The Menopause Nutrition Fix: What Every Woman Over 40 Needs to Know with Dr. Sarah Berry - SUMMER REBOOT - Episode 283

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Dr. Sarah Berry is an associate professor at King’s College London and has run more than 30 human nutrition studies. Most notably, she’s the lead nutritional scientist for PREDICT — the world’s largest in-depth nutritional research at the science and nutrition company Zoe.  

Dr. Sarah Berry unlocks the mysteries of how women's bodies respond to food during the menopausal transition in this eye-opening conversation about nutrition, hormones, and health. As lead scientist for PREDICT, the world's largest in-depth nutritional research at Zoe, Dr. Berry shares groundbreaking findings about the dramatic metabolic shifts occurring during perimenopause and beyond.

Ever wonder why your body suddenly stores fat differently or why your blood sugar feels unstable? Dr. Berry explains the science behind these changes, revealing how dropping estrogen levels create a "roller coaster" affecting everything from cardiovascular health to sleep quality. The research is clear: premenopausal women typically have better cholesterol, blood pressure, and insulin sensitivity than men of the same age—until perimenopause disrupts these protective factors.

What's particularly fascinating is how differently each woman responds to food during this transition. Dr. Berry's research reveals up to 20-fold differences between individuals, challenging the one-size-fits-all approach to menopausal nutrition. Rather than restrictive diets, she suggests practical strategies that work with your biology: time-restricted eating (finishing dinner before 7pm), maintaining consistent sleep patterns, and simply slowing down your eating rate by 20% can reduce calorie intake by 15% without conscious effort.

Most encouraging is the finding that women who improved their diets experienced a 35% reduction in menopause symptoms—regardless of whether they were taking hormone replacement therapy. This suggests that focusing on diverse, plant-rich foods with plenty of fiber can complement medical approaches or provide an alternative for women who cannot or choose not to take HRT.

Whether you're approaching perimenopause, in the midst of the transition, or supporting someone who is, this conversation offers evidence-based hope that small, sustainable changes to how and when you eat can significantly impact how you feel

Chapters

• 0:00 Introduction to Wellness for Midlife Women
• 2:14 Dr. Berry's Background in Nutrition Science
• 5:55 Understanding the Menopause Transition
• 10:33 Health Effects and Symptoms of Menopause
• 17:11 Food Timing, Sleep and Circadian Rhythms
• 28:57 Insulin Sensitivity and Glucose Responses
• 37:15 Diet's Impact on Menopause Symptoms
• 48:00 Components of a Healthy Diet
• 57:40 Four Pillars of Health for Menopause

Transcript

Sandy Kruse: 0:02

Hi everyone, it's me, Sandy Kruse of Sandy K Nutrition, health and Lifestyle Queen. For years now, I've been bringing to you conversations about wellness from incredible guests from all over the world. Discover a fresh take on healthy living for midlife and beyond, one that embraces balance and reason without letting only science dictate every aspect of our wellness. Join me and my guests as we explore ways that we can age gracefully, with in-depth conversations about the thyroid, about hormones and other alternative wellness options for you and your family. True wellness nurtures a healthy body, mind, spirit and soul, and we cover all of these essential aspects to help you live a balanced, joyful life. Be sure to follow my show, rate it, review it and share it. Always. Remember my friends balanced living works. Remember my friends, balanced living works.

Sandy Kruse: 1:28

Hi everyone, welcome to Sandy K Nutrition, health and Lifestyle Queen. Today with me I have a special guest. Her name is Dr Sarah Berry and she is an associate professor at King's College, london, uk, and has run more than 30 human clinical sorry, human nutrition studies. Most notably, she's the lead nutritional scientist for PREDICT, the world's largest in-depth nutritional research at the science and nutrition company ZOE. I hope I pronounced it right, it is ZOE right, I did.

Dr. Sarah Berry: 2:03

It is Zoe. I hope I pronounced it right it is Zoe right, I did, it is.

Sandy Kruse: 2:13

And today we're going to be breaking down the very complex connections between lifestyle, hormones and health, and how diet can lessen the effects of menopause on women's bodies. And I think this is a very important conversation because myself, as a holistic nutritionist, I hear all the time about people who will do everything else in the world but change their diet when they have an issue, and I don't think there is a better person to have this discussion with than Dr Sarah Berry. So, with that, welcome, thank you.

Dr. Sarah Berry: 2:50

Thank you for having me on. I'm excited to dive into it and also dive into why it's so difficult to change your diet.

Sandy Kruse: 2:59

Yeah, I think this is going to be a great topic because, I mean, the science says that diet matters and we can use food as medicine, and this is so important, especially for women who are just kind of entering into these stages and seeing these changes in their bodies, you know, right around perimenopause. So I have to ask you if you could just let us know your background and why such an interest in this field.

Dr. Sarah Berry: 3:28

Yeah, so I'm a nutritional scientist by training. I did my PhD many years ago at King's College London, a university here that has one of the world's leading nutrition departments, and I started off researching the impact that food structure has on our health, and particularly in relation to cardiovascular disease, and how the different fats that we eat and the structure of food, how it impacts what we call our postprandial responses, so our short-term responses to food, so those kind of metabolites that change two to four hours after eating food metabolites that change two to four hours after eating food. And I started to notice that actually people's responses were so, so different. There was like a 20 fold difference between how one person would respond versus another person, and so I had the privilege to get involved with a what was a startup seven years ago and now is a company called Zoe Science and Nutrition Company, and now is a company called Zoe Science and Nutrition Company, who have really been at the forefront of developments in personalized nutrition based on this idea that we all respond so differently to food.

Dr. Sarah Berry: 4:34

And through Zoe we're running this huge program of research that you mentioned, the Predict program research, which is collecting data in hundreds of thousands of people and looking at how we differ between people, how we differ day to day and how we metabolize food, and how we differ depending on multiple factors, and one of those factors we were starting to see a couple of years ago that was actually having quite an impact on how we metabolize food, on our health factors as well related to, like blood pressure, lipids, inflammation was the menopause, and so that's how I kind of dived last few years into menopause research and, more recently, also looking at menopause symptoms.

