P4P Nutrition in Menopause: Managing Your Middle
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[00:00:00] Dr. Alicia Power: Today I'm talking with Kristen Yarker, a registered dietician in Victoria, BC are around nutrition and menopause. We all, if we're lucky enough to get to the age of 50, we all go through this change in life as people who have uteruses. And so this is a really important topic that we're talking about because we all know that food is one of our medicines and how can we make sure that we are doing the best we can for our body and easing this transition, and supporting our bone health, our brain health, our heart health through kind of the menopause transition. So Kristen is a wealth of information and we actually chatted for quite a while around this topic. So really excited to have this conversation with her.
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[00:01:32] Dr. Alicia Power: Kristen, thank you so much for joining me today. We are talking about a topic that actually was inspired by a clinic day a couple of months ago, where I think at nine o'clock in the morning, I messaged you on Instagram because I'd already had two patients asking me about perimenopause and weight gain and struggling with that and not feeling good in their body anymore like there's things changing and so I reached out to you to see if you had an interest in kind of [00:02:00] perimenopausal nutrition and you said that you did. And so then here we are today. And, I'm also secretly very excited about this because I am, in the world of that area myself. I love learning about it and learning around health and and all that. So why don't we start off by you just introducing yourself and telling us a little bit about yourself and what kind of inspires you to do this work?
[00:02:20] Kristen Yarker: Yeah, thank you for the invitation to be here today and talk about this really important topic. And it's really wonderful to reconnect with you in this way. So yeah, I'm Kristen Yarker and I'm a registered dietitian. When you combine my years of training and experience, I've been in this world of nutrition for, it's getting close to 30 years now.
[00:02:40] And I have a practice, The Kristen Yarker Nutrition Agency, where we're a team of dietitians that provide professional and practical nutrition for busy people. And so being that we serve busy people we see a lot of clients in the perimenopause, the menopause transition time, because as you were saying, bodies [00:03:00] change a lot at this time can be prone to a lot of weight change and different health concerns coming up. And so people are often looking for help with their nutrition at this time. And yeah, I've done a lot of background research in this area in order to help them. And then also, like you were saying, I'm 47 myself now, and so I'm beginning in this transition myself too. So there's a little bit of a personal interest as well as looking to help serve clients as well.
[00:03:27] Dr. Alicia Power: Yes. So why don't we start off by just defining what we're talking about when we say menopause and perimenopause. I think most people understand what the term menopause is alluding to, but I think there's also a little bit of confusion around that. So menopause, the actual definition is you have not had a menstrual period in one year.
[00:03:48] So that is the true definition and the average age for menopause is about 51 years old. But what we're talking about is the time leading up to that and the time leading after that. That's not the right [00:04:00] term. Following after that. And so that is the terminology we use perimenopause. So the time around menopause. And we're talking kind of five to ten years leading up to it and five to ten years following it. So like 40 ish until 60 ish is that perimenopause time. And there are huge changes that happen as a result of the hormonal shifts moving towards and coming away from that time in our life. And oftentimes people. I don't think people have a concept of how long that time is and how much hormones impact our body, our metabolism, our mind, our sleep all or all of that. And so we're going to be delving into the metabolism piece today specifically and the nutrition piece because that's where your area of expertise is. We'll probably dabble in a few other spots as both you and I think know quite a bit about this given all of the research we've both done. And we'll have some resources and some action items for people as well. So [00:05:00] let's dive into it.
[00:05:01] So we're talking about metabolism, but before we dive into it, I'm going to back up. There's a lot of the changes that happen include... Our cycle is getting more irregular, oftentimes heavier, sometimes lighter, and that can start, three to five years before we actually hit the menopausal time. A lot of people complain of hot flashes or vasomotor symptoms, so that's one of the most kind of well known feature of menopause.
[00:05:25] But we also have kind of changes in our metabolism, which we'll chat about. After the age of 30, we actually start losing muscle mass, and so sarcopenia is what that's called, and so we're going to talk a little bit about how we can protect against that today. But we also have changes in our mood, changes in our sleep changes in our joints. So much like in adolescence, we have a lot of musculoskeletal complaints in teenagers, the same thing happens around perimenopause, just because of those hormones shifting. Frankly, the same thing happens in pregnancy as well, let's be honest. So these times in our life when our hormones are shifting tremendously, we have a lot of kind of symptoms that [00:06:00] can come along with it.
[00:06:01] And not everybody experiences those the same and not everybody gets them to the same degree. So that's a really important piece that I know you're very good at, is really customizing your advice to the person in front of you. So today we're going to be quite general in our discussions, but certainly when you do have a one on one discussion with a care provider, they are going to be able to do a lot more customization of their advice based on you as a human being, not you as a part of our bigger society that goes through menopause, right? So why don't we get now we can start into it. Yeah. Talking about those metabolic changes that happen in this transition time.
[00:06:34] Kristen Yarker: Yeah. And I really like how you've framed that mentioning like puberty too there because this is a major, a natural change in our bodies that we're going through here. And yet we're, often in school, we might have learned some sex ed and some talk about health and what's happening in puberty. But most women, we don't have that conversation and teaching around what's happening at [00:07:00] this phase in our life. And so a lot of what's going on can feel quite shocking and confused about it. And often people come to me asking for the body they had when they were 25 or 30, and I can say, I can't. I can't do that with nutrition. It would be like someone asking me, what can I eat? When they're like, prepubescent to say, what can I eat to not go through puberty?
[00:07:21] We're going to go through puberty. We're going to grow breasts and hips and have those body changes as a part of puberty. So there's going to be body changes as a part of the menopause transition as well. And so it's understanding that and then our nutrition needs do change at that time, just like our nutrition needs change as we go through puberty too. And so I just like to mention that this is a normal, natural part of a woman's life, or I should say a person with a uterus's life. Of course, not everybody who has a uterus identifies as a woman but it is a normal part of life. And yet, even in the literature, if you're diving deep into the scientific literature, you can still see that, [00:08:00] unfortunately like our scientific literature and our medical system still has a bit of a lens of, that this is an estrogen insufficiency time and that this is like a problem.
