Dhru Purohit Show
Why Women Struggle with Insomnia, Weight Gain, and Debilitating Symptoms During Perimenopause and Menopause and What to Do About It with Dr. Sarah Berry
Wed, 06 Nov 2024
This episode is brought to you by Bioptimizers, Bon Charge, and Lumebox. We know that perimenopause brings a host of symptoms for women entering this stage of life. These symptoms can disrupt sleep, affect mental health, and cause weight gain, often leading to a decreased quality of life. Today’s guest shares insights from her nutritional research to help women reduce these symptoms' impact and feel empowered through this transition. Today on The Dhru Purohit Show, Dhru sits down with Dr. Sarah Berry to discuss a recent study led by her team on the impact of diet in reducing common symptoms for perimenopausal and postmenopausal women. Dr. Berry shares the most commonly reported symptoms and the lifestyle factors contributing to them. She also explains the research behind why muscle mass serves as a protective barrier during this stage of life and discusses the role of blood sugar and a healthy gut microbiome in managing symptoms. Dr. Sarah Berry is a Professor at King’s College London and has run more than 35 human nutrition studies. Notably, she is the Chief Scientist at ZOE, the science and nutrition company. She’s the lead nutritional scientist for the ZOE PREDICT study — the world’s largest in-depth nutritional research program and leads research across menopause, microbiome, and sleep. She's often featured as a guest on ZOE's own podcast, ZOE Science and Nutrition. In this episode, Dhru and Dr. Berry dive into: Weight gain and slow metabolism are the top concerns in perimenopause (1:00) BMI the correlation between more severe symptoms (6:00) Dr. Berry’s study (12:26) The worst drivers of symptoms in women (17:09) What is a MenoScale (24:49) Muscle mass as a protective measure (30:07) Why do blood sugar and insulin sensitivity matter (34:12) Breakfast that can cause huge dips in blood sugar (38:37) How does gut microbiome change as we age (42:00) Doubling down on the basics (56:32) Being cautious about supplementation (01:05:22) Also mentioned in this episode: Zoe Nutrition Study For more on Dr. Sarah Berry, follow her on Instagram, Twitter, YouTube, or her Website. This episode is brought to you by Bioptimizers, Bon Charge, and Lumebox. BIOptimizers Black Friday sale on all their products lasts all November long. Just go to bioptimizers.com/dhru and use code DHRU to get your discount and $100 worth of free gifts today! Right now, BON CHARGE is offering my community 15% off; just go to boncharge.com/DHRU and use coupon code DHRU to save 15%. Starting November 8th, Lumebox is having their biggest sale of the year and is offering my community 50% off their FDA-registered portable Red Light device! Just go to thelumebox.com/dhru to get your device today! Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapter 1: What are the common symptoms of perimenopause?
Dr. Sarah Barry, welcome to the podcast. But I want to start off with something that I know is at the top of the minds of so many of our audience members, women, of course, in particular. And it's something that you guys noted inside of your study. So this is jumping ahead a little bit, but we're going to be zooming in and zooming out.
In your study, you reported that 66% of perimenopausal women reported experiencing more than 12 symptoms, 12 symptoms. And inside of that, the most bothersome symptom reported was weight gain and slowed metabolism 31 of the participants reported having that i know for my audience that this is one of the top concerns as many of them are going through this stage and period in life.
What are the top root drivers that are causing so many women to experience this symptom in particular of a change in metabolism?
Estrogen. Estrogen loss, estrogen decline, estrogen fluctuations. But not estrogen only affecting our body weight and our metabolism, but affecting so many other areas that then interlink with this. You know, our metabolism, our body weight isn't just about how we metabolize food or what we're eating. It's so multifactorial and it's so interrelated to the other pillars of health.
Chapter 2: How does estrogen affect weight gain during menopause?
So our stress, our sleep, our physical activity, as well as what we eat. And we know that menopause impacts all of that. So we can deep dive a little bit into why. One thing just to pick up on, Drew, is actually it was over 80% of our women said that they were experiencing weight gain or slowed metabolism. Wow. That is huge.
And when we think about perimenopause, often people think about hot flashes, hot flushes, night sweats. That's the least common symptom. So as you said, one of our most common symptom was this weight gain and slowed metabolism. So there's different things going on here. We need to step back and firstly think, well, what is the role of oestrogen in our body?
The role of oestrogen is to impact a whole wide range of different processes, different physiological processes, different neurological processes in our body. We actually have oestrogen receptors over nearly every single cell in our body nearly. So oestrogen impacts so many different processes in our body.
And this is why when you go through the menopause transition, which involves the loss of oestrogen, then you have such wide reaching impacts across your body. One of the things that oestrogen does, it has quite an important role in how and where we deposit fat. So where we deposit adipose tissue cells, these are fat tissue cells.
And really simply put, what happens is, is when you've got a good amount of oestrogen, so your premenopausal, the oestrogen kind of directs the fat around your hips. So we typically say, premenopause women have this pear shape look. So they have their fat around their bottom and their hips.
Now, as your oestrogen declines during the peri and postmenopause, you've no longer got that kind of protective effect of oestrogen driving the fat to sit there. It's then repositioned around your belly. What we know is that a fat around the belly, which we call visceral fat, and we call it visceral adiposity, if you have too much fat around the belly,
We know that that's associated with really unfavorable metabolic effects. It's involved with inflammation. It's involved in insulin resistance, et cetera. It's metabolically very active, but in a quite harmful way.
And we actually know that postmenopausal and perimenopausal women are five times more likely to have that central visceral adiposity, so that fat around the belly compared to premenopausal women. So that's one thing that's happening. But what we also know is in addition to that, oestrogen's impacting lots of other areas. It's impacting our brain.
