up because we tend to think of things that are in the past as in the past. But, um, that's not always the case. And, you know, depending on the, the circumstances around the eating disorder, potentially, I think that there could be, um, there could be some symptoms around ovarian aging that may have happened

• 12:47Speaker 00

  as a result of prolonged undernutrition, I guess is the best way to put it. Um, but I don't think that we have enough research around eating disorders specifically and that outcome to be able to say that that's something that everybody will experience. But it's a great question.

• 13:01Abbey Sharp?

  Yeah, that's super helpful because I do know that there is, you know, there was a huge study on women who are currently underweight, you know, in their, you know, in their 40s or whatever. And, and that increases the risk of early menopause. So, you know, I think it's just a really good reminder, and this is why I do what I do, you know, whatever age you're at and you're listening to this, chasing skinny at any and all costs can and does have significant long-term risks. So it's something just to, you know, keep in the back of that mind. And speaking of chasing skinny, I want to talk about the weight gain. Because as I've mentioned earlier, you know, I grew up in the toxic 2000s and I feel like

• 13:42Abbey Sharp?

  I just always saw these women's magazines in my grandmother's house about the menobelly and, you know, how to lose weight and menopause. That's basically the entire narrative of what I was taught when it comes to what to expect at this stage of life. Can you explain what's actually going on and what people can expect?

• 14:01Speaker 00

  Yeah, and you know, weight gain is a symptom that I think takes people by surprise, even though it's all over the media, because we tend to think of it as something that we have 100% control over, right? Because that is the narrative that we've been given, that if you eat the right way and you move the right way and you do the right things, you can avoid it, you can prevent it, you can escape this dreaded awful symptom. But a lot of the changes that are happening are changes that are programmed into our DNA. So we know from research that upwards of 90% of people will experience body changes, including weight gain. And on average, that's going to be between 5 and 20 pounds. So that's an average. That means that there's going to be some people who gain less and some people who gain more. So don't get fixed on the numbers, is what I tell people. Just

• 14:45Speaker 00

  know that the experience of your body changing is a normal thing that happens to almost everyone. But there's also this redistribution of assets that's happening, as I call it, because we have this shifting levels and declining levels of estrogen in particular.

• 15:00Speaker 00

  We tend to shift from this kind of gynoid or pear shape to more of an apple shape. And so even if you're not seeing changes on the scale, what you see in the mirror and how your clothes fit are definitely going to be changing. And that contributes to this syndrome of not feeling like myself.

• 15:16Abbey Sharp?

  Right.

• 15:17Speaker 00

  Where you just kind of feel like you're having an out of body experience. And that's a really uncomfortable thing at any age, but it's especially uncomfortable when it's happening alongside all of these other symptoms. That all of a sudden, your favorite jeans don't fit anymore, or you have to go up a size. And it feels like, because everyone is telling you, it's something that you should, quote unquote, be able to control. But as you and I both know, weight isn't a behavior. And that doesn't change with menopause.

• 15:46Abbey Sharp?

  Right. And it's no different during, you know, pregnancy or postpartum, like, you know, you're watching your body change at what feels like a rapid pace compared to the rest of your life. And, you know, seeing yourself in the mirror as a different person, it's very difficult for a lot of folks. So I really do empathize.

• 16:02Speaker 00

  Yeah. And just to add a little bit to kind of the body changes, you know, so we have these hormone changes that are happening. But we also have this age-related, possibly menopause-related change in muscle mass. So, you know, decade over decade, we start to lose muscle and it becomes a little bit more challenging, but not impossible to build. We have to work a little bit harder at building and maintaining it, but there is kind of this age-related decline. And there's also a change in just your daily activity levels. And so I have, you know, almost 15 and 17-year-old kids. If I think back 13, 14 years ago, I had three kids under the age of three and I was running after toddlers all day long. You know, now I have teenagers who sit in their room all day and really just come out for food.

• 16:46Speaker 00

  So my daily kind of activity levels have changed significantly. And so this convergence of changes, some hormonal, some life, some age, may actually be changing our energy needs. And that's not to say that you have to count, measure, track, overanalyze and try and control that, but I think just understanding that it's normal for human bodies to change as they get older and go through the lifespan because of all these things. And it's not something that you have done wrong. It's not something that you need to feel guilty for or feel shame around. A human body is a changing body.