[00:08:13] And yes, there are health concerns and things that come up at this time, but it is a normal part of a woman's life. And realistically, like we women have about a 3rd of our life post menopause. So there's still lots of life in us at this time. And so I just like to put that framing in place of, we don't learn about it, and so that's why it can feel strange if we don't know what's going on, but it is a normal part of our life. And so we want to be, embracing that and changing that, but also recognizing that unfortunately, our society doesn't value, us as much as we go into this later stage in life, because of a lot of bigger context things. And so that is an emotional piece of what's going on with us, as we're going through this stage too.
[00:08:57] Dr. Alicia Power: Yeah, and I think it's really interesting that you mentioned that, [00:09:00] normalizing that this does happen to everybody with a uterus. And I love that you're using that language in, as well. But also recognizing that there's a huge cultural piece to it as well. And if you look at the literature different cultures have very different experiences. And they, and people within those cultures interpret their symptoms in very different ways. And so it's fascinating to look at that and I think in our culture we're shifting, I hope we're shifting, along with many things and de patriarching, is that a word, de patriarching?
[00:09:32] Kristen Yarker: I like it, yeah.
[00:09:33] Dr. Alicia Power: Transitions in our lives. And a lot of people after menopause actually feel that their power increases, right? Because they've got that knowledge and wisdom and you actually look at leadership, use the term women, but women in leadership and their confidence actually increases the farther they like in their journey in their 40s and 50s, their confidence is increasing than their leadership, their self perception of their leadership skills, increasing. Where you look at, I'm going to use the term men, it actually decreases [00:10:00] then. So it's really fascinating how that cultural piece and that societal piece plays a huge role in our experience and our knowledge and our view of this normal transition in life, right? That we all hope that we're alive to go through in our late 40s and early 50s.
[00:10:18] Kristen Yarker: It is a blessing. Yeah. And and so definitely, when we start talking about the scientific literature and that sort of piece, that's what I would say is the biggest piece that's missing now is looking at us as women within the context of our lives, or people with uteruses, within the context of our lives and all the things that are going on for us, that aspect really has not arrived into the scientific literature at all. It's still very much looking at the person as just a body, not the bigger picture. So I just want to put that in some context before we start diving, into the literature here and talking more specifically about, what's going on metabolism [00:11:00] wise that can contribute to the weight gain that is often seen at this stage in life. And some of that weight gain, I would say we can attribute to metabolism changes that are going on, related to the hormone shifting there, also related to general aging too. And so a lot of the research so far has been looking at what is specific to the menopause transition and what is specific to like, aging chronological aging, getting older that's not related to the menopausal shift there, and so that's what a lot of the research is trying to dig out. pieces there, but then there's a lot of other contributors to that weight gain, too, when I'm working with individual people, as you said, that I'm looking at a lot of different factors going on there.
[00:11:49] Yeah, as we age unrelated to the metabolic shift, as we age, metabolism does slow down. That seems to be a normal part of aging [00:12:00] and not related to the menopausal shift. And, of course, we, as we're going through the menopausal shift, we're also getting older at the same time. So you can't really tease those apart, but those are layers that are happening there.
[00:12:13] And as we're. As our metabolism does slow down, we need to eat less food and often we just need less calories or and calories are just a unit of energy like Celsius is a unit of temperature or kilometers is a unit of distance there. So we do need to eat less energy because we're burning less energy just naturally in our, in our metabolism there, and so that seems to be as the research is showing, it seems to be more related to aging rather than the menopausal transition there perhaps. Although some of that metabolism drop that we're that we see in people is often related to, as you were saying people being less physically active and [00:13:00] therefore having less muscle on us, because muscle is a more metabolically active tissue in our body parts of our body there. And again, some of that aging is metabolism, slow down with aging is related to the actual aging, but a lot of it perhaps is related to doing less physical activity there, so there's decrease in physical activity, which is slowing the metabolism. Of course, if we're being less active, then again, we need to be eating a few, less energy, because we're expending less energy. So that's a compounding thing with the physical activity relating to the metabolism, but then, we're expending less, and then with the specific with the menopausal transition, there, as the about 2 years on average before we actually have that last period, the estrogen starts to drop. And as that estrogen drops, every cell in our body [00:14:00] has receptors for estrogen. So it's going to have an impact on every single part of our body. And the research is still discovering what that impact is.
[00:14:09] They're used to just be understanding that, oh, just certain reproductive related parts of our bodies have estrogen receptors. Nope. It's now been discovered that every single cell has estrogen receptors. And so now the research is okay what does estrogen do on all these cells? Then if there's a receptor for it, it must be doing something.
[00:14:28] But what we see is that, in that, as that estrogen decreases, it does put ourselves in relatively higher testosterone and androgen hormone balance there which does tend to then create a situation in our bodies where we tend to shift where we store fat. So when estrogen is higher people with the uterus tend to store fat more in the legs and the hips type of placement. And then as that, [00:15:00] the estrogen is decreasing, then by comparison relative, then the androgens or the testosterone is higher. And so then we tend to do more of that belly fat storage, that, that apple shape. They're more of that kind of beer belly ish, we might call it on someone without a uterus there type of shape there.
[00:15:20] And that shift is happening because of the shift in the relative as the estrogen is decreasing. So there tends to be that shift, and so it's more of that what's called technically the visceral fat storage and more of that shifting of the fat stores towards the belly there. And that's often what people come to me complaining about is that they're like, oh, like, where did this belly come from? And where is the belt? That sort of thing is talking about with folks through the menopause transition, they're really seeing that they're like, where I never had this shape before. What's, where is this coming from? And that's come from that estrogen decreasing. And as I said, that tends to be [00:16:00] about like, 2 years before the the final period there. That's happening and then we do tend to see also that weight overall tends to be increasing a number of years before that last, that last period there, they 5 to 10 years before that is typically when the weight starts to be coming up.
[00:16:24] And there is some research, again it's quite early research so hard to, I'm not making certain conclusions yet around it but that, follicle stimulating hormone FSH typically is shortened to uh, increases about 10 years before that last period. And that seems to be, correlated or at the same time that weight seems to increase for people. And so there's kind of curiosity in the research of oh, could that hormone be doing something that's contributing to the weight? Again, hard to say, just because things are happening [00:17:00] together doesn't mean that it's one is causing the other. That research is still to be done, but the weight doesn't tend to just snap on, it tends to be that when I'm talking with people, it's yeah, the last 5, 10 years it just is slowly creeping up. So that is a hormonally, a piece that is probably happening or might be happening they're researching, there.
