Podcast Episode 5: Navigating your nutrition during the Perimenopause and Menopause with Healthy Eating Doctor, Harriet Holme
With so many differing accounts of how best to ‘fuel’ our bodies, making decisions about how we should be eating, can prove confusing. In this episode of the NHMS podcast, nutritionist Harriet Holme helps to demystify healthy eating and sheds light on the simple nutritional adjustments that can make a big difference. Harriet explains that whilst the “foundations of a healthy diet are really similar” at different life stages we will all have different nutritional needs. Breaking this down as it relates to the perimenopause and menopause, Harriet provides straightforward advice to help make navigating our nutrition a piece of cake.
Harriet is interested in exploring the ways in which our health is connected to what we eat, she is particularly passionate about sharing evidence-based knowledge to help people understand more about their own diets and health. Before becoming a registered nutritionist, Harriet worked for over a decade as a doctor and completed a PhD in cancer genetics. She offers nutritional consultancy as well as lecturing on culinary science and nutrition.
You can listen to Harriet on her own podcast, ‘Eating for Health’ and find out more about her work by visiting her website: healthyeatingdr.com
Find Harriet on social media at:
Facebook – @healthyeatingdrcom
Twitter – @healthyeatingdr
Instagram – @healtheatingdr
Lauren Redfern [00:00:06] Welcome to the podcast for the Newson Health Menopause Society, a multidisciplinary collective of interested professionals passionate about improving hormone health across the world. The society exists to educate and inspire others to raise the standard of menopause care and access to treatment, to facilitate research collaborations across specialties and countries, and to provide expert advice and guidance to our associates. The ultimate aim of the Newson Health Menopause Society is to improve the lives and future health of women and all who experience the perimenopause and menopause. I’m Lauren Redfern. I’m a medical anthropologist, and I’ve been exploring the experiences of those using testosterone as part of their HRT treatment. In this podcast series, I’m going to be talking to guests from a variety of different disciplines in order to share knowledge and ultimately improve our understanding of the perimenopause and menopause.
Lauren Redfern [00:01:05] Cardiovascular health. Bone health. Mental health. Sexual health. Hormonal health. These are just some of the medical arenas that increasingly recognise the correlating relationship between physiological responses and adequate nutrition. Whilst we may recognise that our health and wellbeing is intimately correlated to our nutrition and (in the case of perimenopause and menopause), acknowledge that nutrition may be an important factor to address in pursuit of symptom relief, with so many conflicting accounts of how we should be fuelling our bodies, where does one begin? Here to help me unpick the relationship between what we eat and how we feel is Dr. Harriet Holme. Harriet is a registered nutritionist specialising in nutrition science and prior to working in this field, Harriet completed a PhD in cancer genetics and spent over a decade working as a paediatric doctor. Needless to say, there are many strings to your bow, Harriet. Thank you so much for being here with me today. I suppose I would really like to start by touching on the extremely interesting intersection of medical fields that you specialised in. And I guess ask you a little bit more about why you decided to move into working in the field of nutrition.
Dr Harriet Holme [00:02:19] Well, thank you so much for inviting me. It’s a pleasure to be here. Yes, I guess I sort of come at things now with a sort of multifaceted opinion, I guess. And I’ve got the sort of science, the medical and then the nutrition. But I started off, as you say, in paediatric oncology, and I really enjoyed the research side of that and then stepped out and did a laboratory-based PhD And it was during that time that I learnt a lot more about cancer genetics, genetics in general, and the microbiome, and that was when my interest, first, was really sort of started in nutrition. And from there, then I went on to further my interests in it, become a registered nutritionist, lecturer in nutrition. And I think probably having that background gives me certainly a different perspective, and it enables me to see and to understand the science having worked in the laboratory and understanding the cellular stuff, animal models, how that translates into humans and then how it relates with disease. And I find it really fascinating.
Lauren Redfern [00:03:18] I mean, it is fascinating. It makes my mind boggle a little bit if I’m honest to know all of the intersections between it. And I think that in a way, it touches on where we started, and I think it’s worth returning to and thinking about in a little bit more detail. With so many multiple and conflicting accounts regarding how we manage our nutrition, how do we see the woods through the trees and when it comes to navigating our diets? Where do we go to find accurate and insightful guidance about managing our nutrition?