Dr. Sarah Berry: 5:14

So looking at the relationship between both diet and menopausal health, and by this mean I mean all the unfavorable health changes that happen peri and post menopausally, but also diet and menopause symptoms, which is what many people talk about when we think about menopause. So that's how I've ended up where I have. So menopause for me is a relatively new area, but I have spent 25 years looking at the relationship between diet and all of the kind of factors that actually are relevant in menopause kind of factors that actually are relevant in menopause.

Sandy Kruse: 5:47

I'm going to say one thing that really stuck out that you just said is the bio-individuality aspect and how certain foods will affect you differently than it will affect me, and I think that this is key here. Because think that this is key here? Because, excuse me, I noticed in this area of health and wellness we get a lot of advice and it gets very complex, especially for women who are experiencing these changes in their bodies. And even though I'm a holistic nutritionist, that doesn't mean that I'm not going to have challenges. But when we hear advice, that's pretty blatant advice you must do this, you must do this, you must eat this, you must have this, you must take this. It gets very daunting for a lot of women, especially because we're already dealing with these changes. So I love that there's that whole bio-individual aspect to what you do, sarah. It's amazing. So I guess we could start about, because you have such vast experience in this, what do we see around menopause? That maybe makes this whole food aspect a little more complex.

Dr. Sarah Berry: 7:13

So I think we need to step back and think well what is menopause? And I know many of your listeners might know this, but there might be many listeners that don't know this. There might be some men listening who have women in their lives that are going through this. So if we can just pause for a moment and think about what menopause is, then I think it puts into context why food might be relevant and why we have such wide-reaching health effects related to menopause. So menopause, very simply put, is the point in time one year after your last menstrual cycle. So it's the point in time a year since you had your last period or last menstruation bleed. Now you don't go to bed one night premenopausal and wake up hey presto, I'm postmenopausal, that's it, it's all over. No, it doesn't work like that.

Dr. Sarah Berry: 8:00

There's an entire menopause transition period, and this menopause transition period starts when your oestrogen levels start to decline and, in the definition that we use as scientists, it ends 10 years after your last menstrual cycle. Now the perimenopausal phase is the phase that your oestrogen starts to decline up until when you have that last period, or the year after your last period. This can last anything from two years to eight years, depending on individuals. Again, we're all so different. But what's really important to notice in this perimenopausal phase what happens is not this beautiful slow decline in oestrogen that your body adjusts to day by day. No, it's a roller coaster. It's this phase of hormonal chaos where you've got these peaks and troughs and moving around in oestrogen, and that's why the perimenopausal phase is so challenging. Postmenopausally it's more stable, but your body's still adjusting to this change in oestrogen. And the reason that we know that perimenopausal and postmenopausal women have a multitude of issues is because oestrogen receptors are all over our body. Oestrogen receptors aren't just down there, related to our reproduction or our ovaries. We have oestrogen receptors in our brain, in our muscles, in our bones, in our heart, everywhere, and so as we lose estrogen, we aren't getting these estrogen receptors stimulated and therefore they're not doing the job that they are there to do, and this is why we have such far reaching issues or symptoms.

Dr. Sarah Berry: 9:39

We have health related issues that we talk about a lot less, I think, or not as much as we should relate to menopause. So we know, for example, from our own research and other published research, that premenopausally, women are doing quite well in terms of health. So by this I mean at any given age compared to a similar age man, and I'm talking about the average here. Women on average premenopausally have lower blood pressure, have better cholesterol, have better insulin sensitivity, have less visceral adiposity, so less fat around the belly, have lower cardiovascular disease risk. What happens is when they meet the perimenopausal transition phase, suddenly these start to go up and suddenly their risk, these intermediary risk factors associated cardiovascular disease, their blood pressure, their cholesterol, the insulin resistance, the inflammation, the visceral adiposity, suddenly goes up to the level of men and in some cases in our own research, for example with blood pressure we see it even overtakes men. So firstly you have these health effects related to menopause, which we know diet can have a really fundamental role in helping negate.

Dr. Sarah Berry: 10:50

And then you have the symptoms.

Dr. Sarah Berry: 10:51

This is what I think many people think about when they think of menopause.

Dr. Sarah Berry: 10:54

You have these really impactful symptoms.

Dr. Sarah Berry: 10:57

Again, they vary from one person to the other and by symptoms I mean everything from the neurological symptoms so the memory loss, the brain fog, the anxiety, the mood swings, the depression, the low mood to physical symptoms so achy bones, achy shoulders, poor skin, poor hair, etc. Such as, you know, the poor sleep, for example, and you know, sexual symptoms as well loss of libido, vaginal dryness, etc. So we also have these far reaching symptoms and the reason is, again, is because we have estrogen receptors all over our body. We've not got estrogen binding to them. They're not doing what they should be doing and so suddenly we're hit with these awful symptoms, and this is one of. We've been looking at both of these in our ZOE predict research. We've been looking at the health aspects. We've been looking at how they differ from people, how diet might help, and then we've also been looking at symptoms, how prevalent they are, how impactful they are in people's quality of life and where diet might fit in with these, and also where other hormonal kind of therapies fit in as well.

Sandy Kruse: 12:08

Has the research that you guys have done at Zoe explained the whys? Like I know, you can't speak about prescriptions or anything, but you see a lot of women are. I guess it's suggested to them by their primary care physician to go on a statin because their cholesterol shoots up. So why does that happen, other than? Is there another reason other than the fact that you know, we just don't have the estrogen anymore?

Dr. Sarah Berry: 12:54

So that's a really interesting question, because what's very difficult with menopause research is to disentangle natural parts of aging versus what's due to estrogen. Specifically, menopause is an age-related event, and so how do you disentangle? Well, this is just because you're getting older. So we know, for example, in men, as they get older, their cholesterol tends to go up.

Dr. Sarah Berry: 13:19

In women, your cholesterol tends to go up. What's due to the menopause versus what's due to age. Now we do suddenly see like an inflection point, so to say, where cholesterol might steadily increase and suddenly at the menopause phase it suddenly goes up. We know that there are some underlying mechanisms for this. We also know that for the majority of people, if they then start taking hormone replacement therapy and see this for in our research, for example, then your blood cholesterol levels go back down. So again, building that picture that it's not just age-related, that there is a direct effect of oestrogen, and this is for multiple reasons. So one of the reasons is that we know that your body composition changes during menopause, so estrogen changes where we deposit fat. So in a kind of very simple, using very simple terminology, we know that estrogen kind of directs fat to our hips and our bottom.