[00:17:21] And then I just want to also mention because I'm working with so many individuals in this life stage, what hasn't been shown in the research, but I think is really important for us to be looking at is, often, as you were kind of leading, like mentioning with the role of leaders at this time, often people at this time are really advanced in their careers, right? They've got really big jobs. So there's a lot of stress happening with that. They're also often the sandwich generation in this time when we're looking after children, but also looking after aging parents. Often there's a lot of also like volunteering and, [00:18:00] and, household responsibilities and that sort of thing.
[00:18:03] So it's also a time of really high stress, chronic stress, difficulty fitting, taking care of yourself into all the gazillion things that you have to be doing in the day. And I think there's a, that's the piece that we haven't looked at in the scientific literature is like how much of this might be related to what's physically going on with chronic, you know, with chronological aging and with the menopause transition. But what also might be related to what's going on in people's lives at this time? What might be related to chronic stress and maybe cortisol being chronically high? Why is that physical activity falling off the plate when maybe at earlier life stage, there was more physical activity? Probably because there's a heck of a lot of other things going on.
[00:18:45] And so I think we need to be, really, that's the piece that I think is a really big piece that I see when I'm working with individual clients of how can we get practical ways of taking care of yourself fit back in the gazillion item long to do list.[00:19:00] And, it really hasn't looked at that there. So I think we need to be. I want to respect that's probably a big piece that's going on that we don't have answers to yet.
[00:19:10] Dr. Alicia Power: Yeah, and I think that's a really important thing to mention. So thank you for doing that. Sarah and I are doing some work around I guess we're calling it energy management in, in health care providers, but also in our patient populations around all of these pieces, because there are so many pressures on people in this stage of our lives, and you bring up a really good point around that, that how can we start actually looking at the work that we're doing, all of the demands on our time and energy, and how do we either start recognizing that some of that can go, so that we can actually care for ourselves better, so that we can I say it care for others better because, maternal guilt and childhood guilt always is impactful, right? So if you say, take care of yourself so you can take care of others, people are more likely to do it, right? They'll prioritize themselves so that they can recognize that. But we're starting to do with some work around that because it's such an important [00:20:00] piece. And I think people, it's not easy. It's not easy.
[00:20:04] It's not easy work to do, right? And it's often one of those things that gets pushed to the side. Oh yeah, no, I think that's really important, but I don't have time for it right now. So I'll do it in five or 10 years when I've got time. Then you're you've missed, not missed the boat, but this is the time that we really need to be spending that time doing it. So I think that's a super important piece that you mentioned.
[00:20:20] Kristen Yarker: Yeah, and I just want to add in that one piece I didn't mention there that also has a lot of ripple effects, like metabolism. Otherwise, is the sleep piece so often that's not addressed. And so sleep can often be disturbed during this time and sleep has a lot of ripple effects on weight and nutrition, too. So whether it's so sleep when we're underslept, it puts our body in more of a fat storage rather than a muscle building mode that shows that when we're underslept it has an impact on our hunger and satiety controls there, so we feel hungrier. [00:21:00] When we do eat, we feel less satisfied. But also on the, like the chemicals, are the chemicals in our brains, the has impacts on like our serotonin and that. So we actually crave like the sugars and like the refined carbohydrates. So the sugar, the candy, the chips, that's the pastries, that sort of thing, which again, will create more fat storage. And so there's a lot of ripple effects on that sleep. And so whether that's sleep disturbances related to menopausal transition symptoms. A lot of times it's people are experiencing the hot flashes and the night and that, and they're waking up, because of that, and then having trouble falling asleep.
[00:21:39] But also, it's interesting to see, how much that sleep, and this is something that hasn't been seen in the research yet, but from my own clients, but also from my own life how much of that sleep disturbance do we attribute to the menopausal transition when it's actually related more to that chronic stress in our lives?
[00:21:59] Just a little [00:22:00] quick story from my own life there, a few years ago, I was living with my partner and was in a stepparent role. My business was going boom. Of course it was the pandemic. So there was a lot of concern around that. I'm the only health professional in our households, and so I was like taking the lead role in what do we need to do for this? As well as my aging parents, one of whom my father's health is quite at risk and he would've been at, at high risk for having, of dying of COVID, quite frankly he has all the risk factors, there. And so I was like trying to keep them safe, trying to keep us safe. Let me tell you the step parenting role, not easy. And then there was a lot of difficulties within the co parenting relationship there and concerns for the children and engaging in court process and all of these things going on. And my sleep was horrible. And I attributed it to, okay I'm 44 now, so it must be the menopause transition, there goes my sleep quality.
[00:22:55] Okay. I guess this is just the life stage, that I'm in there. [00:23:00] But interestingly have made obviously we're in a different place pandemic wise. Now we've been vaccinated, things like that. Also, yeah, I've made some decisions, often tough decisions within my life there and, conditions have gotten a little smoother there on the kid front. And so my stress levels have dropped considerably because of those difficult life choices that we made. And back then I was doing some walking, but it really cut back on the physical activity. Now I've created time by making some tough choices, taking fewer clients, doing some things like that. I've created time to have hobbies.
[00:23:36] I've increased my physical activity as picking up some of those hobbies. And I now sleep great again and I'm 47 now. So it's okay, like if anything metabolic menopause transition wise, my sleep should be worse, but I'm sleeping better now because my stress level has significantly decreased and I'm physically, my physical [00:24:00] activity has increased. So I'm more physically tired at the end of the day too. And yeah the softening at the middle that was happening is starting to Retreat has been about 6 months there that I'm even seeing it, I teach this for people, but I was still seeing that change in my body. And I thought, okay, menopause transition, here this goes. But, I've made those life choices that again, weren't snap decisions. They took some time to implement and that sort of thing. But 6 months of, of living much lower stress levels, more physical activity the waistline is going back in and my sleep is, I sleep, I go to, I fall asleep and I stay asleep until my alarm goes off in the morning, which was not the case before. And it makes me kind of question. Okay. So what is, do we attribute to the menopause transition? And what is actually that chronic stress that many of us are experiencing?