• 17:21Abbey Sharp?

  That is so helpful.

• 17:36Abbey Sharp?

  And I think just back to your point about, you know, the fat redistribution and, you know, basically just to give a little bit of background for folks who don't quite understand how that affects kind of everything else and the other hormones in the body, you know, when we talk about the fat redistribution and the kind of apple shape, we're kind of talking about potentially an increase in that visceral fat. And, you know, visceral fat is not just kind of like extra fluff. It can increase the risk of insulin resistance. And just to elaborate on that for a minute, there's a few mechanisms here at play. So for one, estrogen regulates the hormone adiponectin, which can help drive sugars into the muscle cells. So less estrogen means less adiponectin, which can increase sugars in the blood. And

• 18:21Abbey Sharp?

  two, that extra visceral fat secretes inflammatory cytokines and also kind of physically gets in the way of kind of normal blood sugar signaling. And what's annoying, I guess, is that body weight and insulin resistance are bidirectionally related, where insulin resistance can increase visceral fat and visceral fat can further worsen insulin resistance.

• 18:44Speaker 00

  And the other interesting thing about the visceral fat deposition especially is that it also produces a type of estrogen. So it produces estrone, and that is a type of estrogen. So one of the theories around possible benefits or reasons why this is happening is to give us that little bit of extra estrogen in post-menopause. So even though there definitely may be things that are happening metabolically as a result, there can also be some, maybe some side benefits that are impacting our long-term health in a positive way.

• 19:14Abbey Sharp?

  That's really helpful to keep abreast of. So now, I want to talk about kind of, kind of the food cravings, because a lot of women will complain that suddenly, you know, they were never into sweets before and suddenly like all they want to do is just like eat candy and chocolate. It's like, you know, it's like back to their like heavy period days and they're kind of like crying and wanting to have a big pint of Ben and Jerry's. What is going on with these kind of newfound food cravings that perhaps we haven't experienced before?

• 19:43Speaker 00

  And you know, the interesting thing about food cravings is I think we would all love to be able to just look into a crystal ball and be able to say like, oh, this is happening because I'm low in this or I'm missing this. And there's a lot of talk about like, oh, if you crave chocolate, then you're, you know, deficient in magnesium and all that kind of stuff. And you know, cravings are typically, well, I mean, there's different ways to look at it. Sometimes it's because you're hungry, right? So sometimes it's related to hunger and fullness, but often it's related to emotional hunger. And so anybody familiar with intuitive eating knows that kind of emotional hunger is that strong, intense desire to eat something just because it tastes good. And you know, it's going to make you feel better.

• 20:23Speaker 00

  And if we take that back one more step, what's happening in midlife as you're also experiencing these symptoms where you're not sleeping well, is you might feel like you're at capacity. We're in the sandwich generation, right? We have kids and aging parents. And we're also in the bottom of this U-shaped curve of midlife, which, um, you know, is a theory out there that says like, when you're in the forties, in your forties, early fifties, you're kind of in the thick of life. And so statistically, you're probably not at your happiest and most carefree. So there's a lot of reasons why we might be craving a moment of pleasure. And food is a really accessible moment of pleasure for lots of us. So I try and insert this kind of dose of self-compassion that like, hey, life is hard right now.

• 21:07Speaker 00

  There, there are things happening that you can't control, that you just have to wait them out. It's not to say you can't seek treatment and, and should if needed, but you know, you can't speedrun menopause. You can't bypass it. Neither can you speedrun midlife. And so trying to understand maybe what's at the root of those cravings? Are there other needs that aren't being met? Do you need more sleep? Do you need more rest? Do you need a break? Do you need help? And just normalizing that everybody craves a moment of pleasure when you're in the suck of life. And so I just try and normalize it and, you know, tell people, welcome it. Welcome pleasure on your plate. Welcome the pleasure of eating and see if we can maybe just normalize that a little bit so that you don't have to add guilt on top of everything else that you're feeling.

• 21:52Abbey Sharp?