Dr. Sarah Berry: 14:18

So women have this pear shape. When you start to lose estrogen, you lose that kind of protected direction of fat to an area that we know is quite safe to have fat and what happens is is therefore you start to deposit fat around your abdomen, around your belly, so you increase what we call visceral adiposity, which is basically tummy fat, and we know this is really metabolically active. We know it's unhealthy fat. We know it's more linked with inflammation, with cardiovascular disease, with type 2 diabetes, with higher blood cholesterol, blood pressure et cetera. Because it's so metabolically active, menopausal women have five times more likelihood of having visceral adiposity than if they're premenopausal.

Dr. Sarah Berry: 15:00

So firstly, you've got kind of indirect effects going on because of oestrogen's impact on other areas, so, for example, increasing adiposity. We also know that oestrogen impacts many enzymes involved in how we metabolize fat, how we produce fat in the liver, how we remove fat from the circulation. We also know it's involved in processes related to how we process glucose as well in the blood, so from the carbohydrates in the meal, because it's it's has an impact on insulin, for example. It has an impact on these enzymes, lipases, involved in how we process fat. So we know that these again are all mechanisms that are important in also some of the underlying pathways related to recordings. I feel it really gives more of an authentic.

Sandy Kruse: 16:08

Take on all of my recordings and, as a woman who's almost 55 and menopausal exactly what you're talking about, and I know I'm an N of one but I see exactly that when my estrogen is not optimized, I get that central belly fat. And this isn't to insult menopausal women at all. I'm not saying that. I'm just saying that you can almost visually see that center of a woman get larger and it's like their bum and their hips disappear, you know. And so a lot of women are like, oh my God, I don't know what's going on. I'm getting this belly fat and for me personally, again N of one. I know it's all about that optimization for estrogen, but I'm on bioidentical hormones and that might not be the choice for every woman. So this is where we go. Okay, well, how can I optimize my body composition? Using food and using lifestyle?

Dr. Sarah Berry: 17:28

Lifestyle matters too, and movement too, and movement, yeah, and I think it's challenging and I don't want to. I'm reluctantly, rather I'm reluctantly saying this, that it's challenging, it's tough, but I think we have to be realistic in these conversations. You know, I would love a belly like Jennifer Lopez. I would love, you know, to look like Halle Berry. The reality is I don't. I'm 47. I'm starting to get a bit of a belly around my tummy. I've not put weight on and I know it's because I'm in that perimenopausal transition. But we have to be realistic about what we can do about it. And I think that I'm not just saying we accept it, that this is just inevitable, but we have to accept it's going to be harder to maintain the body shape we had before if we're peri and post-menopausal. And this is because, as well as that direct effect that I talked about on estrogen and where it directs the fat, you've got so much else that's going on, which is where what you've said lifestyle also comes into it. Diet comes it. So, for example, most peri and post-menopausal women and we see that 85 percent in our cohort say that they're not sleeping well, that they have sleep disturbances. So 85 percent of perimenopausal women are having sleep disturbances. Now. Sleep impacts so much. Sleep impacts our desire to do physical activity. Sleep impacts our mood. Sleep impacts our stress level. Sleep impacts the dietary choices that we make.

Dr. Sarah Berry: 18:59

If we've had a bad night's sleep, the reward centers in our brain are heightened and they'll be saying hey, sandy, I know you were going to have this nice, healthy breakfast, but, damn it, you've not slept very well. Go and have a quick fix. You're fighting against that. What we also know from our own research, from our Zoe Predicts studies, is if you've had a poor night's sleep, you also have a difference in your metabolism immediately the next day. So we gave people identical meals across a number of different days to have for breakfast. These are high carb, high fat meals and what we found is on the days that people had a poor night's sleep, when they had that high carbohydrate meal for breakfast, they had a higher postprandial glucose response, and by this I mean circulating levels of blood sugar after having that meal. They had a higher response compared to days when they had a good night's sleep.

Dr. Sarah Berry: 19:49

So you've got women who are having all of these things being thrown at them the lack of estrogen directing fat to their belly, the poor night's sleep, the higher glycemic responses, the craving for different kinds of food, the low mood, the less desire to do physical activity, et cetera, et cetera. It's kind of creating this perfect storm. And, yes, we can try and fight against the perfect storm, but I think we have to recognize that it's going to be harder. And do we want to fight against the perfect storm? Do we just accept? You know what my body shape is changing? But what I will do is make sure that I'm eating as healthy as I can, but I will accept that my body shape is going to change. It's a personal choice.

Sandy Kruse: 20:44

And I love that you said that about the sleep, because I think this is key If women can really kind of have that as your foundation and utilize the tools that are available to you, because I do feel that we need more tools in order to sleep well.

Sandy Kruse: 21:12

I mean, if you're a mom, it kind of starts when you have babies and then you end up having teenagers and then you end up having menopause and it's tough. But I think if we put ourselves first and we do whatever it is, whether it is working with your physician and I know for me I began using bioidentical progesterone, starting off with the cream and this isn't what this discussion is about, but for me it immediately helped me to optimize my sleep. That's where it kind of began in my 40s, because I recognized that nothing else was working and I needed to do what I could for my sleep. Now, the other thing I do find interesting is I'm sure you've looked at this and I wonder if Zoe has in the Predict, research has looked at this Just in terms of you know, our blue light and how that might affect our circadian rhythm, which can in turn affect our hormones. I don't know if Zoe has done that. Any research there.