[00:24:53] Dr. Alicia Power: 100 percent I would 100 percent echo that my story is a bit different, but still, I was not sleeping well, [00:25:00] again, all of this other stuff happening and I made about a year and a half ago started making some concerted changes, and I am back to sleeping eight to nine hours every night, except when I'm on call. I exercise five days a week. My middle is not shifted that much, but it's not increasing anymore. So that's good. But yeah, I 100 percent agree with you. I think we, we put the onus on whatever is easy for us to accept or takes less work or we have less power over, but I think there's a lot of things that we can do on a day to day basis to actually decrease our stress levels and improve our well being that are hard things to do though, and that's the thing, they're hard things to do.
[00:25:43] Kristen Yarker: And the changes to the body are slower at this life stage too. So I have a lot of conversations with people who are like, ah, am I, when I was younger, I knew what to do. If I noticed the scale going up, I knew what to do. I put that in place, boom, this, the weight would come off again. Now that doesn't seem to be happening. And yeah, the research does [00:26:00] show that, yeah, weight changes, we can have an impact on that after we going through the menopause transition, but the weight does change more slowly. In that, there does seem to be like a thickening of the waist that is a part of the life stage. Just like in puberty, we grow breasts and hips. So some of that is happening, but what we want to be doing, lifestyle factor wise is minimizing the extra weight gain that could happen so easily.
[00:26:25] Dr. Alicia Power: Yeah, I think the research shows about four and a half pounds of weight gain in menopause which isn't a huge amount. It is for people who are, have been stable and they're like, what's going on? And I think we're talking about weight here, but I think we're, what we're more talking about is overall health and well being. Because I think we actually know that people who have a BMI that are closer to 30, are actually have healthier lives long term, right? Post menopause, like decreased fracture risks, as long as they're healthy and so I think that's a big thing is, we're talking about this came up because patients ask about their weight, but I think it's those shifts in their bodies that [00:27:00] is more concerning and more distressing for them because it's not what they're used to. And so this is not a weight discussion. This is a healthy well being discussion that we're having today and I, we're using weight because that's the easy measure or that kind of, that changing in our body, but I think we're really really wanting to focus on what can we be doing during this time to improve our health and accepting that there are going to be some changes that occur. But we actually have a lot of power over how we interpret it and how we move forward with it and how we incorporate those really positive changes in our life.
[00:27:30] We've touched a little bit around, a lot around the metabolism, but let's talk a little bit about kind of those health changes that can happen. So that truncal obesity is often increased or associated with an increased risk of insulin resistance. For people who don't know that you need more and more insulin for, to act, to get the sugars into your cells. So more sugar floating around in your blood is how I phrase it, which can then be deposited in different areas, your liver, fat stores, et cetera. But there's certainly some other health issues that [00:28:00] can start to come up around now. So why don't we have a quick discussion around some of those and we'll just touch on them.
[00:28:05] Kristen Yarker: Yeah. And so those are specifically related to the menopause transition. And again, starting to recognize the role that particularly estrogen has and a lot of all those, as we said, all the different cells in our bodies have those receptors. We're starting to see that it has a lot of protective effect around things like heart health risk and blood sugar management. So type 2 diabetes, bone health, cognitive health, those sorts of things. And so as that estrogen declines there, then an increased risk for those health concerns for people who go through the menopause transition.
[00:28:38] So yeah, increased risk for type 2 diabetes increases in cholesterol, triglycerides, so heart health. Concerns increased risk for the non alcoholic fatty liver, increased risk for osteoporosis, and certain cancers as well as cognitive declines, so dementias and that sort of thing do [00:29:00] increase as we go through the menopause transition there.
[00:29:04] And yeah, a lot of the, way recommendations for eating is looking at minimizing those risks there. So looking at eating in a heart health, protective way, eating in a way that manages blood sugar, recognizing that our bodies, they don't manage blood sugar, less well, naturally at that age, we want to be adjusting our eating so that it's supporting that eating in a way that supports bone health. So those aspects is how, influences the changes in the nutrition that we're recommending there. And so it's more related to that. The research around what is the best way to eat for the menopause transition to minimize the fat gain or the gain in the waist to hip ratio there, the waist circumference that research is just at its infancy.
[00:29:58] Now, I know if you're like, people are looking in [00:30:00] social media all over like magazine covers, all of that, they'll see all these answers, the best diet for this is the way to lose weight best, that sort of thing. There's all of these claims out there. And I can just really clearly say there is not solid scientific evidence for one right way. So if somebody's claiming that I would be putting up a little red flag and being a little skeptical there. But the really the 1st yeah, the 1st, studies have come out around that, 1 just was published in 2023 that looked at over 4, 000 women in the UK, pretty much all of them were white, so again, we need to look at does this apply to everybody or, we don't know that yet. And they looked at, people who are eating a self reported Mediterranean style and people who are eating a self reported way similar to the UK's version of the Food Guide. Here we call it the Canada's Food Guide. The UK has their own type of version there. And the research [00:31:00] did show that eating more closely to related to the UK's version of the food guide and eating the more Mediterranean style did seem to, people who are eating more similar to that way self reported, did seem to have the least increase in the waist circumference there. So those seem to be protective.
[00:31:22] Dr. Alicia Power: The Mediterranean diet?
[00:31:23] Kristen Yarker: The Mediterranean or the UK's Food Guide. Yeah. So eating close to either of those ways seems to be protective from a, yeah, increase in the waist circumference point of view there. And but neither one was protective of overall weight gain. So that was interesting. But from that more the waist circumference, which does seem to be the fat gain that does tend to have the most health, negative health impacts on like heart health, type 2 diabetes, etc. seems to be that that gain there, that was interesting again, 1 study, it was self [00:32:00] reported how they were eating in the past, so there's always, how much are people really remembering lots of biases there, but that's that's like the literature like right there, like that's it. It's very early days there. So when I'm advising people I'm looking at, okay, we do need to eat less overall than we did in the past because our metabolism is slowing down. We do want to be eating in a heart healthy way. We want to be eating in a way that manages blood sugar and in a way that supports bone health. So that's what I'm looking at when I'm recommending nutrition changes versus saying, oh, yeah, this is like. Okay. Everybody needs to be vegan, or everybody needs to be keto, or everybody needs to be doing intermittent fasting, or everybody x, there's just that's really solid evidence is just not there for me to be, like, yes, this is the one, best answer for everybody going through the transition.