Dr Harriet Holme [00:03:53] I mean, so I think that’s a really valid point that there’s a lot of noise in the nutrition sphere. Nutritionist isn’t a protected title so anyone could set themselves up as a nutritionist with no qualifications and start giving information. So you really want to be looking for someone who’s a registered nutritionist or a dietitian, and you want to be getting information from robust sources such as the Scientific Advisory Committee on Nutrition (SACN) or the British Dietetic Association, the BDA. They are great sources of information and then really looking at the studies and looking at places or people who make those studies more accessible and studies in nutrition are really quite difficult because a lot of it relies on food recall, and that’s notoriously difficult to measure and difficult for people to recall accurately. So unlike drug studies where you’d be looking for a biomarker and it would be something you could physically measure in the body, it’s a lot harder with nutrition. So you want really robust, good studies, and if you can find someone who gives you a narrative story on that and referenced papers or referenced articles that’s really helpful and accessible.
Lauren Redfern [00:05:02] Can I ask a bit on that? And I suppose also for my own interest in terms of the differences between a dietician and a nutritionist, if any, how they differ.
Dr Harriet Holme [00:05:13] So I actually find that quite difficult to answer, to be perfectly sure. Dietitian, you have to do a dietetics degree and then you become a dietitian. And they primarily work in hospital or within the NHS setting. And I think the way I see it is that they more often work with sick people, whereas a registered nutritionist has to do a specific nutrition degree, and they will then have the ability to become a registered nutritionist and they are more likely to work outside of hospital and work more with sort of well people and optimise their diet all with, I guess, less sick people, more healthier people. I would sort of say, but there’s, you know, quite a lot of blurring between that, you know, if you have some dietitians who work with well and some nutritionists who work with unwell.
Lauren Redfern [00:05:58] So in relation to perimenopause and menopause, which we’re all here to talk about and are interested in, would you be able to talk us through what the associations are with nutrition in relation to menopause and perimenopause, and not only why it matters, but what those experiencing symptoms should be paying attention to in order to be improving their nutritional wellbeing?
Dr Harriet Holme [00:06:22] Sure. So I think if we start with the symptoms first, so hot flushes are something that a lot of women experience and lots of people think that having the phytoestrogens or soya will help with hot flushes. So phytoestrogens are compounds that are plant derived that have similar structure to human estrogen, but a weaker activity so similar but weaker activity. And they are found in quite a number of foods, but also in a more concentrated form in supplements. They are frequently marketed and chosen specifically to target those hot flushes. And then there are a number of herbal medicines that contain phytoestrogens that are marketed to help with the symptoms of menopause and things like St John’s Wart, Black Cohosh and Genistein. So there is mixed evidence with those that they may help in some people with hot flushes. I think it’s worth pointing out that red clover is another phytoestrogen, and that’s not advised in women with breast cancer, but soy otherwise is probably safe. But if you think that those supplements are concentrated soy in concentrated phytoestrogens and there’s limited mixed evidence that they may help if you’re just eating foods that contain phytoestrogens, it’s probably really unlikely to help. But they are still healthy foods and are good to include as part of a healthy diet, and they include things like sesame seeds, chickpeas, soy, apricot, flax seeds. So you should still be including those in your diet, whether they help with hot flushes or not, but it’s certainly something you could try to see if they do help.
Dr Harriet Holme [00:07:54] And then caffeine is another thing that – and hot, spicy food – that if you try and reduce those, they may help in some people. There’s quite a lot of individual variation, and while it might help one woman, it might not help another. But again, you know, people don’t really like me saying this, but alcohol, you know, it doesn’t really have any health benefits and.
Lauren Redfern [00:08:15] None at all?! We can’t even… [laughs].
Dr Harriet Holme [00:08:17] Sadly not, but reducing alcohol has other health benefits. So lowering your risk of liver disease, cancer, type two diabetes, osteoporosis, cardiovascular disease. So yes, you might feel great with it. And there’s a mental health side a lot of people, you know, actually feel low after it.
Lauren Redfern [00:08:35] No absolutely.
Dr Harriet Holme [00:08:35] But there are other, better ways that you could do that instead, arguably. So if you can reduce your alcohol, it’s better for your health in general and certainly might help those hot flushes as well.