  Hundred percent. I think that's so important. This really speaks to, you know, my general approach to, to eating, which is absolutely important during this phase of life as well, which is all about, you know, an additive approach to, to nutrition. So yes, like if you are craving that, you know, a little bit of chocolate at the end of the day, you know, don't make yourself feel guilty about it. This is, this is not, you know, foods may not be nutritionally equal, but we can make them morally equal. And why don't we add something to that chocolate? Why don't we have that as part of a snack with some protein and, you know, just build it into your day. It doesn't need to be all or nothing. And I think that's, you know, I know how much that mindset has helped people. And I think it's particularly

• 22:36Abbey Sharp?

  useful in times like this where there are, you know, heightened needs for, for that kind of little bit of kind of craving. Not to mention, there's other hormonal things that are happening likely that maybe can be contributing to that, which again, is kind of out of our control. Because for example, if you are not sleeping, because again, menopause, um, you know, that increases your cortisol level. Cortisol has been shown to increase cravings for high sugar, high fat foods. That's, it's just, again, like we have to exercise some, like you said, some, some, some self compassion, some empathy that we're kind of just in this and, you know, we're just going to ride it to the end and take it day by day.

• 23:19Speaker 00

  And the neurotransmitters play into this as well. So it's not just hormones, especially for people who are still cycling. So anybody who is still having a period, that extended PMS that I mentioned as a symptom of perimenopause, you are likely having dips in neurotransmitters like serotonin and dopamine. And so you may actually be craving things that make you happy. And, and I think that chocolate is some, if chocolate makes you happy, then it needs to be part of your life in, in menopause, for sure.

• 23:50Abbey Sharp?

  I love that. Yeah. Now, naturally, when people think about all these things together that we've just talked about, you know, weight going up, insulin resistance, cravings for high sugar foods, they assume that the solution is to, they need to go low carb or they need to go keto. Should people in menopause be going low carb, super, you know, go keto, carnivore, whatever it is, to manage these kind of hormonal body changes?

• 24:17Speaker 00

  Well, I mean, this is all based on the idea that carbs and the insulin response are somehow pathological and that something happens when you become, you know, a midlifer, or if you're somebody who lives in a larger body, that you can't quote unquote, process carbs normally anymore. And as I'm sure your audience knows, that has been disproven many, many times. This carb insulin model of weight regulation is way oversimplified. And we need to recognize that carbohydrates are and always will be our body's preferred fuel source. So when we cut carbs, what tends to happen is our, our energy levels drop, our mood can drop. It can make it harder to fall asleep and potentially stay asleep.

• 25:01Speaker 00

  And that's not something that we want to add to at this stage of life. And we don't need to. The other thing about carbohydrates is that they are a great source of different types of fiber, especially soluble fiber, which as we get into midlife and we start to try and navigate some of those increased risks to heart health and increasing cholesterol, or trying to reduce the risks of certain cancers. We want easy, delicious, affordable, accessible ways to get that fiber in. And if you go keto, you're going to cut all of those out. And that's not to say that you can't choose carbohydrates with some intention in mind. You know, we can choose carbohydrates that happen to be higher in fiber or protein,

• 25:44Speaker 00

  or have other things that might help to slow the absorption of those carbohydrates. But it's not the carbohydrates that are bad, so we don't need to cut those out. And anybody who is, is sharing that message really doesn't understand what's happening and is just looking at kind of the surface level information of how weight is regulated.

• 26:01Abbey Sharp?

  Yeah, it does feel like a little bit of a Band-Aids solution, uh, just to kind of, just to tackle the weight loss. And, and again, like, that doesn't even make sense if you can't keep it up. And we've seen in tons of research how, you know, sustainable keto is, is typically one of the least sustainable diets out there. People just do not stay on it for very long as, and you can imagine why, because it's kind of miserable to not ever have carbs again. But it just seems like such a, it is a backwards suggestion in general, especially considering, you know, we even have ample evidence that leaning towards more plant-based proteins over things like red meat is associated with fewer menopausal symptoms. And like you said,

• 26:42Abbey Sharp?

  The the heart health, the um blood sugar regulation, so important to get that fiber in. We have research that carbs before bed can increase our deep REM sleep, reduce the time it takes to sleep. Like, why would we make things more miserable for the for ourselves by just not allowing ourselves the, you know, the the one part of uh the food component that has all of these benefits? So, oh.

