A Functional Medicine approach to Perimenopause – Part 3
If you have read part 1 and 2 of this series, you should by now have a fairly good understanding of the underlying imbalances that can contribute to perimenopause chaos, and why they matter. If you have missed them, catch up on them here (part 1), and here (part 2).
But it would be all doom and gloom if we left it at that, and that is definitely not what Functional Medicine stands for.
Within Functional Medicine, we aim to empower you to take your health into your own hands, by uncovering and then addressing those underlying imbalances, and bring them back to balance. You can think of it much like a cogwheel that has started to get rusty and build up sludge, and slowly run less efficiently. That’s what happens when all the different factors accumulate over the past decades. In today’s post, I am going to walk you through No. 1 of the top 5 lifestyle tweaks you can start right away to clean out the cogwheel and get everything running super smoothly again, and to turn your perimenopause years from chaos to a win.
The Top 5 Lifestyle tweaks to upgrade your perimenopause transition
- Nutrition – What to eat to nourish your cells and balance your hormones
- When to eat: intermittent fasting, cycle & circadian eating
- Stress reduction
- Sleep & circadian rhythm living
1) Nutrition – what to eat to nourish your cells and balance your hormones
As you may recall from part 2 of this series, a crucial piece to the perimenopause puzzle, and how smooth or rocky your transition may be, is your blood sugar balance and insulin sensitivity. As you may recall from the previous blog post, most of us have grown up on diets based on sugars and carbs, even if it is the ‘healthy kind’, ie granola, porridge, quinoa, beans, fruit, with the result that by the time we hit our 40ies, most of us are relying mostly on carbs, and our bodies have lost their ability to use other fuels such as our body fat and ketones for fuel. This means that if sugar supply drops, it isn’t very efficient in creating ketones quick enough, and our brain thinks we are starving. We aren’t ‘metabolically flexible’ any longer. Result? Hot flashes, insomnia, visceral fat and irritability.
As a general rule of thumb, to balance your blood sugar on about 6 days per week stick to 2 portions of carbs per day, ie one with your lunch and one with dinner. Examples of one portion being 1 piece of fruit, or a small handful of rice/ potatoes/ etc, or a row of dark chocolate!
Ideally have one piece of fruit per day, and rotate which ones you have for most benefit. An apple a day keeps the doctor away really does deserve the saying, with its high antioxidant content, and other nutrients like quercetin that help lower histamine (‘allergies’), pectin which supports gut health and weight loss, and so much more.
Research has shown that women that consume a piece of fruit daily are less likely to go into premature menopause, and thereby not only extending fertile years, but also reducing potential health concerns such as increased cardiovascular risk which becomes higher the earlier the menopause starts.
To keep your thyroid firing at the highest possible level, with it your metabolism and also keep your leptin levels well balanced, research suggests one day per week to go higher in carbs, ie base your meals on carbs, rather than have them as a condiment as you’d do on the other days, also called a ‘carb refeed’ day.
What about going keto? – a word of caution.
Despite being keto (very low carb) being all the rage, and a lot of research supports its many health benefits, ranging from being anti-inflammatory to resetting insulin resistance to fat burning to anti-cancer properties, these have mostly been studied in people being in a ketogenic state intermittently only. Over the past years, more research has started implicating that if overdone, a strict ketogenic diet that is done continuously may in fact cause hormone havoc such as increasing estrogen dominance and suppress ovulation with a resulting drop in progesterone, but also hamper with thyroid function (metabolism!) and may even damage heart muscle cells. More research must be done to be sure on the very best way of reaping its benefits without running into trouble, but the best way appears to include a few keto days during day 1-12 of your cycle, and also stay generally low carb for the rest of the cycle (no more than 2 portions of carbs most days), with intermittent fasting and exercise added in, so that the body does drop into a ketogenic/ fat burning state for some of the day, aka ‘intermittently’, but doesn’t stay in it continuously.
Goal is to become ‘metabolically flexible’, teaching the body to be able to shift between burning glucose for fuel, and seamlessly shift over to burning fat and producing ketones once glucose drops. Being in a low carb, and sometimes ketogenic state appears to increase insulin sensitivity, utilisation of belly fat for fuel and as a result less accumulation thereof, less ‘reactive hypoglycemia’, that state when blood sugar drops but the body isn’t able to shift to fat burning quick enough, which has been linked to hot flashes, irritability, and getting woken up at night.