Dr. Sarah Berry: 22:20

No, we haven't done research specifically related to blue light. We have done lots of research looking at how time of day impacts our responses to food, how time of day impacts our post-prandial responses, like our glycemic responses, how factors like meal ordering, time-restricted eating. So we've done lots of work around that and I think what this work shows to us is that there's lots of tools to our toolbox. So it goes back to something you were saying earlier. That, again, know, I was saying earlier how tough it is and I think that we can try to change our diet. It's hard, but we can also try and change other factors related to how we eat, and this is where I think the whole circadian biology is fascinating. So, whilst I don't know how the blue light and circadian biology fits in specifically with hormonal levels, what we do know is if you're eating late at night. So, for example, in our cohort we see that 30 percent of people are snacking after nine at night. That's huge. We know that if you're eating after eight or nine at night, you're at higher risk of metabolic disease. You're at higher risk of higher inflammation, higher blood pressure, higher inflammation, higher blood pressure, higher cardiovascular disease, et cetera. And again, because postmenopausally you're already at higher risk of that. These are the kinds of things that we could be quite mindful about. Even if we're not totally changing our diet or making big changes to our diet, why don't we change how we're eating the food? So why don't we stop eating late at night if we can try and shift the last meal of our day a little bit earlier and then change other factors related to how we try and give our body a kind of fast period? So try and make sure we're having 12 hours, ideally 14 hours, where we're not eating anything.

Dr. Sarah Berry: 24:08

And we run this study called the Big If Study, the Big Intermittent Fasting Study, where we asked people at a population level just try reducing the time window in which you eat your food. You don't need to go crazy. All the studies out there use these crazy eating windows of only eating four hours or six hours. That might work for some people. Certainly wouldn't work for me. So we just said you know, maybe have your last meal of the day at seven o'clock. That means you can have your first meal of the day at nine o'clock the next morning. So you're eating in a 10 hour window. This improved people's mood improved, their energy levels improved their hunger levels, improved their weight, and we saw this worked really well as well in peri and postmenopausal women. And we did this in 150,000 people in and we told them to carry on the normal way you live your lives, carry on that noisy way you live your life, don't change anything else. And we saw an improvement. And I think where we saw the biggest improvement was actually those that were doing what we call early time-restricted eating, so those that were making sure they finished a bit earlier, so with, for example, having their last meal at least before seven in the evening, and we saw a benefit across everyone. But the fact that we saw an even greater benefit in some of the parent postmenopausal women, I think is really promising.

Dr. Sarah Berry: 25:25

And then another area that kind of fits into this again it's I have to caveat, it's not related to the blue screen, but it fits into this whole idea of the circadian biology that we're talking about is that also, we know that consistency in sleep is really important, consistency in the time you go to bed. So we did some really interesting research that we published a couple of years ago on what we call social jet lag. I don have you ever heard of social jet lag? No, no, so it's a relatively new term and what it basically means is inconsistency in when you're going to bed, in your sleep pattern. So, for example, people who are being sensible in the week, coming home, going to bed at 10 o'clock every night on a weekday because they're getting up for work and then at the weekend they're going out, partying, going crazy, going to sleep in two in the morning. Or it might be the other way around. You might be like me, who works incredibly late every evening because I get so excited by all the signs. Then at the weekend it's like catch up time and I'm going to bed early. But it's that inconsistency and we call this social jet lag, where you're changing your sleep pattern, not because you're on a plane, but because of how you might be living your life socially.

Dr. Sarah Berry: 26:36

And what we see is, if you have social jet lag, we see that that impacts different areas related to health as well.

Dr. Sarah Berry: 26:43

We see it impacts some of the dietary choices you make, and we see that it also impacts your microbiome composition in a way that we know is unfavorable and may lead to other unfavorable health effects. And so I think this is fascinating. And the reason it's fascinating is because I think, as nutrition scientists, we've always thought it's all about what you eat. Change your diet, reduce this, reduce that, cut out this. Well, firstly, I think, as nutrition scientists, we should say this is what you should add in to make it healthier.

Dr. Sarah Berry: 27:10

But secondly, we've got all of these other tools we can fiddle with. We can stop eating late at night. We can try and you know eat in a more consistent way. We can do things like slow down the pace in which we eat our food. You know, there's amazing research showing that if you can just reduce how fast you eat your food by as little as 20%, you can, without even thinking about it, reduce the amount of energy, so the amount of calories you're consuming, by 15%. So, instead of having your breakfast in 10 minutes, have it in 12 minutes, because, without realizing it, the evidence shows that, on average, you'll actually eat 15% less calories. So there's all these different tools that menopausal women can bring in to help them on their journey.

Sandy Kruse: 27:53

That's one I've never heard, sarah, I love that.

Dr. Sarah Berry: 27:59

So eating rate is fascinating. And I tell you why the rate's fascinating. Firstly, because there's randomized controlled trials now showing if you just tell people to slow down their eating rate, you can see significant weight loss so doing it in a controlled environment. So there's randomized controlled trials where they randomly allocate, you know, overweight individuals to either eating at their normal rate, or eating fast, or eating slowly. Those that are told to eat slowly and eat slowly lose more weight than those who are told to eat at their normal rate. We also know it affects the rate at which we metabolize food. It affects our hunger feedback signals. And what's really interesting about this as well is that we know it's one of the mechanisms why these heavily processed or ultra processed foods, as we call them, are bad for us. We eat ultra processed foods on average 50% more quickly than unprocessed, nutritionally matched foods.

Sandy Kruse: 28:58

So I think that's very fascinating, like I've always been taught to eat slowly because you will be. It's just like what you said about the hunger signals you will feel satiated much sooner, but I find that really fascinating. And here's something you were talking a lot about the eating window and the fasting. So I think you're going to find this interesting. Back in 2022, this was the year that I first experienced I was 52. My cycle was really off. I think I had only five periods that year.

Sandy Kruse: 29:37

Well, I was listening to and I like to call it the maniverse the advice of all the giant, you know, voices in the wellness space, and it was all about fasting, and so I'm like they say to do this. So I'm going to do this, and I was doing intermittent fasting with only an eight-hour window where I could eat, and so I would stop eating whatever 6.30 at night or so, and then I wouldn't eat until 11 o'clock or so 11, 1130 the next morning. I had a very small window. So during that time that I was actually experiencing a lot of perimenopausal symptoms, my HbA1c went up to 6.1. So I was essentially insulin resistant at that point. And so this speaks to exactly what you're saying about how everyone's different and you have to be really cognizant of whatever advice you're taking in around menopause that it's really applicable to you. So after that I actually I became a certified metabolic balance coach and I actually did my own program. I changed the method in which I ate, changed how I ate. So I went back to three meals a day, but I still had a fast of you know, between 12 and 14 hours overnight. I started to eat with protein first.