• 27:06Speaker 00

  And the pleasure of it, I mean, what's better than bread? Who wants to live life without bread?

• 27:12Abbey Sharp?

  Totally agree. And speaking of not having bread, um, you know, back to the eating disorders thing, because I think a lot of folks think about eating disorders, disordered eating as being, you know, a teens or early twenties problems. Uh, but menopause is another phase of life when we're just kind of like particularly susceptible to these hyper restrictive diets and behaviors. Why is this just generally not a good time to be engaging in, whether it's keto or carnivore, intermittent fasting, like whatever it is, like, why is this just not a good time to be engaging in extreme diets?

• 27:42Speaker 00

  I mean, any time that we're we're thinking about extremes, it's going to require a lot of our capacity because it's never going to feel intuitive. And so the more rules you apply to anything, the more brain power, time out of your life, resources that are precious and valuable and few and far between sometimes, that we need to access to maintain this. But, you know, the other thing that I try and remind people of is that at this stage of your life, you want to be thinking of the next half, the next third, the next whatever it's going to be for you. And the way that restrictive diets work and how pursuing intentional weight loss works is that you will lose fat, but you will also lose muscle.

• 28:26Speaker 00

  It is very, very difficult to remove that side effect of pursuing intentional weight loss. And if we want to maintain our health, our independence, our mobility, our everything, we want to put our effort into maintaining and building muscle. And so the more restrictive you are, the greater the risk of losing muscle. And the longer you restrict, the greater the risk of losing muscle.

• 28:55Speaker 00

  So I always, you know, try and remind people, again, it's about what you add in. Add muscle, add activity, add joyful movement, add in things that you enjoy for reasons other than what they might be doing to the size and shape of your body. And, you know, just try and stay away from those rules because the interesting thing about eating disorders, especially at this stage of life, is that we do see the second peak of them in midlife. And so, you know, we often talk about perimenopause as being a reverse puberty. This may also be happening in the brain, and this is an increased, you know, time of susceptibility that people who have had eating disorders, but also people who have never been diagnosed with an eating disorder can be, you know, diagnosed with

• 29:40Speaker 00

  them in their 40s and 50s. And so, we, we want to try and, and prevent that as much as we can.

• 29:45Abbey Sharp?

  Yeah, so, so helpful. Another great reminder. But yeah, you're right. Like, you know, because estrogen increases muscle protein synthesis and turnover, so when estrogen declines, we're already losing muscle in menopause. And dieting and weight loss, especially when it exceeds the, you know, 0.5 to 1% body weight per week rate, also risks muscle loss. Plus, of course, the greater, you know, the greater the calorie deficit, that the more extreme the diet, the more of the stress induced cortisol, like, we're just, again, we're just putting, we're just building layer upon layer upon layer of hurdles for ourselves for long-term health.

• 30:37Abbey Sharp?

  And so we talked about muscle. That's really important. I also want to talk about bone because, you know, estrogen's, one of its protective perks is that it helps to support the absorption of calcium, helps regulate the bone remodeling process. So as estrogen drops, we experience a loss of bone mass. And again, this is a reason why we don't just want to be skinny no matter what. And having some weight on us is actually protective of our bones. So what can we do at this stage to protect our bones?

• 31:08Speaker 00

  So the most important thing is knowing your family history because there is a strong familial component to osteoporosis. So if you had an older sister, mother, aunt, grandmother, or male parent as well, if you have osteoporosis in your family, then that's a really important thing to know. And we often think about, oh yeah, grandma fell and broke her arm when she was 59, and that may not register. But any broken bone over the age of 50, I believe, is kind of a red flag to just look into bone density because there's a good chance that for more people than we think osteopenia or osteoporosis is at play. But weight bearing exercise, in addition to eating

• 31:53Speaker 00

  enough, is probably the most evidence-based way of building and maintaining muscle. Because when we are building muscle, when we're using the muscles, when we're contracting the muscles, they are, you know, those attachments are pulling on bone and they're stimulating new bone growth. After about the age of 30, 35, we're playing a game of slow the loss, right? We reach peak bone density somewhere around our mid 30s at most. And so after that, it's about slowing the rate of loss. So being mindful of things like not smoking, being mindful of your alcohol intake, salt intake, those kinds of dietary components, excess caffeine, so no worry about a cup of coffee