Lauren Redfern [00:08:45] I think for all of us, I found on your website, Harriet, looking a little bit before we spoke, you do talk about taking a holistic approach when you work with your clients, and there are references also to the microbiome. So, I suppose it’s a twofold question I have really is a) I think we talk about the microbiome and I’m not sure we all really understand exactly what that means. But also, I wonder if you could talk us a little bit through how you look at this in an individualistic way when you are working with your clients to tailor treatment for them?
Dr Harriet Holme [00:09:19] Sure. So I’ll just clarify, first of all, what those terms mean for your listeners as I think there’s often some confusion. So microbiota are your bacteria, fungi, viruses that live in your guts, on your skin, they live all over your body and in different regions. There are different species. So incredibly, there are different types of skin where some are sort of more moist areas, some are dry areas, some are oily, sebaceous, and all different colonies, different types of bacteria in their own specific microbiota and the same in the gut as well. You’ve got trillions of these microorganisms and they all live in your gut and perform actually a really important role in our health. And we’re really only just beginning to understand, I think with the last 5-10 years understanding what healthy microbiota looks like and then how an unhealthy microbiota and how you might be able to modulate all sort of just part of our current recent understanding. So if you sequence the DNA and the RNA, if you sequence all the genetic material in those microorganisms, that’s then called the microbiome. So just in the same way, if you sequenced your genetic material, it would be your genome or your exome sequencing, depending how much you sequenced. If you sequenced all that information from your gut bugs, then you’d come up with your gut microbiome. So that’s a really easy way of actually looking to try to understand what the diversity looks like, so how many different types of species you’ve got and their abundance within your gut and it really does have an important role in things like autoimmune diseases. So that’s the development of what’s called tolerance. So identifying cells, so your own cells and identifying harmful bacteria. So that’s the basis of autoimmune diseases where your body thinks, Oh, goodness me, this is a dangerous thing that’s attacking me. I need to attack it. Well, actually, it’s your own cells, your own body, and so that’s sort of the basis of that. There are many autoimmune cells. It’s a really high concentration of autoimmune cells within the gut, and they are all thought to be now interrelated with these, you know, communication that the gut bugs are there and helping with that not just autoimmune process and the tolerance, but also with chronic inflammation. We know that chronic inflammation actually now has a role in things like cardiovascular disease, diabetes, cancer. So what you eat determines your gut microbiota and the microbiome. And also, interestingly, there’s a two way connection with your gut and your brain, and your gut bugs can actually help to determine your mood and therefore what you eat. So it’s all very interrelated, and it’s quite fascinating how the more we find out, the more links, the more interrelated it seems to become. And the role these gut bugs play seems to be almost endless in a way. So it’s now known that there’s estrobolome, which actually is a sort of collection of gut microbiota that are involved in the metabolism of estrogen. So your liver conjugates estrogen, and that means it turns it into a water soluble compound so that it can try to excrete it. And it goes out into your faeces. And then these gut bacteria actually can unconjugate it. And therefore, it can then be reabsorbed back through your gut wall and then circulate back around your body, so it’s what’s called an enterohepatic circulation of estrogen. So you actually reabsorb your own estrogen and actually in quite a significant amount. So this circulation is actually really important. And depending on what type of gut bugs you have will depend on how much you absorb. So we’re sort of learning all about that, and there’s still a huge amount of work that needs to be done. But it does appear that actually your estrogen levels in your body also impact on those gut bacteria. And so your microbiome does actually change at the time of menopause. And then you’ve got this sort of bi-directional change that you’ve got the estrogen levels affecting your gut bugs, your gut bugs are affecting your estrogen levels, and how it sort of interplays with the role in things like breast cancer. I mean, it’s still very much in its infancy trying to unpick that research, but really interestingly, if you’re a vegetarian, you actually have great excretion of estrogen in your faeces and urine, so you absorb less because of the different gut microbiota. They don’t help you to reabsorb it. You actually excrete more. So a diet rich in saturated fat and red meat, you’re more likely to reabsorb estrogen. But we don’t really know, although you might think from a sort of, ‘Oh, well, I’m going to have some more estrogen, that’s great’, it doesn’t actually look as though that’s helpful. And actually, that looks like it’s unhelpful. So it’s all to do with these different types of estrogen. Estrogen isn’t all the same. They’re different, estrogen 1, 2 and 3, their different compounds, have different effects, and it’s a lot more needs to be understood about it.