Sandy Kruse: 31:18

So the order I don't know what you think about this and I'd love to hear your opinion or if there's research I would start eating my meals with protein first and at least a couple bites of protein before I ate anything else. I didn't go keto or low carb or anything like that, but I had really high value I like to call it high value carbohydrates, much more on my plate. Not that I ate a ton of bread anyway and I lost a ton of percentage. I'm going to say I'm not going to give the exact percentage of body anyway and I lost a ton of percentage. I'm going to say I'm not going to give the exact percentage of body fat and I lowered my visceral fat during that time to be within a healthy range.

Sandy Kruse: 32:05

So my question to you is does the food order because you hear a lot of different opinions on this matter, on how you're going to eat your meal Like, if you start with protein, does that matter? Does that help with being almost like a buffer for whatever else is coming afterwards? Like, what are your thoughts on this? Because there are a lot of big names who talk about eating veggies first and then, like I would love to hear your take on this, because there are a lot of big names who talk about eating veggies first and then. You know, like I'm, I would love to hear your take on this.

Dr. Sarah Berry: 32:39

So I think there's two different aspects to this that we need to think about. There's what I call meal ordering, so the order in which you eat your meals over the day, and then there's food ordering the meal in which you eat your sorry, the order in which you eat your food within order, in which you eat your food within a meal. So we've done some research at zoe looking at meal ordering, where we randomly allocated in a clinical trial, people to different breakfasts, these kind of high carbohydrate breakfasts, um, and it was in a crossover design. So over a period of a couple of weeks every day they would have a different type of breakfast, but everyone had all of those breakfasts. But then at lunch they were all given exactly the same meal. So they had different breakfasts over the 14 days but they had exactly the same lunch on every single one of those 14 days. And what we saw was that what people were having for breakfast was partly shaping their post-translucent glucose response, so their post-transfer glucose response, so this post-meal sugar response to what they were having at lunch. So there were certain breakfasts that were causing people to have a higher blood glucose response to their lunch compared to other breakfasts, even though the lunch was the same. Now I don't know if you've heard of the post-meal sugar response. I don't know if you've heard of it was moderate. How that would impact over many, many years. Probably it wouldn't impact things that much. And this is where I think we need to be very, very cautious. We need to be really cautious about how we're eating our food and the impact it has in terms of the size effect. So let's now step while thinking about that. Let's think about the food ordering which is what you're talking about.

Dr. Sarah Berry: 34:16

So, yes, meal ordering has an impact. There isn't loads of research around the order in which we eat different foods or different nutrients within the food and how it impacts our health, how it impacts our metabolic responses. There's lots of anecdotal evidence and from very well-known people saying this is how I've done it and this is what's worked for me. That works for you great. If that's how you want to eat your food, great.

Dr. Sarah Berry: 34:41

I think what the evidence does show is that, yes, if you have protein and particular types of protein as a preload, so particular types of protein that we know increase insulin. So whey protein, for example, that we know increases the secretion of insulin and you have that as a preload, and there's quite a few studies that have done this, where it's given like as a preload, maybe 30 minutes before a meal or 15 minutes before a meal. What that means is that you've got an insulin response so that when you're then eating the carbohydrates, the insulin's already circulating the blood. Hey presto, it can quickly then dispose of that glucose. So it's lowering your postprandial glucose response. What we also know is that adding fiber, any type of protein and any type of fat to a meal, that delays your gastric emptying, so it delays the rate at which your stomach empties. So you will have glucose appearing, appearing sorry glucose appearing in your blood at a slower rate, and at a rate that then can be removed, so to say, more quickly by the insulin. So it's slowing down the rate.

Dr. Sarah Berry: 35:46

Now, whether, therefore, you should sit in a restaurant or sit at your dinner table and say, well, here's a lovely meal, there's some potatoes, there's some fish, there's some fish, there's some vegetables. I'm going to eat that fish, I'm going to wait five minutes, because that's my protein bit, then I'm going to eat the vegetables or potatoes, or whether, according to other people, I'm going to eat the fiber rich vegetables first and then I'm going to eat the others. Yes, I believe, based on what evidence there is, it is going to reduce your postprandial glucose response. I believe, though, it's only has a relatively small impact, and I think what we have to remember is what impact is eating that way had on you, for your pleasure of food? Because what worries me so much in the wellness world and the diet world is that we are often recommending or making changes that actually have a really small size effect just because a scientific study has showed it's significant. Does that really mean it's going to, over a long period of time, actually have that much of an impact? And also the variability in how these different bits of advice impact someone is huge. So someone on social media who does the fiber first, for example, or the protein first yeah, it might reduce their post-vendor glycemic response by 50%, but actually, on average, it's probably not going to do that, and probably for many people it will have almost minimal effect.

Dr. Sarah Berry: 37:20

So I'm a great believer in food being about joy, about being about pleasure, about being about our social connections, our culture, and so personally, I would never change the order in which I eat my food unless I liked eating a particular bit of food first. My kids sit down. They eat their vegetables last, but that's because they don't like vegetables and I tell them they have to eat that at the end. That's just the way that they naturally eat. When I eat my food, I just eat it in a random order. I don't even think about the order in which I eat it. My food, I just eat it in a random order. I don't even think about the order in which I eat it.

Dr. Sarah Berry: 38:00

But despite the evidence to show that, yes, it might impact it, I think it's going to have such a small impact compared to other things that I do, compared to the fact that I should have done that run that day, which I never do, the fact that I didn't go to bed at that time, the fact that I still had that glass of wine that I told myself I wouldn't have. They're going to have a huge impact and I should focus my efforts on those. I don't think I should focus my efforts personally on some of these micro things. However, having said that, for many people, it's micro habits that are easy for them to do, sustainable for them to do and therefore, in combination, if they do many of them, it might improve their health. So I'm very much sitting on the fence on that, but that's because of my own personal view of how I think we need to be careful in optimization that we don't just have fun. Have fun in life, have fun with food. It's a pleasure.