• 32:36Speaker 00

  or two, but if you're somebody who's still drinking a lot of caffeine, that may also have an impact on bone density. But we do want to be thinking about, how can I slow the rate of loss? And engaging in strength training and muscle building is a great way to do that. But we also want to be thinking about balance because it's not just about bone density, it's about, you know, fall prevention. And we tend to think of like fall prevention as like grandma standing at the top of her stairs with a cane, but fall prevention is really anytime because if you have a loss of bone density, if you are at risk for a fracture, then you need to be maintaining mobility and balance as well. So there's the bone density conversation, and then there's also the fall prevention conversation, and they definitely need to be happening at the same time.

• 33:21Speaker 00

  With nutrition, you know, we do, we have a couple of areas of interest. And one of them is protein. And you know, the protein conversation with bone density, I, the jury's still out. It's certainly high protein intakes don't appear to have any negative benefit, but we're not entirely sure if they actually benefit that bone density over time. So, meeting your protein requirements for your other needs is probably meeting your bone requirements as well. Calcium is the conversation that has gotten a lot of confusing airtime over the last few years. And so, you know, I have been a dietitian now for 25 years. I started studying almost 30 years ago. And at the time, calcium was the be all and end all.

• 34:03Speaker 00

  And you were put on a calcium supplement regardless, because you just, more was better. That was absolutely the take home message. But over the last probably 10 years, we actually have quite a bit of research that tells us that calcium supplements do not reduce the risk of fracture. And so, they are no longer recommended as a blanket recommendation. You know, there may be individual recommendations made by people's doctors for whatever reason, but as a blanket, anybody over the age of X should take a calcium supplement. That is no longer the case. But that doesn't mean that calcium-rich foods aren't important. And if you think of your bones as your calcium bank that your body is drawing from every day, because your heart in particular relies on calcium,

• 34:45Speaker 00

  you want to make sure that your body is borrowing from the bank as little as possible. And so, maintaining your dietary calcium, keeping those calcium-rich sources in your diet on a regular basis, is the best way to withdraw from your bank as little as possible. But we, at this point, we don't actually know if we can really meaningfully redeposit. But that doesn't mean that calcium's not important. And it's a bit of a difficult or kind of nuanced conversation, but. That's kind of where we're at right now.

• 35:15Abbey Sharp?

  Yeah, I mean, like, the nice thing about a lot of calcium-rich foods, if we're talking about dairy, for example, or fortified soy, which we'll talk about in a second. But, you know, it's a full kind of food matrix going on. We have protein there, right? When we're talking about Greek yogurt, cottage cheese, you're getting the protein, which, again, really important to support muscles, especially if we're doing the resistance training. And so many, so many reasons to do that, especially at this age, to maintain muscle mass, which, again, because we know that's going to decline. You know, our metabolism, for example, is actually quite stable from the ages of like 20 to 60. People always think, oh, when I get to like 30, it's all going to shit.

• 35:57Abbey Sharp?

  But really, it's like, you've got until about 60, and then we start to see a decline of about 1% each year. So maintaining that muscle mass, so important for longevity, so important for weight management, so important for insulin sensitivity, because the more muscle we have, the more calories we burn at rest, but also the more active cells to take up the sugars in the blood. So, so many reasons to think about those kinds of, like, the food matrix that combines that calcium with the protein. So I think that's really helpful. I just mentioned soy, so I want to really talk about that, because I feel like there's a lot of fear around soy. There's always been a lot of misconceptions and fear mongering and pseudoscience.

• 36:40Abbey Sharp?

  But soy is kind of like the big M best friend. Can you tell me why?

• 36:45Speaker 00

  Well, and it's, a lot of it is this food matrix that you've been talking about, in that, you know, I like to think of it almost like a capsule wardrobe. And then if I was putting something in my menopause capsule wardrobe, soy would fit all of the criteria, because it is, you know, plant-forward, plant-based, it is a source of protein, it does have fiber. Many sources, things like fortified soy milk or tofu are also going to have calcium. Edamame beans and soybeans are naturally high in apalinoic acid, the precursor to omega-3. So there's all kinds of reasons why the food matrix of nutrient density is definitely there for soy foods. But the other interesting piece is around phytoestrogens. And so...

