Diet and menopause: the seven key nutrients

Women in menopause in Spain and surrounding countries They present a “very high” nutritional “inadequacy”in line with several studies that detail that the consumption of some key nutrients for this period is “lower” than the recommendations, according to a report prepared by the Scientific Committee of the Spanish Agency for Food Safety and Nutrition (AESAN).

“Especially in the case of vitamin Dwhich is already well known, but also calcium, magnesium and some relevant vitamins such as vitamin A, vitamin C, vitamin E or vitamin B“, detailed this Thursday in the presentation of the report, the endocrinologist and coordinator of the document, Irene Bretón, who specified that this deficit contributes to the risk of osteoporosis, sarcopenia and greater morbidity.

The report, focused on nutritional risks for women during menopause, perimenopause and postmenopausehighlights that the nutritional health of this group must be a “health and public health priority”, taking into account that the menopausal transition and postmenopause affect a relevant percentage of the female population.

According to him, an early age of onset of menopause, especially when it is not related to genetic factors, increases the risk of suffering from cardiovascular diseasesespecially stroke, as well as osteoporosis and other problems. However, a healthy lifestyle, which includes a Mediterranean diet pattern and avoiding toxins such as tobacco or alcohol, can significantly mitigate this risk.

Along these lines, the report emphasizes the benefits of physical exercise. Thus, it recommends regular practice, with a frequency of 150 to 300 minutes a week of moderate aerobic activity or 75 to 150 minutes of vigorous activitywhich includes two or more strength sessions. In this way, it stands out that muscle mass and bone quality are preserved, the cardiometabolic profile, mood, sleep and quality of life improve.

Nutritional supplementation

The report states that calcium and vitamin D supplementation It may be indicated when there is a risk of deficiency of these nutrients. However, it warns that the evidence and safety on the use of other dietary supplements, a common practice, is not sufficiently studied, which is why it requires individualized evaluation and more research.

Besides, dedicates a section to obesitywarning that in the perimenopausal and postmenopausal stage it increases the risk of metabolic syndrome, metabolic hepatic steatosis, hormone-dependent cancer and fractures. According to him, a balanced diet and the practice of physical activity are the appropriate strategies to ensure weight loss while maintaining muscle mass and bone health.

Finally, the scientific committee insists on the need to promote an “integrated strategy”, which includes nutritional and functional screening and evaluation, cardiometabolic and bone health evaluation, which allow nutritional education and adapted structured exercise programs to be carried out.

In parallel, he states that additional research must be carried out to define specific recommendations, as well as develop public health policies aimed at this population group.

Bretón, associate doctor at the clinical nutrition and dietetics unit at the Gregorio Marañón General University Hospital, pointed out that, currently, women spend almost half of their lives in a postmenopause situation. For this reason, he stated that an “adaptation effort” is required to “understand better.”

According to the AESAN, these are seven key nutrients in menopause:

1. Proteins: The daily consumption of foods rich in protein is essential for the maintenance of muscle mass and strength and physical function, essential in the postmenopausal stage. The sources of plant-based proteins in the diet are legumes, nuts, whole grains and foods made with soy. The sources of proteins of animal origin They include fish, eggs, milk and dairy products, and meat.
   
2. Omega-3 fatty acids: Omega-3 fatty acids are a type of polyunsaturated fatty acids, beneficial for cardiovascular health and that can help reduce inflammation, but which the body cannot synthesize, so they must be ingested through diet. Foods rich in omega-3 include certain fish and shellfish; some vegetable oils, such as olive oil; dried fruits (especially walnuts); flax seeds and green leafy vegetables.
   