Lauren Redfern [00:14:15] I mean, it’s fascinating. And I mean, even listening to you, talk about that and your prior comment about, you know, reducing things like alcohol. Obviously, alcohol has a massive impact on many different functions of the body. So I’m also assuming that that in itself, having a healthy liver, having healthy functioning of your body also helps with that process, hormonal process as well.
Dr Harriet Holme [00:14:36] Yes, it shows that alcohol does increase your risk of fatty liver and a liver that doesn’t work as well, but actually, it also impacts your microbiota. So, yes, you know, has that sort of multifaceted effects, really? So and it looks like this enterohepatic circulation, how that’s affected by things could be quite significant. So who knows how it will affect, you know, cardiovascular disease and sort of understanding that a bit more, I think it would be really interesting, but it’s I think as we sort of understand more, we’ve all known that alcohol is not very good for you, but you don’t really know quite why it’s not so good for you. We know that a vegetarian diet, is good for us, for example, you know, lean meat, avoiding saturated fat and red meat. We have only just started to understand all of the reasons why that might be true. So about this enterohepatic circulation, about this effect on the microbiota, and I think it’s really interesting quite how much it is connected.
Lauren Redfern [00:15:36] When we talk about individualised microbiota or microbiome. I think one thing I’m really struck by is how much information is out there about tailored programmes, tailored nutrition. Where do we begin to understand the differences in choosing and figuring out what our biological make up looks like when we’re looking to tailor our nutrition, when there are so many adverts for, you know, looking and understanding your particular biological makeup, I’m just wondering your thoughts on that.
Dr Harriet Holme [00:16:07] I think there’s sort of different facets to answering that question. So number one, I think that for the vast majority of people, the foundations of a healthy diet are actually really similar. So you want be having fruit and vegetables, whole grains instead of refined carbohydrates, fermented foods, avoiding sweeteners. You want nuts and seeds and lean protein and then the healthy unsaturated fat, olive oil, avocado. So that’s your sort of main foundation. And then really at different life stages, you will have different, especially micronutrient needs. So you will have different calcium needs in pregnancy or breastfeeding and menopause. And understanding what those look like I think is really important, actually really difficult for women and men to know what 120 milligrams of calcium or 1000 milligrams of calcium look like. So I designed a free checklist that you can work out what a portion of something is and how that relates to calcium, because I don’t want people to be weighing food, but I think that it’s empowering to know that you’re getting enough and how to meet your own micronutrient needs. And then there will be people who have different triggers. They’ve got irritable bowel syndrome, they’ve got different triggers for foods that cause problems and symptoms, so it’s identifying those and then you have different people who’ve got different health concerns and specific health concerns. You know, you need to make specific adjustments, whether it’s high cholesterol or diabetes or gestational diabetes or those kind of things. And then I think that it’s quite easy now to get a microbiome test and lots of people are advocating those. But I think at the moment personally that we don’t know – we know sort of what’s normal – but I think that I’ll sort of say how I used to practise medicine…
Dr Harriet Holme [00:17:51] So when I was in medicine, I think that my philosophy, especially during paediatrics, was always, was it going to change management? So there was no point of doing an intervention if it didn’t change management and I could do blood tests on everyone, but what was the point if I was going to make a clinical diagnosis? Actually, the blood tests are meaningless, because you’ve already made your diagnosis.
Lauren Redfern [00:18:11] Yeah.
Dr Harriet Holme [00:18:11] And it’s not going to change management. Why are you doing it? Why are you putting that child through it? And I think you mind just really focuses a lot more in paediatrics to have that approach than in adults because, you know, adults can put up with a chest X-ray or, you know, a blood test a lot more easily. But in paediatrics, you know, you’re really focussed on doing no harm and not doing unnecessary investigation. So I think that it’s possible to diagnose dysbiosis – that’s where the balance of bacteria is upset in most people – without doing microbiome studies. So what’s different? How is it going to change your management? I think that really depends on whether you’re going to give probiotics to try to change it or whether you are more going to be based on food. And I don’t think the evidence there is strong enough yet for probiotics in many circumstances. I think for very specific circumstances, there’s a role. And I also think that while many people think that supplements must all be safe, as they’re just supplements, they’re not like drugs. That’s not always the case.