• 37:27Speaker 00

  Phytoestrogens are estrogen-like compounds that are found in almost all plants, but they're particularly high in soy and in the form of what we call isoflavones. And we know that they combine to one of our estrogen receptors, primarily the beta receptor. So we have two kinds of receptors. The alpha receptor is like the front door. It's the one that everybody sees first and knocks on first, and it's the one that's going to get you the most attention. It has the doorbell essentially, but the back door is kind of like the beta receptor, and it it helps to balance things out. And so what we know about beta receptor activity is that it is anywhere between 1/200 to 1/1,000, the strength of the alpha receptor activity, but it is also protective.

• 38:09Speaker 00

  And so things that bind to that beta receptor exert a protective effect compared to the alpha receptor, which we tend to associate with things like breast cancer or some of the more negative effects of estrogen. And for people who are experiencing the symptoms of estrogen deficiency or decline, like hot flashes and night sweats, adding these foods in regularly can help to mitigate those symptoms for some people.

• 38:32Abbey Sharp?

  So helpful. And you just mentioned breast cancer. I just feel like we have to set this record straight. Does soy increase the risk of reproductive cancers?

• 38:40Speaker 00

  It does not. And this is something that has been studied extensively. It is something that we have a lot of research on. And, you know, what we, the most reassuring research that we have is actually from people who have had estrogen receptor-positive breast cancer. And studies that have been done on this group of this population of people for several years, I think in one case it was 20 years, found that people who consumed soy post-treatment, post-diagnosis, post-recovery, had a reduced risk of recurrence. And so this is pretty consistent, that even many of the major cancer organizations say that it is safe for people to consume soy foods. And I think it's important to make the differentiation between soy foods and soy supplements,

• 39:22Speaker 00

  because we don't have enough data on soy supplements to say that they are also safe, but we do know that consuming soy foods, including tofu, including soy milk, edamame, all those kinds of things are safe and likely reduce the risk of many cancers for most people.

• 39:37Abbey Sharp?

  Love it. I'm drinking my soy milk latte right now. Maybe the coffee's canceling out the benefits of the soy, but I'm going with it because I'm never giving up the coffee.

• 39:46Speaker 00

  Go for it.

• 39:46Abbey Sharp?

  And, and for folks listening who are struggling to find peace with their kind of like seemingly new, brand new body, and they're tempted by the detoxes and the hormone balancing cleanses and the extreme carnivore diets that they see in their feed, what advice do you have?

• 40:03Speaker 00

  A lot of it comes back to what I said at the beginning, that a human body is a changing body. And we have been sold this bill of goods that we can maintain the same size and shape if we just try hard enough. And instead of trying to maintain that really narrow version of yourself, working on something like body neutrality, which isn't saying that you can't work on improving your body image or shouldn't, but that we're not trying to make our body image the judge and jury of how we feel about ourselves. And similarly with diet, you know, with food, food matters. You and I both know that. It can be an amazing tool in your toolbox. It can make a huge difference to how you feel in your body and how your body works.

• 40:47Speaker 00

  But you can't treat and prevent everything with food either. And so a lot of these messages around extreme diets are if you do it perfectly, you will live forever, or you will have this perfect, happy life. And as you and I both know, that's not how it works. And so really working on a more flexible relationship with food and a more flexible relationship with your body, I think is the right mix of caring enough, but not making it your life's work.

• 41:13Abbey Sharp?

  Super helpful. I'm sure so many people listening right now have found this just really enlightening. And you have your own podcast, The Midlife Feast.

• 41:23Speaker 00

  Yeah.

• 41:24Abbey Sharp?

  Amazing. Okay, so tons of evidence-based information there on menopause. So I will definitely leave some links to that in the show notes, along with your website and your socials. Just a great resource if folks are looking for some one-on-one support. So thank you so much for joining me, Jen.

• 41:40Speaker 00

  Thanks so much for having me, Abbey. It's been a great conversation.

• 41:42Abbey Sharp?

  So great. Thank you.

• 41:48Abbey Sharp?