[00:32:51] Dr. Alicia Power: And I know you are well aware of this fact, because you live and breathe this all the time. But we've talked about it before. These are hard changes, right? And so we need [00:33:00] to, work in a way that works for us because if it's eating in a totally different way, and your family's not on board, or you don't really know what you're doing, it's going to be really hard to implement it, and more importantly, sustain it.
[00:33:14] The things that I often talk to people about are making these small changes over time that lead to big changes, but are easy to start create a habit and then continue to work on over time, because if you try to change everything at once, well the best of luck to you because none of us are good at change at the best of time. And if it doesn't work in our life and we're not supported by the people around us who are close to us and in the same household often or our close friends It's really hard to sustain that so are you able to give us some tips and tricks? So tips and tricks to help support those changes. So when you're talking about bone health and you're talking about that metabolic health heart health, what are some of the things that you and that, and the muscle wasting. So the sarcopenia or the decreased muscle mass with time, what are the, some of the changes that you recommend to your clients?
[00:33:59] Kristen Yarker: Yeah, [00:34:00] absolutely. And I'm absolutely the same on board. That's why our little tagline for our, our practice is professional and practical nutrition. It might not be the sexiest tagline, but we want to set people up to succeed. And so our advice is really practical, in that way. And it's really what the behavior change science shows is that the way human beings really make a change in their lives is doing small things that they can keep up, and then you keep moving forward, stacking those small things over time. There's a small percentage of people who can do big drastic changes and maintain that, but they're like in the single digit percentage type of people. That's, it's just not, sustainable for most of us. Yeah, so what recommend as far as specific changes, as I already said, we need to be starting to eat a little bit fewer, like calories, a little bit less overall but what I recommend is to make sure that you're not eating that little bit less from the protein containing foods. So we want to be making sure we're including a lot of protein there. So a bit of higher [00:35:00] protein. There's all sorts of kind of numbers batted around. I would say the science probably doesn't know exactly, if, should it be two grams per kilogram body weight? Should it be two grams per pound? There's a lot of different numbers that are floated out around there, but we definitely want to be including protein rich foods in our way of eating. And so I recommend including protein rich foods at each meal and most likely for most people at a snack in the day too.
[00:35:29] And it's for a few different reasons. So the protein is our building blocks of our muscle. And as we talked about, we want to be keeping that muscle on us both because it's protective from a bone health point of view. Also, it's that helps to keep that metabolism. Firing so it's protective that way and then just from a long term mobility point of view, we want to be able to, we don't want to be those older ladies who can't get up out of the chair because they have no upper body strength left. We want to keep that up. And the research seems to show that. [00:36:00] Maintaining as much muscle mass on us, maintaining our physical activity can perhaps help prevent some of that that weight gain that is happening there. So we want to be eating in a way that's protecting the muscle, but also from that blood sugar management point of view, protein doesn't spike the blood sugar itself, but also when we have protein at the same time as we eat foods that contain carbohydrates there, so things like starch foods, like our breads, our pastas, our grains, our cereals, potatoes even some of the fruits or some of the veggies there. When we eat protein at the same time as those, that protein blunts that blood sugar spike, and so it keeps our blood sugar much steadier. So that's example of how we want to be eating to help our bodies now that it's not handling those, that blood sugar quite as well on its own. The protein helps with eating, with the muscle, but also that it also protein keeps us full for longer [00:37:00] too, it helps keep us. And so we end up often then, not snacking as much and not eating, overeating as much because we're not eating as frequently there. We eat a meal that includes protein in there. Then it helps keep us full for more into that 3, 4 hour range where if we have just a piece of fruit or just some bread or something alone, we tend to be hungry like an hour or 2 later. And so then we'll end up eating more frequently. So we'll end up eating more. And that's how that kind of calorie, we can end up eating too much there. So yeah, definitely including protein rich foods. Pretty much every time you're eating, it's a good kind of...
[00:37:35] Dr. Alicia Power: That's a lot of protein we need to be getting in. I've been trying to get my protein in it. It's hard work. What are some protein rich foods just for people who and recognizing that, a plant based diet is also a very healthy way of eating. So some more traditional protein rich foods like animal sources, but also not that they're not traditional, they're very traditional, the plant based sources as well. Just a couple of ideas.
[00:37:58] Kristen Yarker: There you go. Yeah, I was going to say [00:38:00] traditional for which type of culture. Yeah, anyway, but yeah protein rich foods, the animal based sources are things like our meats, our poultry, seafood, eggs. And then more plant based foods would be things like beans, lentils, chickpeas, they contribute protein nuts, seeds and their butters, almond butter, peanut butters include, you contribute protein there. Soy foods, like our tofus, tempehs, that sort of thing contributes protein. And then dairy foods have protein as well, particularly the yogurts and cheeses contribute protein there. The plant based milk alternatives usually don't contain much protein. So if you're doing like an almond milk or like a, an oat based yogurt alternative, they don't tend to be very high in the protein. But if you're like, some of the cheese alternatives, like the, because they're made with cashews or things like that, they can contribute some protein as well, and then [00:39:00] proteins sprinkled through other foods, too. So things like quinoas or even whole grain breads, they contribute, some more protein to there.
[00:39:09] So an easy tip if you are animal based and include some, animal based foods is to perhaps include more, pulses the beans, the lentils, the chickpeas, that sort of thing, as your starch food instead of like a rice or a pasta or something like that, because so there's lots of dishes like that, for example, like a cassoulet, which is like a chicken stewed with beans, for example, or very classic French dish of serving fish on a bed of lentils, then instead of with rice or potatoes or something like that is a great kind of swap to do to sneak in some extra protein there.
[00:39:50] But also those pulses having them as a starch food in that way they are an extremely steady non blood sugar spiking type of starch food. [00:40:00] And they're also rock stars in the fiber department. And the fiber is helpful, again, from a heart health point of view, from a blood sugar management point of view. All of those things.
[00:40:09] Dr. Alicia Power: From a pooping point of view.
[00:40:11] Kristen Yarker: Absolutely. Yep.
[00:40:13] Dr. Alicia Power: Can't forget the poops.