3. Fiber: During the menopausal transition, a series of metabolic changes occur that include an increase in the proportion of adipose tissue, an increase in visceral fat and a decrease in energy expenditure. In addition, there may be a deterioration in insulin secretion and insulin sensitivity, as well as an increased risk of type 2 diabetes mellitus. There are also several pathologies or conditions whose risk may be increased in women during menopause and postmenopause, such as cardiovascular disease or some types of cancer. It has been seen that the intake of dietary fiber can reduce the risk of the appearance or development of these pathologies. It has been shown that dietary fiber reduces the risk of obesity, can help regulate the use of sugars in the body, helping to control hunger and blood glucose levels, and plays a beneficial role on the intestinal microbiome. It has also been shown to have a protective effect against different pathologies, such as cardiovascular diseases, breast and colorectal cancer, and diabetes. The European Food Safety Authority (EFSA) establishes the adequate fiber intake for the adult population at 25 g per day, although there are authors who, for women in the menopausal stage, recommend a daily intake of 30-45 g. On the other hand, it has also been seen that excessive fiber consumption, greater than 50 g/day, can have a negative effect since it can cause bloating, increase the binding and excretion of useful substances and lead to digestive problems. Dietary fiber can be ingested in the diet through foods rich in fiber such as whole grain cereals and derived products, which prevent the rapid absorption of carbohydrates, which classifies these foods as having a low glycemic index, unlike refined cereals, which, being formed only from the endosperm of the grain, have a majority nutritional composition of rapidly digestible carbohydrates.
   
4. Calcium and vitamin D: Calcium and vitamin D are crucial for maintaining bone health and their deficiency, prevalent in postmenopausal women, is associated with loss of bone mass and an increased risk of suffering from osteoporosis and bone fractures, risks to be taken into account due to the decrease in estrogen levels during menopause. Food sources that provide calcium are milk and dairy products (yogurts, cheese); legumes (chickpeas, beans); dried fruits (almonds); chia seeds; vegetables such as kale or kale and fish such as sardines (with bones). For its part, vitamin D It is a fat-soluble vitamin that promotes the absorption of calcium and phosphorus, essential for bone formation, and can also reduce the growth of cancer cells, help control infections and reduce inflammation. Few foods contain vitamin D naturally, so many are fortified with this vitamin, such as milk and dairy products and cereals. Vitamin D3 (cholecalciferol) is produced, primarily, in the skin of humans and other animals by the action of ultraviolet B (UVB) rays from the sun (hence its nickname “the sunshine vitamin”), while vitamin D2 (ergocalciferol) is produced in plants, fungi and yeast by solar irradiation. Among the foods that are natural sources of vitamin D3 are fatty fish (salmon, tuna, sardines), eggs and cheese. Some mushrooms contain vitamin D2.
   
5. Iron: Although iron needs decrease after menopause due to the cessation of menstruation, it is still important for women’s health in general and it is necessary to control and maintain adequate iron levels in order to prevent fatigue and anemia related to deficiency of this mineral. Iron from food comes in two forms: heme and nonheme. Heme is only found in the liver and meat of animals. such as beef, poultry and fishing products (clams, mussels). Non-heme iron is found in foods of plant origin, such as legumes (lentils, soybeans); dried fruits; seeds and green leafy vegetables (spinach). Non-heme iron can also be found in animal meat (since animals consume plant foods with non-heme iron).
   
6. Magnesium: Magnesium is present naturally in various foods and plays an important role in facilitating numerous enzymes in the body to carry out various chemical reactions such as the formation of proteins, the maintenance of bone mass and the regulation of blood glucose, blood pressure and muscle and nerve functions, therefore, a severe deficiency of this mineral would lead to significant health problems. Magnesium is found in plant foods such as legumes; dried fruits; whole grains; seeds and dark green leafy vegetables; and also in foods of animal origin such as fish, poultry and beef.
   
7. Vitamins: Vitamins B6 (pyridoxine), B9 (folate), and B12 (cobalamin) are important for cardiovascular health and cognitive function. Deficiencies of these vitamins can cause high levels of homocysteine, which is associated with an increased risk of heart disease and stroke, as it can promote the formation of blood clots and excess free radicals, in addition to harming the normal functioning of blood vessels. Especially in premenopausal women, low levels of vitamin B6 have been shown to confer a 2-3 times higher risk of vascular disease. Group B vitamins are present in various foods of plant and animal origin, such as dark green leafy vegetables (spinach, Brussels sprouts, broccoli, lettuce); fruits such as banana, orange or melon; legumes such as chickpeas, beans or soybeans; dried fruits; milk and dairy products; fish such as tuna or salmon; the eggs; the liver, and poultry meat.