Dr Harriet Holme [00:19:12] So there’s some recent studies in Cells which is a high impact factor journal that showed that in people that had antibiotics, which obviously kill off both the bacteria you’re trying to kill off the infection, they also do actually impact your gut microbiota as well. And some antibiotics can have significant long-term impacts, so for example ciprofloxacin actually impacts your gut bacteria for up to two years –
Lauren Redfern [00:19:34] Wow!
Dr Harriet Holme [00:19:34] that people thought, ‘Well I’ll just give some probiotics, and that will help repopulate the gut.’ But in a couple of studies they’ve shown that wasn’t the case, that actually had a placeholder effect where they actually prevented repopulation of the gut bacteria. So I think we need to have a lot more information, I don’t think enough is known. I’m quite cautious about probiotics in general. I think, as I said, certain specific indications are really helpful, but I think that a lot of the time it doesn’t actually change your management of how you treat someone, so I think that’s an important factor. And then the other part of this is not just the genetics of your bacteria inside you, it’s your genetics. And there’s lots of people looking at the SNP profiles. So SNPs are, if you think of your DNA as sort of a large storybook. And in it, you’ve got chapters and pages and paragraphs and sentences. So the SNPs are almost like the sort of little typos or the punctuation. And so they’re just little tiny changes scattered through your DNA, which most of the time, so they’re not mutations, they’re not changes, they’re just natural variation. And so these genetic tests are actually looking at those. So it’s a very tiny snapshot of the variation in your DNA in very specific genes. And I think that they’re becoming increasingly insightful and they’re quite useful in some circumstances, particularly with vitamin D. But I’d be really cautious about people that prescribe specific diets based on those. I think we’re not there yet with that.
Lauren Redfern [00:21:08] And I mean, I know this is rather a crude interpretation of what you’re saying, but I suppose my take home from it is that fundamentally we can know if our gut health is not up to par and we can make the changes, the basic changes, as you inferred, making sure we have enough fruit, vegetables in our diet, including lean meats, including that we have good saturated fats doing that without getting a personalised breakdown of our microbiome.
Dr Harriet Holme [00:21:33] Yeah. And I think that’s partly because projects like the Human Microbiome Project, they’re like the Human Genome Project, where you can’t just infer what a normal microbiome looks like from one person. You need thousands of thousands and while we’re building up that picture now, and we’ve got a good idea of it, we still don’t have a great idea of what different geographic alterations look like of cultural or – you know, there’s so many different facets to this. I think we need more information first.
Lauren Redfern [00:22:01] Absolutely. One factor I did want to touch upon, if we can briefly, is the relationship between nutrition and our bone health. So obviously, we know that there’s a correlation between what we eat and maintaining healthy bones. But I wondered if you could expand a little bit more upon this and provide some information about the correlation and how this relationship works.
Dr Harriet Holme [00:22:22] Sure. So this is really important, especially around the time of the menopause, because osteoporosis is where you’ve got brittle bones and you’re more likely to have a fracture. So a premenopausal 50-year-old woman only has a 2% risk of osteoporosis, while a lady who’s 80, for example, has a 25% risk of osteoporosis. And if you break a bone at that age, it has quite considerable side effects. And that’s primarily due to their much lower levels of estrogen. So diet can play an important role in your bone health. It’s not going to replace estrogen, but your bones also need things like protein. So that’s having lean protein at every meal. And that’s things like chicken, fish, nuts, seeds, beans and then calcium. So calcium is really important and premenopausal, you only really need 700 milligrams a day, while after the menopause that rises to 1200 milligrams. So that’s a lot of calcium, and it’s really important that you get enough and there are lots of ways of do that, tinned fish is probably the best way of getting calcium because you’re eating all of the bones of the fish, and that’s where a lot of calcium is, or dairy. And if you are dairy free or you’re vegan, a lot of people think, ‘Oh, organic is better, I’ll get an organic plant milk.’ But organic is not fortified with calcium, so it doesn’t contain any calcium. So always look for a calcium-fortified, plant based drink, so, calcium and iodine ideally, you need to check that your plant based milk contains those.