[00:40:14] Kristen Yarker: Yep. So those are all in colon health. Absolutely. Yep. So those are, that's like a swap. It doesn't have to be every single day, but like swapping that way could be great. You're hitting extra protein, you're hitting like a lot of like benefits with one little swap there. Instead of having starch food on its own often at a snack, people might be having a cookie or an apple or something like that. I recommend pairing that with a protein containing food. So maybe instead of it, the apple on its own, maybe you have an apple and some smoked tofu there.
[00:40:48] Or maybe you do a apple with some cheese, or you cut the apple up and put some nut butter on there just to add a few more grams of protein, in there. So some kind of sneaky [00:41:00] ways to do that. There's also a lot of a lot of people like the convenience of a protein powder, which is handy. And there's so many things you can do with them now of course, like smoothies were the original, but now people are creating different ways to do protein pancakes or muffins or puddings or things like that, so people find the protein powders handy. There's things we can do beyond always just a smoothie. Although a smoothie. Is tasty too, but we don't have to be going to the protein powders, but just that sort of, yeah, as an example there.
[00:41:29] Dr. Alicia Power: So we've chatted about protein and we've also gotten in some extra fiber as well, which is fabulous for colon health and heart health. We'd love to chat a little bit about bone health and kind of recommendations around that because it's obviously a big one. And as we, as you've said, if our muscle mass is decreasing we're not having that same strain on our bone, increased risk for bone weakening. So a plug for strength training, both for getting muscle mass and improving your metabolism, but also for your bone health. Go. But in terms of kind of vitamin D recommendations or other recommendations that you might increase or change in this time, what would you tell [00:42:00] people?
[00:42:00] Kristen Yarker: Yeah, so the first goal kind of links back again to the protein. So getting enough protein is also supportive of bone health. So just, protein isn't the only thing, but just, another bonus, of it is supporting bone health. Yeah, and then looking at incorporating calcium rich foods into our eating habits. Many of us automatically think of dairy for calcium rich foods, but also the plant based dairy alternatives, like the oat milks, the almond milks, those also have calcium added to them. And so maybe swapping your black coffee for a latte. It's a, an easy switch to include a bit more calcium in the day there.
[00:42:36] But then a lot of the plant based foods contribute some calcium as well. So things like our leafy greens, some of the seeds, almonds, for example have some good calcium containing there and yeah, the there's some good like calcium calculators or calcium food lists available if you're Googling them from some pretty reputable Canadian sources such as if people are in BC here like [00:43:00] HealthLinkBC has some good calcium sources, and that's you can be looking up, you don't have to be doing dairy in order to get calcium in our foods. Another way that is a very traditional way to be getting calcium from our foods is to be including fish that and eating the bones in there. Canned salmon, canned sardines, mackerel, anchovies, those sorts of things really underappreciated food often and made our dominant culture here, but crushing up those little bones and having them is a great source of calcium in our diet, too, as well as the healthy fats that are great from a heart health point of view. And that's so exploring, foods where you're including the fish bones is also a tip I would be recommending. I'm a big fan of what I call the little fish. So all the mackerels and the sardines and those sorts of things. They're a great food for us and also tend to be lower on the food chain from an environmental point of view. And so a great food to be exploring and including if, if [00:44:00] somebody isn't vegetarian or vegan.
[00:44:02] Dr. Alicia Power: And a good source of omegas too, right? For kind of that brain health and that, hopefully, I don't know if there's any evidence around that and the fending off of "the dementia". I'm very technical.
[00:44:10] Kristen Yarker: Yeah, some exploratory there also from a arthritis point of view and that too, but yeah, from, and also some great evidence around it with the non alcoholic fatty liver with including more of those fish oils. So tends to be beneficial again, one of those foods that has many benefits. There's protein in there. There's the calcium in there. There's the healthy fats in there. They check as you go along.
[00:44:37] Dr. Alicia Power: Sardine cassoulet for dinner everybody.
[00:44:40] Kristen Yarker: There you go. I chose my birthday dinner restaurant because they had anchovies on the menu. And I for sure ordered that I loved them. Sardines quite regularly mash them up on a nice baguette with some good quality, olive oil and balsamic and a little sprinkle of salt and yeah, delicious that [00:45:00] Mediterranean lifestyle there.
[00:45:04] But other factors with bone health. Yeah, looking at vitamin D, which most people will need to supplement there for living in Canada at our at our latitude. I don't have specific supplementation recommendations. I tend to work with people individually to be giving those. But also perhaps looking at vitamin D with the K2 that's also in there again. And that would be individual recommendations, but something to be talking with a dietitian or primary care provider around whether calcium supplementation is needed, vitamin D for most of us will be needed and whether the K2 would be a good fit in there
[00:45:42] Dr. Alicia Power: Don't ask me about the K2. I have no idea. I can help you with the calcium and the vitamin D.
[00:45:48] Kristen Yarker: There you go. So that's one that I'm, I'm always looking at there myself. And then magnesium rich foods too. Sometimes people can be helpful from a magnesium supplement, but that has a lot of nuance [00:46:00] to it too. I wouldn't be recommending it in general and then there's different formats and that that can't give a general recommendation around that, but the magnesium rich foods, many people aren't getting enough of them, and they tend to be foods that are super healthy on many fronts. Again, another example of that. So their magnesium is rich in a lot of our leafy greens, a lot of our nuts and seeds, for example, are great sources of magnesium. And again, many people are not getting enough of those. Yeah, so including nuts and seeds each day is a great recommendation. It's can be shown for people who have high cholesterol, which again is a heart health point of view and cholesterol tends to creep up for people post menopause, or, in that menopause transition it's been shown that including that nuts or seeds each day can actually lower cholesterol levels 5 to 10% just in that single action, which is pretty cool. And again, we're talking about the good. It's got the, we [00:47:00] don't know exactly why it's whether it's the good fiber in there, whether it's the increased protein, whether it's the the mega the omega 3s that are in there, whether it's the magnesium, but and I know I keep jumping around, we're talking bone health, then I'm talking heart health and that, but it's because We're not a single system. We're not just our bones or just our heart. And the same with foods. Foods aren't just one thing. They're protein and they're micronutrients and they're the fats and they're fibers. And, so many great things, in there. But yeah, a good kind of actionable thing for someone is to include a serving of nuts or seeds each day.