Candida albicans and how it may relate to your perimenopause symptoms
Another reason you want to keep your sugar intake on the lower end is something called candida. Candida albicans is a pathogenic type of fungus, that populates the gut of most of us, to small amounts. However, if it takes over, which it often does when there either aren’t enough of the good bacteria to crowd it out (ie after antibiotic use),or after years of eating a diet high in carbs, sugars and drinking sugary drinks like sodas, cordial, rose and white wine, it can create havoc in the body, and contribute to many of the perimenopausal symptoms.
It has in particular been linked to brain fog, anxiety and irritability.
Apart from carbohydrate and sugar intake, the quality of what you eat is important too. Whether or not you are getting enough minerals, vitamins, protein, fats, etc to support all the pathways in your body, create and break down hormones, neurotransmitters such as serotonin and GABA, keep your brain, heart, muscle and all other cells healthy and functioning properly, make sure your immune system is strong enough to fight of lingering infections, yet calm and selective enough to not go rogue (autoimmune), and more.
You had some of them tested, and your GP said your levels are fine? As with many other lab markers, what goes under a ‘normal reference range’ may be far from being optimal.
Many of the women I see are normal, yet below optimal in their vitamin D, B9 and 12, zinc, iron, iodine, just to name a few, contributing to less than optimal functioning and symptoms. If your cells are chronically starved off oxygen, such as what happens when iron, B9 and 12 are below optimal, they cannot function properly. If you aren’t getting enough omega 3s, your body will be more likely to be chronically inflamed, your cell membranes won’t be able to do their job as well nor communicate with one another.
So let’s dive into what best to eat to nourish your cells and support your hormones through this transition.
Focus on a Mediterranean style diet that is low in sugars, processed foods, highly heated fats, but high in diverse plant nutrients and fiber, adequate amounts of protein, and omega 3s. Research shows that eating a diet that is mostly based on plants, and high in omega 3s such as found in salmon and prawns, is associated with less severe perimenopause symptoms. Avoid tuna, albeit high in omega 3s it is also high in mercury, which acts like poison to your cells. Baby tuna is ok from a heavy metal perspective, as it wouldn’t have had time yet to accumulate mercury to as high levels, yet that may be a personal choice not to.
A fat that most haven’t heard about, but that is a superstar, in particular during this time period, is GLA – gamma linoleic acid. It is an omega 6 fat, but an anti-inflammatory, hormone supporting one. GLA is mostly found in evening primrose and borage oil, which you may choose to sprinkle over your salads, or take in capsule form.
Make sure you get enough protein, ideally with a good balance of its different building blocks, called amino acids. As a general rule of thumb, anything from 0.8-1.6g per kg body weight is good, but if you are having blood sugar, cravings and weight problems, erring on the higher side may be a good starting point until your metabolism has come back to full speed, and your appetite normalised.
(Side note: If you have a history of cancer, you may have to go lower in protein intake, please discuss with your experienced practitioner on what is best for you in that case.)
I generally recommend 2 big handfuls of protein per day, ideally a combination of plant and animal based, ie tofu, chicken, salmon, eggs, some nuts and seeds. Balance is key, as a diet too high in nuts and seeds can tip the omega 3 to 6 ratio off, and contribute to low grade inflammation!
The different protein building blocks, called amino acids, are needed to make lean muscle, keep you satiated, your thyroid and metabolism at speed, skin and nails strong and radiant, and production of neurotransmitters such as serotonin and GABA strong.
Combine your protein with some vitamin C for the best collagen skin anti-ageing, joint and hair support boost, or consume bone broth or collagen directly! Most know vitamin C is important for fighting off free radicals, but it is also important to keep your collagen production up, keeping your connective tissue healthy, such as skin, joints, and the linings of your organs!
Other than for its vitamin C, opt for a diet high in different colourful vegetables, such as leafy greens, some dark purples (beetroot, peppers, red cabbage, etc).