  Oh, I love that so much because I just feel like we are generally so underprepared for most things womanhood throws our way. So I'm really hoping that that was, you know, as helpful for you as it was for me when it comes to getting ready for this next phase. And speaking of feeling prepared, I wanted to close off with just a quick little short list of some evidence-based gentle nutrition tips for optimizing your health and minimizing unpleasant symptoms in this stage of life. So number one, try eating a whole food Mediterranean-style diet, rich in plant protein, fish, olive oil, fruits, veggies, and low in processed and red meats.

• 42:32Abbey Sharp?

  Research suggests that this whole food diet may help to reduce the risk of heart disease, cognitive decline, breast cancer, obesity, muscle loss, and vasomotor symptoms like hot flashes and night sweats. Number two, include protein at every meal and most snacks. I believe in the power of protein throughout the life cycle, but there are unique benefits during menopause to counter the natural declines in metabolism, bone mass, muscle mass, and insulin sensitivity, and to reduce the risk of visceral fat gain and food cravings. Research suggests that post-menopausal women should aim for between 1.2 to 1.6 grams of protein per kilogram of body weight.

• 43:17Abbey Sharp?

  But I really don't want you to get out your MyFitnessPal and start tracking again. So just consider that to be about a cup or so of cottage cheese or Greek yogurt, around three ounces of chicken breast, or a cup of firm tofu. And speaking of tofu, number three is to work soy products into your menu more often. As we discussed earlier on, soy protein, which is found in things like tofu, tempeh, enemame, soy milk, and countless foie gras products, is uniquely rich in phytoestrogen compounds called isoflavones that mimic the effect of androgynous estrogen in the body. Research has found that soy protein may help to reduce visceral fat gain, bone and muscle

• 44:02Abbey Sharp?

  loss, depression and anxiety symptoms, hot flashes, and vaginal dryness.

• 44:08Abbey Sharp?

  One study specifically found that a vegan diet that included just a half a cup of cooked soybeans daily reduced moderate to severe hot flashes by an impressive 84%. Soy can be a real game changer here, so try to include at least one to four servings of whole soy food per day to get the best results. And four, focus on fiber. As we briefly discussed, the hormonal shifts associated with menopause often can increase the risk of visceral fat gain, insulin resistance, and cardiovascular disease. But fiber can help to address all of these things by lowering cholesterol, improving satiety, and slowing down the absorption of carbohydrates to deliver more stable insulin

• 44:53Abbey Sharp?

  responses. And since research suggests that hot flashes occur most often when blood sugar levels drop, maintaining more stable levels with fiber-rich carbs may help minimize the sweats as well. Thanks to the many fast and furious physical and emotional changes that define menopause, it can be a very delicate time for women's relationships with their body and food. It's also a really easy target for wellness culture snake oil. And while there absolutely are unique food and supplement considerations for menopause specifically, the most evidence-based recommendations are actually pretty mundane and basic.

• 45:33Abbey Sharp?

  In other words, we'll get way better bang for our buck not by going on a fringe carnivore diet or hormone reset cleanse, but by engaging in regular exercise and eating a balanced whole food diet that focuses on fiber-rich fruits and veggies and lean proteins with a healthy dose of plant-based proteins like soy in the mix. Practicing good stress and sleep hygiene, avoiding smoking, and limiting alcohol and caffeine will also help. If you're struggling with menopause symptoms, I strongly suggest working with a dietitian like Jen, who specializes in menopause, and speaking to your doctor about medical options. And that's all that I have for you guys today.

• 46:18Abbey Sharp?

  If you haven't already, I would love if you would please subscribe and follow Bite Back wherever you get your podcasts. And also, please leave me a review. It really does help me out. Signing off with Science and SaaS, I'm Abbey Sharp.

• 46:45Speaker 02

  Now, more than ever, we need someone on our side. But Rob Whitman? Whitman's votes drove up costs, cut Medicaid, and risked 350,000 Virginians' health care to pay for tax breaks for himself and his donors. He's not on our side. Shannon Taylor will fight corruption, cut taxes, and bring down costs. This November, vote for Shannon Taylor. She's for us. Paid for by HMP, the House Majority PAC dot com. Not authorized by any candidate or candidate's committee.