[00:47:36] And to maybe mix it up. Sometimes I see people, yeah, I have almonds every single day. And I'm like, that's great. Almonds are great, but there's a world beyond just almonds out there too. Maybe switch it up. And maybe you've got chia seeds sometimes, and pumpkin seeds sometimes, and cashews sometimes, and, Brazil nuts sometimes. We can mix it up, but yeah, including the natural seeds each day is a great habit to be [00:48:00] starting during that menopause transition there.
[00:48:04] Yeah. And then yeah, so that's from a bone health point of view. And I've as I said, already segued into a few other things, but something that I want to make sure we cover, today is making sure you're getting enough vegetables and or fruit. Cause that again is something that's going to hit on so many different levels. It research shows that the people who live the longest, healthiest lives are the people who eat the most vegetables and or fruit there. So that is just a consistent thing, whether we're looking at from a heart health point of view, or a cancer prevention point of view, or, again, like list, whatever it is. And yeah, a lot of times people are like, oh, I eat vegetables and that's yeah you do at dinner, but but doesn't end up, being as much. So I recommend aiming for basically half of what you eat throughout the whole day to be vegetables and or fruit there.
[00:48:54] And as we're going through the menopause transition I do recommend the emphasis being a bit heavier on the [00:49:00] vegetables and a little lighter on the fruit. I'm not anti fruit at all, but just as we talked about our bodies do manage the blood sugar a little bit less well at this life stage. And and the fruits tend to. be a bit higher in the natural sugars there. So you don't have to cut them out altogether, but if you were mostly a fruit person and not much veggies, it's time to switch over to mostly veggies and some fruit in that balance there.
[00:49:23] Dr. Alicia Power: And I don't want, and I just want to we're talking about fruit, not fruit juice. So fruit juice is not fruit because it doesn't have that fiber associated with it, which we've already discussed is good for you and also helps to slow down the spikes in your sugar. So focus on if you're going to have fruit, focus on real fruit, not squished fruit. Yeah. But yes, shifting more to the veggies and kind of berries, I feel like, are a little bit lower in that glycemic spike, right? So bananas are horrible for that kind of big spike of sugar. I'm making stuff up. Ignore me.
[00:49:57] Kristen Yarker: A little bit, but again... Shifting more to the veggies. I [00:50:00] think yeah, moving more towards the veggies, but I don't want to vilify anyone. I'm not going to say don't have bananas or, that sort of thing. Especially if we're encouraging people to have more vegetables and fruit, we don't want to be suddenly taking ones that they might enjoy off and making it harder, there. But yeah but, each meal, each time you're eating, so similar as I was saying pretty much every time you eat, you're having protein. Every time you eat, is there vegetable or fruit present? And particularly, if your bigger meals of the day tend to be lunch or dinner there, looking to have a good 2 servings at that lunch and dinner and a serving a good way to eyeball the serving. And the way I count servings is about the size of your fist there.
[00:50:39] An apple is about that big, or this many carrots or this much broccoli, brussel sprouts, that sort of thing. If you're talking like, a leafy green, like a lettuce style, or like a kale, swiss chard, bok choy style. It's more like a big open handful is a serving. And so we're looking for 2 of those at our lunch and [00:51:00] dinner. If those tend to be your bigger meals of the day there. And often people have a little bit, like maybe 1 serving present there, but often not the two and that's what we're looking for, like that volume of veggies or fruit. And often people find it hard to include that much and a trick to help shift that to make it easier is that, often the vegetable is the afterthought when you're planning a meal, right? You might be like, oh, I'm in the mood for chicken. And then you think, okay, how am I going to cook a chicken? And then what goes with chicken? And then you think of okay, I'll have maybe rice. And then what vegetable, like it's tends to be the last part of those thinking.
[00:51:41] And instead I recommend at least sometimes change it up so that the vegetable is the source, like the first place you start. So it's okay, I can maybe ooh, like it's fall time when we're, recording this. It's ooh, butternut squash is in season. Let's do butternut squash. What goes with butternut squash? And then maybe you're going [00:52:00] to have okay, we're going to do like a squash ginger soup and add some pumpkin seeds in there and. And you and then a nice piece of crusty bread with that yeah, that's what we're going to, and so you build the meal from the vegetable and what complements it or what's in season or what's on sale, as food costs go up, maybe it might be based on what's on sale, right? You look at the Flyer for the grocery store, and oh, bell peppers are on sale, like the big bag of colored peppers. Awesome. Let's do stuffed peppers, for our meal. We'll put some veggie ground round in there and rice and onions and garlic and that and, and we'll do stuffed peppers this week. Okay. And so switching from starting with the protein food and then what complements it to starting from the vegetable. And then what complements it can be a good technique for bumping up that vegetable. Yeah, proportion that we're eating there.
[00:52:57] Dr. Alicia Power: Awesome. And so one [00:53:00] last question that we wanted to discussed is what about alcohol?
[00:53:09] Kristen Yarker: Yeah, and so alcohol in the menopause transition specifically there isn't a lot of evidence around alcohol in this time. Most of it is, most of the research has been looking at does it, having a lifetime of drinking alcohol change the timing of when you will go through the menopause transition. And there's some really mixed evidence around that perhaps being a light drinker might delay it. But again, I say that with a big question mark absolutely not certain. So we're far from knowing should you be drinking alcohol during this time of life or not? Or, does it have an impact on symptoms? That sort of thing. Still not much evidence or zero on those pieces, but again, I look at it from the health concerns that change at that time. And so we know that alcohol consumption can increase the risk for [00:54:00] certain cancers. Alcohol consumption can increase the risk that can weaken the contribute to weakening the bones there. So those are concerns. But something that I look at with clients individually recognizing that the, that we do need to be consuming a little less energy, so a little less calories at this life stage. Alcohol contributes calories. There, and they're in a way that we don't feel less hungry when we've eaten them, right?
[00:54:27] If you have an appetizer before your meal you go out for dinner, let's say, you have an appetizer before you meal, your meal, you might end up eating a bit less of your meal because the appetizer has filled you up a little bit, but if you have a glass of wine with the same number of calories in it as the appetizer, and then you have your, a glass of wine with your meal, you don't need any less of your meal because you had the glass of wine There, if anything, it's going to lower inhibition, so that you might have dessert when you might not have had it otherwise.