Sandy Kruse: 38:53

Yeah, you're talking to a girl who lost her thyroid at 41 and has done every single diet under the sun since then. So you know, I think there's a lot and that's a totally different conversation. But in this world of food and wellness there's a lot of what I call orthorexia, and I'm the first one to admit that I have had a lot of challenges around food because I kept trying and you also mentioned that I kept trying to chase this pre-thyroidectomy body that I had before. It's kind of like these menopausal women chasing their pre-menopausal bodies and it's like you know that whole thing about food and pleasure.

Sandy Kruse: 39:43

I come from a family where food is celebratory, but I also come from a family where you never leave anything on your plate. You see what I'm saying. So you know like I come from parents who were farmers old farmers in Croatia where food was scarce and you know there's scarcity in there. So there's a lot of topics surrounding that. But I do agree with you that food, you know it can be pleasurable and I think a lot of women around menopause have this fear around food and so you know, I know that you would know even about cortisol and how that can affect that weight gain, and if you're always stressed around what am I going to eat, what can I eat? And if it stresses you out to eat food in a specific order, well then is it giving you that benefit anyway.

Dr. Sarah Berry: 40:45

No, and I don't believe so. You know, I often finish all my academic talks by saying if a food or meal is too healthy to be enjoyed, it's just not healthy at all, and I think we really need to remember that when we're thinking about the choices that we make. But I think it's hard, because I think we all want to eat the best, to maintain how we might have been or what we might have been able to get away with 10, 20 years ago. When we become pre and post-menopausal, it's tough.

Sandy Kruse: 41:19

It is, it is. It's just like back in the olden days where you would sit in front of the TV and get your popcorn and watch a movie. You know, you never had to think about it and every once in a blue moon. My husband and I will still have those nights because I'm really trying just to be more present and, as you know, I was in Europe for 10 days. I didn't look at what order I was eating my food, I wasn't careful. I'm like I am going to be so present in this experience. But it's not about gorging. That's not what this was about. It was about just being present and enjoying the food that I was trying from different cultures. So I do have to ask you more about this insulin sensitivity we kind of touched on cholesterol insulin sensitivity. We kind of touched on cholesterol yep. So is it because our estrogen lowers that? We lose that sensitivity and we become more insulin resistant, it like. Why does this happen? Is it specifically estrogen related?

Dr. Sarah Berry: 42:30

so, again, I think it's multifactorial. Um, and I know as nutrition scientists we say this about most things, but it is because that's the reality. So, just like cholesterol, I think we've got the same thing going on. So, for example, you've got that increased visceral adiposity. We know that that certainly impacts our insulin sensitivity. You've got the effect that estrogen has on insulin, for example, on insulin release as well.

Dr. Sarah Berry: 42:58

And then what we've seen in our research and this was published about two years ago, it's very novel research is we saw that people had, yes, very different insulin sensitivity depending on whether they were peri or premenopausal. But what we saw was there was a difference in their postprandial glucose response. So we saw that postmenopausal women and I think I mentioned this earlier had a higher postprandial glucose response, so a higher blood sugar response after having carbohydrates in their food, compared to if they were premenopausal. And what was interesting is that we were able to look. Was this due to oestrogen, do we think, or was it just naturally part of aging? So, firstly, we looked at do we still see this when we adjust for lots of other factors, like BMI, like the background, diet, like age, et cetera, et cetera and we saw that it was still there, that, even when we adjust for these other factors, you still saw this difference in this post-meal glucose response.

Dr. Sarah Berry: 43:57

But it's very difficult to ever fully adjust for age, and so what we did is, because we had such a big group of women that we had been studying, we actually took what we call an age-matched cohort, so we took a subgroup of individuals and we matched them for age so that we could remove this confounder of age, the confounder of the fact that menopause is an age-related event, and what we found is there was still a significant difference in postprandial glycemic responses, so these post-meal sugar responses, depending on whether you're a pre-peri or post-menopausal, with the peri and post-menopausal having higher responses, even in an age-matched cohort, which suggests that, yes, it is a direct effect of oestrogen, related to insulin or related to the metabolism of glucose. And this is after we adjusted for factors like BMI as well. I don't know the exact mechanism, it's not something that we've looked into at the kind of molecular level, but I know that there's other people that have been looking into this.

Sandy Kruse: 45:00

Just curious with that research that you did was sleep in there, because that's the other factor, right, just like what you were saying. We all know that if we don't sleep well, we tend to eat poorly the next day. We tend to crave those, those carbohydrates that aren't really good for us. So was that accounted for other than just age?

Dr. Sarah Berry: 45:28

that's a very good question and I cannot remember.

Sandy Kruse: 45:31

I'm just curious because then it would be age pre post-menopausal sleep. Do you get what I mean? It would kind of have all those components. Would be interesting to see. Yes.

Dr. Sarah Berry: 45:45

I can't remember if we adjusted for sleep. We adjusted for lots of different variables, like how healthy the background diet was, like BMI, and we did see a difference, obviously, in sleep quality between the pre and post-menopausal. So yeah, it would be interesting to see how our results play out if we adjust for sleep and then if we don't take the sleep into account.

Sandy Kruse: 46:07

Yeah, yeah it would be interesting.

Dr. Sarah Berry: 46:08

You might have done that.

Sandy Kruse: 46:09

I can't remember everything that we've published that I can't remember everything that we've published. Okay, so let's move on to symptoms, because symptoms are big and I know that there are plenty of herbals and things like that that women can take to help with symptoms. What about food?

Dr. Sarah Berry: 46:31

So we've just recently completed a huge study this is in 70 000 women, where we ask them questions about their symptoms and we ask them what symptoms they had and we ask them to grade them on a scale of zero to five into how much they impact their quality of life.

Dr. Sarah Berry: 46:47

From this we generated a score using something that we call our meno scale calculator, and this is a calculator that's available for anyone.