Dr Harriet Holme [00:23:51] And then vitamin D, so the sunshine hormone. The NHS advised that everyone in the UK should be having vitamin D supplements during the autumn and winter months. But if you’re high risk and that’s where you’re either very covered up or you don’t get out, or you’re housebound, then you should really be considering taking that all year round. So it’s really difficult to get enough vitamin D from your diet alone. Although it’s contained in some food, you really do need to be taking that supplement. And just to say that lots of people worried before that sunscreen might prevent you from naturally making it in your skin, evidence suggests that it doesn’t impact, so always put on your suncream, avoid the midday sun, have that 20 minutes of sun a day if you can get it, and if you can’t, then you should be taking that vitamin D supplement.
Dr Harriet Holme [00:24:35] And then vitamin K is the other really important micronutrient, and it’s important for bone strength. And it’s actually multiple compounds all come together to form vitamin K, so you need to be having a range of different foods to have all of those components of vitamin K, you need to be having green leafy vegetables, fermented food, meat and dairy to get vitamin K. And really interestingly there are actually other countries in the world, for example, Japan, which have done studies and have found that vitamin K actually reduced osteoporosis, so they now use it as a treatment for osteoporosis. We don’t do that yet in the UK, but it’s certainly important to be having those items in your diet. And just to say that it is a fat-soluble vitamin, so it is possible to take too much and we don’t know what those side effects are. So I wouldn’t recommend a supplement, especially if you’re on blood thinning medication, you really shouldn’t be taking it, but you certainly should be trying to get all of those items in your diet. Really, fermented food isn’t just good for vitamin K, it’s also really good for the microbiota. And then magnesium and phosphorus, they’re also really important as well. I think in a lot of people think that maybe they should take magnesium supplement, but you really should be able to get enough magnesium and phosphorus in your diet if you’re having a healthy diet so those whole grains, pulses, beans, seeds, green leafy vegetables. So if all of those things are in, you should be having lots of those in your diet and be having them.
Lauren Redfern [00:26:04] So I think that’s sadly all we actually have time to discuss today. There is so much on this topic that’s fascinating that I just want to pick your brain for hours, but I really want to thank you so much for spending that time and chatting with me today. Harriet, it’s been such an interesting and insightful conversation, and as ever, there’s far more we could discuss, but I wanted to finish by asking if there were any takeaways you’d like to emphasise to those listening today.
Dr Harriet Holme [00:26:32] I just go back to the foundations of a healthy diet, so that’s your 30 grams of fibre a day, fruit and vegetables, fermented food, healthy unsaturated fats, olive oil, avocados, handful of nuts and seeds a day, beans, lentils, chickpeas, lean protein, oily fish, the omega three and then just variety, variety, variety, variety. So important, don’t stick to the same brand. Think of a different vegetable every week, if you like kimchi, and that’s really great as a fermented food or sauerkraut. And don’t just stick to the same brand have a different one each week. It’s going to be a different process, potentially different bacteria. So just enjoy foods. Healthy food doesn’t have to be boring, but it really can reduce your long-term risk of osteoporosis, cardiovascular disease, cancer, bowel cancer. It’s really important to look after ourselves today for the long term.
Lauren Redfern [00:27:26] Can I ask for a personal, I guess? Do you have any favourite foods at the moment that you’re just absolutely loving and enjoying cooking with and eating?
Dr Harriet Holme [00:27:35] I really love foods that have got umami, so I love miso, I love kimchi, I love sauerkraut. I love Asian type food. I love all those types of food, to be honest. But I think it’s just variety. It’s trying to keep yourself interested in food, and it’s great for you, great for your gut bugs, and healthy food really doesn’t have to be boring at all.
Lauren Redfern [00:27:57] Absolutely. And if you’d like to know a little bit more about Harriet and the work that she does, you can visit her website, which is healthyeatingdoctor.com and find out more information. But I just want to say thank you so much, Harriet. I’ve actually taken – I feel really selfish in this – I’ve taken a lot away personally for myself that I’m going to go and try and implement. But yeah, I really appreciate your time.
Dr Harriet Holme [00:28:17] Thank you so much, it was a pleasure.
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