Another often overlooked category are cruciferous vegetables. These super foods are needed to make our very own antioxidant glutathione, to keep free radical damage at bay, but also to support our liver to break down hormones, get rid of toxins, create a healthy and non-stagnating bile (bye gallstones), and more. Make sure to eat them mostly cooked, and with some iodine (seaweed) and Brazil nuts (for selenium) to stop them from causing damage to your thyroid. I know, it all is a balancing act. Do I want for you to go and have raw kale juice every day? No! It may block your thyroid. Do I think kale is bad for you in general? No, it is a great superfood if consumed as part of a balanced, varied diet.
A word on food intolerances.
You may recall from the previous posts, that chronic lingering inflammation can contribute to perimenopausal symptoms, especially irritability, brain fog, and that muffin top. Once hormones become erratic, and progesterone may drop, other factors that have been kept under the lid by progesterone may show up more now. One is food intolerances.
Many of us have food intolerances they aren’t aware of. They may not have any digestive issues, and as such don’t expect or ever test for them. Food intolerances are different to allergies, where symptoms are instant, a scratchy throat, a runny nose, maybe red blotchy skin. Allergies are triggered by histamine and an antibody called IgE. We won’t go into detail here of what these are, as most people that have allergies most likely are quite aware of them. Food intolerances are different. They are caused by a different antibody in the body, called IgG. Since covid 19, many are now aware of IgG antibody testing, as that is (part of) what the body produces in response to an invader like a virus, and keeps as a memory for future ‘attacks’. When we have IgG food intolerances, our immune system responds to a food as if it was an invader, and mounts a response. This response is an inflammation, with the aim of killing this invader off. However, if we continually eat these foods, we continually have a low grade inflammation, contributing to abdominal fat accumulation, bloating, autoimmune conditions, irritability and more. I generally recommend a food intolerance test (via blood) for IgGs, as to rule out any of that happening in the background. And no, not everyone is intolerant to gluten and dairy, so there is no need to universally cut those out entirely.
2) When not to eat – intermittent fasting, cycle and circadian eating
Intermittent fasting, much like the ketogenic diet, has gained a lot of popularity over the past few years. And much like ‘going keto’, using intermittent fasting has tremendous health benefits, and is an important piece towards health optimisation and anti-ageing, yet if overdone, can cause trouble, in particular in women.
There are different versions of intermittent fasting, such as alternate day fasting, prolonged intermittent fasts, or daily periods of not eating. Unless you have a more serious health condition such as cancer, your best bet likely will be daily intermittent fasting. Research has shown that women and men have different effects on prolonged fasting (more than 24 hours). If women fasted more than 24 hours, their blood sugar and other markers, along with their heart rate variability, an important marker of overall health and stress level, all deteriorated.
Other studies showed that if women waited with their first meal of the day much later than noon, around 3pm, again, their blood markers were worse than eating a normal 3 meals per day.
Yet intermittent fasting, if done right, is a great tool to improve insulin sensitivity, decrease visceral fat, inflammation, support energy production (mitochondrial health), increases ketone production and metabolic flexibility, and much more.
Research suggests that the safest way to include intermittent fasting, reap its benefits, without running into trouble, appears to be a daily fasting window of about 14-18 hours, but ideally in tune with both your (monthly) cycle and circadian rhythm. The best daily eating window appears to brunch and linner, ie an early lunch and early dinner, around 10am-12pm and 4-6pm, where that is possible. Stretching the dinner to slightly later, around 7pm, should still be ok, and likely more realistic for most people, but you may want to monitor your sleep efficiency if eating much later than that, as it most likely will tamper with it.
And what about your monthly cycle? Much like ketosis, you may experiment with slightly longer fasts during the first 1-11 days of your cycle, yet ideally have your first (or even only meal of the day if you’d like to try ‘OMAD’ – one meal a day) meal not much later than noon due to above mentioned reasons. Leading up to ovulation (days 12-14), and during the luteal phase (in particular days 18-24), you want to make sure to support your hormones with 2 meals per day (no OMAD!), and place special emphasis on no waiting too late to break your morning fast.
I hope this all made sense, comment below if you have questions! I’d love to hear from you.
Next up are the other 3 basic pillars of perimenopause optimisation, stay tuned xx.