Dr. Sarah Berry: 46:50

And what this calculator does it generates a score using something that we call our Menoscale calculator, and this is a calculator that's available for anyone. And what this calculator does it generates a score out of a hundred. So you've got and this is based on what we know from published research and our own research of the 20 most common symptoms. Now I know that there's 50 or more known symptoms, but you know we have to stop somewhere in research. So we selected the 20 most prevalent symptoms and then we asked people, on a scale of zero to five, how much of an impact does having a quality of life, and you return a score out of 100. This meno scale is available for anyone to complete. It uses modern language, because lots of the other menopause symptom questionnaires use old-fashioned language like how excitable are you, which personally makes me want to throttle the person that generated that. They're typically generated 50 years ago, by men as well, who have no idea of what these women were going through. So we're using modern language, accessible language, it's free for anyone to go on. You can go to zoecom, uh forward slash meno scale and anyone can fill it out. If you fill it out, then you get returned a score. You get told how you compared to someone your similar age on hrt or not on hrt, what your top symptoms are and how they compare. So we've got all of this data. We've got people's meno, so their average score related to the impact that the symptoms have on them.

Dr. Sarah Berry: 48:17

And then we've also got for these 20 different symptoms and what we see first is that symptoms are really prevalent. We see that the kind of symptoms that we used to think were the main symptoms, like hot flushes, are actually the least prevalent. The most common symptoms are the things like the sleep disturbances, the brain fog, the anxiety, the low libido, the weight gain, the slowed metabolism, low mood, irritability, etc. What we see as well in this cohort of 70,000 people is that people have more symptoms as their BMI goes up. So people living with obesity have an increased risk or an increased chance of having symptoms and having them more severely as their body weight goes up. Now, this is a problem because, if we go back to what we were talking about 15 minutes ago, it's really difficult to maintain your body weight and you're going through the menopause. This becomes really problematic.

Dr. Sarah Berry: 49:13

What we also see on a more positive note, is that people have a reduced likelihood of having symptoms if they have a healthy diet. If they have an overall healthy diet and I don't mean by this you know very specific foods, but I mean overall if their dietary pattern is more healthy, they have a reduction in symptoms. Now, this data was collected at one point in time. It's what we call cross-sectional data. So what we did is we then looked at does the symptoms that people are experiencing change if they go from an unhealthy diet to a healthy diet? And what we see is, if we follow people up over a period of time, as people change from an unhealthy diet to a healthy diet and these are people following our ZOE program, which is this personalized nutrition program we see that they experience a reduction of around 35% in their menopause symptoms. Now, that's huge. Now, this isn't a randomized clinical trial. There isn't a control arm, so obviously we have to be slightly cautious with how we interpret this in terms of the causality. But what we are seeing is, in those who follow our ZOE program, who improve their diet, there's a 35% reduction in symptoms. We know from other published research people following a Mediterranean diet also experience a reduction symptoms, so it's not that we're just sticking out. What's interesting as well is we looked at these individuals according to whether they were on hormone therapy or not on hormone therapy. Those that were on hormone therapy obviously have a lower starting point in terms of their symptom burden, but what we see is they still benefit from improving their diet. They still get a 35% reduction in symptoms.

Dr. Sarah Berry: 51:02

And I think this is really really important that HRT alone is not the only answer. You can use diet with or without HRT to have a significant impact on your symptoms. Now, this is going to vary person to person and I know we talked about this earlier in our discussion. Some people will respond really well, some people will respond less well, and it's about finding what works for you, and this is what I love about our Menos scale that we've generated. People can use that to track how their symptoms change. So if they're starting on HRT, if that's their choice, they can see. Well, let's track each week how my symptoms are changing. Is it working? If they're embarking on a diet or a lifestyle change, they can use the Menoscale again to try to see. Does this work for me? Does it improve my symptoms in a slightly more objective way than necessarily kind of trying to remember, or do I feel a bit better this week?

Sandy Kruse: 51:46

Oh, I love that. Now people who are listening are probably going to say well, what is a healthy diet? I know you mentioned Mediterranean. I typically follow a Mediterranean diet. I would say, for the most part I am a big personally. This is me now. I believe in the 80-20 rule, I believe in a balanced diet, but for the most part whole, real foods. So what is classified as a healthy diet?

Dr. Sarah Berry: 52:26

So a healthy diet means different things for different people, and I think a healthy diet also varies depending on where you are right now. So for the average American, average British person, who consumes 50 to 60% of their energy from ultra processed food, a healthy diet might just be reducing that ultra processed food by 10%, just increasing an extra few vegetables, et cetera. So I do think we need to bear that in mind. But when I talk about a healthy diet, and when I talk about a healthy diet in relation to these results, it's a diet that is very high in fiber. It's a diet that's high in plant-based whole foods, like you mentioned. So these could be fruits, vegetables, pulses, for example, whole grain. It's a diet that is low in these heavily processed, unhealthy foods, so low in refined carbohydrates ie, white bread, white rice, for example. Low in ultra-processed meats. So you know your salamis, your hams, those sorts of things. It's a diet that's diverse salamis, your hams, those sorts of things. It's a diet that's diverse and this is really important because we know on average, a food contains about 72 000 different chemicals. We want to get a diversity of chemicals and so we often talk about having 30 different plants a week to get that diversity doesn't have to be 30, but making sure you're eating a diverse uh, you know array of different fruits, different vegetables, different plant-based foods, and trying to eat the rainbow. So food, uh, plant-based foods, often pigmented, like red peppers, beetroots, these sorts of things. The pigments can come from polyphenols, come from these magical bioactives that we know improve health. So making sure you're also getting a diversity of colors in your diet. And then there's some evidence as well, when it comes specifically to menopause, that soy isoflavones might improve your health. Now, this isn't specific advice that we give in our ZOE program, what I've just mentioned before. That is advice that we give that we see improves people's health.

Dr. Sarah Berry: 54:35

But I do think it's worth mentioning, related to diet, that I'm very, very skeptical about different supplements. There's a term we use in the UK called menowashing. Stick the word, you know the term menow in front of it and you can charge 10 times as much. There's so many supplements out there that are being sold to women at very expensive prices to say this will cure your menopause, this will solve your menopause symptoms. There's really, really inconsistent evidence. Now what I would say is, if it works for you, great, because again, it's going back to that. We all respond differently. If you find a supplement that works for you, I think that's fantastic. Respond differently. If you find a supplement that works for you, I think that's fantastic.