[00:54:53] And so the alcohol contributes extra calories that at a time when we're wanting to decrease our calories [00:55:00] while still getting lots of the good quality nutrition, the protein, the vitamins, the minerals, the healthy fats, all that stuff at the same time is we're decreasing calories. So when we're including alcohol in there, it gives us even less room to get all that good nutrition in. Because, of course, the alcohol isn't bringing vitamins, or those sorts of things, along with it. So it does become a bit harder to include it. I don't necessarily say everybody suddenly has to become sober but it is something to be looking at.
[00:55:29] But also, as we age, we do know that our ability to metabolize alcohol decreases. So that those two glasses of wine that you might have always had since your 20s, like with dinner, becomes more like two and a half, three glasses of wine, like for the body to be processing there. And so we do get like drunker off of less alcohol as we age, we want to put it that way. And so it does make sense to also be [00:56:00] decreasing the amount of alcohol that we're having, even if we're wanting to so called maintain the same amount of alcohol that we're have the impact on our bodies. You do need to start slowly having less as we get older there, because it has that stronger impact, on us.
[00:56:15] And then the last piece I always look at is looping back to a conversation we had early on is that it's often a time of super high stress. And, I'd have this conversation a lot with clients when the pandemic hit, and we were in the secure the real lockdown time, a lot of our sources of pleasure were taken away from us at the same time as the pandemic, as the stress cranked up, and so a lot of people started drinking more at home. It was springtime here in BC, the weather was nice. You're sitting on the patio, having a drink maybe every day. Cause there was not much else to look forward to at that time. And, but now it's four years later and still doing that and using it as like a way to. Compensate with the stress. It's a very common, [00:57:00] right? Mommy juice or we have all these cutie little like sayings about how normal it is for us to be managing our stress with alcohol consumption. And we've seen particularly amongst and I'll use the term women here, because that's what's been used in the research, that alcohol intake has increased to considerably amongst women over the last number of years.
[00:57:19] And to be, I think it's, while it's common in our culture to use alcohol as a stress reliever, is that the healthiest way to be managing our stress? And perhaps we need to be embracing other self care tools, building up our self care toolkit with other actions and activities to be managing our stress so that we're not relying on emotional eating and or alcohol as our primary stress reduction techniques.
[00:57:47] Dr. Alicia Power: And I think the other thing that maybe people realize, maybe not, is alcohol actually really negatively affects our sleep. Although it might, you might feel like it improves your getting to sleep, it actually worsens your overall sleep. [00:58:00] So we were talking about earlier how worse sleep decreases your ability to, both that impulse control for what you eat, but also changes the neurochemistry so that you're actually craving things that are maybe not the healthier choices. And alcohol definitely impacts your sleep as well, which during this time in our life is probably one of the worst things that can be impacted because that sleep is so important to us. And so just another kind of reminder around that.
[00:58:25] Kristen Yarker: Yeah. And then, some, something else to be considering too is sometimes to manage menopause transition symptoms, people will be prescribed antidepressants or those types of mood related medications, many of which don't mix well with alcohol. So that's to consider. And if sleep is a problem for someone, I'm so glad that, we're talking today. You're a physician. We could be talking about this because it's something I'm often talking with my clients around, is to have a conversation with their primary care provider around [00:59:00] whether I call it supplemental hormones, hormone therapy would be a fit for them. Because if the hot flashes is what's causing you to have the poor sleep, right? Then we know that poor sleep is contributing to the weight gain, etc. And people are like, oh I should do good sleep hygiene. And, it's no, the hot flashes are what's waking you up.
[00:59:20] Like sleep hygiene is not going to improve your sleep. We need to be, but, as a dietitian, it's not my role to be prescribing or recommending medications. But often I'll be asking my clients, if they happen to be lucky enough to have a primary care physician, they are in Victoria these days to be having that discussion with their primary care provider to see if supplemental hormones might be a good fit for them with the symptoms they're experiencing so that they can be improving their sleep and then not having quite the same level of weight changes that are happening from that natural ripple effect from the sleep.
[00:59:57] Dr. Alicia Power: Yeah, for sure. And that's a whole other podcast[01:00:00] hormone kind of supplementation replacement therapy, but some great resources if people are interested in learning a bit more about it. Menopause.org is a fabulous organization. And so they've got lots of great patient handouts. And provider information and then a Menopause and U, which is through the sogc.ca website is another one. So we'll link those in the show notes below. And we'll also link to Kristen sent us a whole whack load of resources and list of kind of studies and stuff. So we'll link that to as well in the show notes, if you're looking to delve in a little bit deeper. So I think that was a ton of information. Thank you so much. A quick recap is significant hormonal changes can lead to changes in fat distribution and muscle loss in this time in our life. But in this time of our life, we also often have a lot of added stressors and our, struggling, we're managing a lot of different things and so that can also contribute. So taking out a kind of a whole person look at those things. [01:01:00] We discussed about making sure we're getting enough protein. We're talking about making some changes to add that protein in, but also incorporating heart health and bone health. And you love nuts and seeds so every single day and I noted how you put some pumpkin seeds in the butternut squash ginger soup that you made sounds delicious. I might be doing that tonight.
[01:01:19] And then we also talked about how alcohol in itself. Can cause challenges with sleep, but also extra calories and maybe decreasing impulse control. Leading to again, more calories eaten than you necessarily would if you weren't drinking it. And so maybe that's part of the correlation with how, why people are noticing a little bit more, of that, those changes in their lives. Anything else that you would add and where can people find you if they want to connect with you, Kristen?
[01:01:45] Kristen Yarker: I just need to give that shout out to the veggies. So yeah, get your veggies too. I couldn't leave a wrap up without mentioning veggies there. That is the dietician in me. But yeah, so we're Kristen Yarker Nutrition Agency. If you just Google [01:02:00] dietician, Victoria, BC, we come up with one of the first options there. And we do serve clients throughout BC by secure video call. And yeah, happy to share, connect with people if they're looking for that individual support.
[01:02:13] Dr. Alicia Power: Thank you so much for chatting today. You are a wealth of information.
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