Dr. Sarah Berry: 55:19

But what we do know is that the only supplement that I believe there's sufficient evidence to show that it works is soy isoflavones, and these are a kind of phytoestrogen and these are a chemical that mimic the estrogen molecular structure and they bind to our estrogen receptors. So we know that countries where soy isoflavones are consumed regularly to a high amount like China, japan they have lower menopause symptom burden. We know that if you supplement people at a certain level with soy isoflavones, then they will have, on average, an improvement in symptoms if it's a certain level. But we know that there's huge variability. And we know there's huge variability because what we also know is that your gut microbiome impacts how you metabolize soy isoflavones. So some people have a gut microbiome such that they get a huge benefit from soy isoflavones and other people have a gut microbiome such that they might only get a small benefit. So it takes us back to that point earlier of again. You might see a huge benefit from taking soy isoflavones.

Sandy Kruse: 56:20

You might recommend that to your friend and they might say oh, it's just not doing hardly anything that's because we always want so differently and for a whole array of different reasons okay, um, I know, okay, I know that we're coming close to the end of the recording, but I can't not ask you about this topic and maybe you'll answer this, maybe you won't, but what are the top three issues women need to consider at menopause and how can we really use? We touched on so many different things. I just want something that someone can take away from this podcast and say, okay, I'm going to stop here. I want to address these top three issues and we can eat the way that we've been talking about. Go check out Zoe, which I would like you to summarize what that's about as well. But what are top three issues Like? Is it heart health? Is it brain health? Like what are the top three menopausal issues that women just need to think about?

Dr. Sarah Berry: 57:35

Really difficult. I think we need to be mindful of our heart health, because our cardiovascular disease risk goes up. I think we need to be mindful of our bone health, because we know that estrogen impacts our bone health. And I think we need to be mindful of our brain health as well, because of how it impacts our cognition, but also how our brain ages due to changes in estrogen. And I think what's common to all of those three issues are the four pillars of health, and I know that many know these are important. But I think it's really stepping back and thinking about these four pillars of health and can you change any of them?

Dr. Sarah Berry: 58:18

Physical activity, weight-bearing exercises, in particular for bone health. Physical activity for heart health. Physical activity for brain health, reducing stress it's hard. Perimenopause and postmenopause is a time where women experience much stress. Often they're still got teenage kids, they're still working full-time, they might be caring for elderly parents. It's hard to minimize stress, but being mindful of the stress, I think, is important. The third pillar of health is sleep, which we've touched on. Anything that we can do for good sleep hygiene to help our sleep in any way that we can is going to help. And then the fourth one is diet that we've talked about, and those four pillars of health will impact all of those issues our brain health, our heart health and our bone health.

Sandy Kruse: 59:06

I love that. Now tell us a little bit about Zoe a little bit about Zoe.

Dr. Sarah Berry: 59:19

So Zoe is a science and nutrition company and Zoe is building on seven years of amazing science that we've been doing and the hundreds of years before that that scientists all over the world have been doing in nutrition science to enable people to make the smartest food choices for them. So it started out on the basis of investigating how much variability there is between individuals in how they respond to food and seeing that there's a huge difference in how one person responds compared to another person. And then we've been conducting lots and lots of trials looking at, well, what explains this variability? Why does someone respond like that versus someone respond a different way? And can we use vast amounts of data to predict how people respond to deliver the best advice? And so we deliver advice that's personalized to an individual's biology.

Dr. Sarah Berry: 1:00:08

So we look at people's biology, so we look at their microbiome. We look at their blood health, so we look at various chemicals circulating in their blood. We look at people's biology, so we look at their microbiome. We look at their blood health, so we look at various chemicals circulating in their blood. We look at their glucose responses, etc. We ask people about their health history and so many other factors.

Dr. Sarah Berry: 1:00:23

We look at how people live their lives.

Dr. Sarah Berry: 1:00:24

We look at how people make the dietary choices they make, why they make the dietary choices they make, what their preferences are, and people undergo a two-week test period where we test lots of different things.

Dr. Sarah Berry: 1:00:35

So they're wearing different wearable devices, they're monitoring their glucose, their blood fats, their microbiome and then, using this years and years of science and these hundreds of thousands of data points that we've collected, we feed back to people after they've done this two-week test phase how they should eat best for them.

Dr. Sarah Berry: 1:00:53

That fits in with the way they live their lives. So it's an app-based product after they've done the test phase and enables people to look for every food whether that's the best food for them. It enables people to monitor the food they're having. It enables people to track their progress, to see whether they're having a healthy diet for them as an individual and overall, and people can sign up to do this for 12 weeks or six months or 12 months, and it's following. This ZOE program that people have signed up for is where we see these big improvements in menopause symptoms. We've also published a randomized controlled trial in Nature Medicine a few months ago where we compared health outcomes cardiovascular health outcomes on those who were following the ZOE program versus those following standard US dietary recommendations, and we found that those following the ZOE program had significant improvements in cardiovascular related health outcomes, as well as body composition so well weight and waist circumference.

Sandy Kruse: 1:01:53

And it's available in the US. It is Okay. So what is the website? Just zoecom.

Dr. Sarah Berry: 1:02:01

Go to zoecom and you can find out about the science we're doing. You can find out about the commercial product that we offer. You can find out also about our mena scale and all of our other research that we've got going on.

Sandy Kruse: 1:02:15

That's amazing, and I know that they're on Instagram, as are you as well, dr Sarah Barry, so I will have all this information in the show notes and I just want to thank you so much for the wonderful conversation.

Dr. Sarah Berry: 1:02:29

Our pleasure. It's been lovely chatting to you. It's just been like sitting having a chat over a cup of coffee. I don't have my cup of coffee with me.

Sandy Kruse: 1:02:37

Not at this time, right, not at this time?

Dr. Sarah Berry: 1:02:42

Yes, not at this time. It's half five here in the.

Sandy Kruse: 1:02:43

UK. I hope you enjoyed this episode. Be sure to share it with someone you know might benefit. Share it with someone you know might benefit, and always remember when you rate, review, subscribe, you help to support my content and help me to keep going and bringing these conversations to you each and every week. Join me next week for a new topic, new guest, new exciting conversations to help you live your best life.