So it's impacting our perception of hunger and fullness. And there's some evidence now emerging that actually food that would have kept us full when we were premenopausal
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Chapter 3: What findings did Dr. Berry's study reveal about menopause symptoms?
living with obesity or living with being overweight is making your symptoms worse those symptoms for most people are then going to make it harder for people to lose weight and so i do think there has to be an element of being kind to ourselves as well as peri and postmenopausal women that look it is harder it is tougher it is a perfect storm the odds are stacked against you but having said that
there is still hope. There are still things we can do about it.
Yeah. And we're going to get into some of those things that you had the study participants do and the improvements that they saw in the symptoms that they were facing. But let's start off a little bit big picture. We kind of talked about it. You talked about it a little bit. So just explain high level this study. Who was a part of it? You mentioned it was 70,000 people.
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Chapter 4: What is the Menno Scale and how does it work?
And then there was another signature of species, so another group of species that were associated with worse levels of health, i.e. higher inflammation, higher blood pressure. And what we found is those species that were associated with favourable measures of health were also associated with favourable measures of diet.
And those conversely associated with unfavourable measures of health were associated with a poor diet. Now, this is association data. It's not showing causality. It doesn't show, okay, can you modify the microbiome through diet to change your health outcomes? This is where we're focusing our attention now.
And this is where many other researchers are focusing their attention, kind of trying to piece together that chain that you have. And I think that there's good evidence emerging now that if you can use diet to change the microbiome, that that will have knock-on effects in changing health.
And we certainly know from our own ZOE research as well, that by delivering personalized advice to individuals based on their microbiome of what dietary changes they should make to improve their microbiome, we see these changes coming out in their microbiome. So we know that we can deliver targeted dietary advice that will modify their microbiome.
Now, whether that is directly impacting their health is the next part of the chain that we need to show. But what we know from a study published this year, again, in Nature Medicine, it's from a randomized control trial that we ran where we randomly allocated people to either follow the ZOE programs, the personalized nutrition program, or follow the US dietary guidelines.
We found those following the personalized program that's very much focused around changing the microbiome that that resulted a change in microbiome composition and it did result also in a change in many health outcomes as well. Now, how it relates to menopause and aging, again, is something that not many people are looking at.
There has been some research that's shown that postmenopausal women have a microbiome composition that's quite similar to an average male and that premenopausal women have a microbiome composition that's different to the average male and different to a postmenopausal woman. We also looked at this in our ZOE predictor research and we found something similar.
We found that peri- and postmenopausal women have a different microbiome composition to premenopausal women. And what we saw was that there were some specific species that were increased in postmenopausal women.
And these species were the ones that we'd identified with our previous research as part of this kind of microbiome signature that we developed to be the ones associated with higher inflammation, higher blood pressure, higher cholesterol, etc., So they seem to have these species that I'm very loosely going to call bad bugs. Any microbiologist would probably hate me using that term.
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Chapter 5: Why is preserving muscle mass important during menopause?
I think that unless a woman is going through it, or is being very conscious in trying to teach themselves about it, then I don't think that it's easy to really understand what an individual experience is. So whether it's your physician or whether it's your husband, your partner, your friends, I think there needs to be a greater understanding of just how much it does impact women.
In terms of hormone replacement therapy, I'm not a medical doctor. I'm a research doctor. So it's really important I caveat that I can tell you what I believe based on the evidence that's out there. And I believe that the evidence for hormone replacement therapy, if delivered
transdermally, so using like the gel or patches, if given at least within 10 years or even five years of people becoming menopausal, but preferably starting at the first stages of perimenopause, that there are benefits in terms of symptoms. We know that. That's, I think, irrefutable. Everyone differs in terms of how effective the hormone replacement therapy is. Some people have huge benefits.
Some people don't have a huge benefit. but on average, people will benefit. What we see from our data, and I think there's a growing body of evidence around this, but it's not conclusive yet. What we see in our data is if individuals are taking HRT, they do have lower risk of these intermediary risk factors. They have
In our data, lower blood pressure, lower visceral adiposity, lower bad cholesterol, the LDL cholesterol, lower inflammation, better insulin sensitivity. These are all risk factors for chronic disease.
We cannot say conclusively yet whether taking HRT will reduce our risk of heart disease, type 2 diabetes, et cetera, because we haven't been studying it long enough in the way that it should be delivered. In the past, hormone replacement therapy was given orally as a tablet, which we know is metabolized very differently to how transdermally, so with the patches or the gel, it's metabolized.
We know if it's given orally, for many women, it might not have the same favorable effects in terms of these intermediary risk factors because of how it's metabolized by the liver. In the UK, I don't know what it's like in the US. HRT is given transdermally now. It's not given orally because we know that it can have an unfavorable effect if it's given orally.
And so based on what evidence there is for transdermal, so the application to the skin HRT, I would say that there are discussions that every practitioner should have with a perimenopausal or postmenopausal women.
as long as it's within 10 years of them becoming postmenopausal, about how it's going to improve their symptoms and about how it may impact some of these other cardiovascular risk factors. It's not licensed in the UK for prevention of cardiovascular disease. So I'm saying this with a note of caution and just telling you based on the results that we received.
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Chapter 6: How do blood sugar and insulin sensitivity impact menopause symptoms?
So if you metabolize the soy isoflavones to Equal and you're supplemented with soy isoflavones, you have a 75% greater reduction in symptoms than if you're not an Equal producer. And the reason I want to mention that Drew is because that takes me back to my point a few minutes ago that everyone will respond differently. So for example,
If I went and started taking soy isoflavones and I'm not an equal producer, but my best friend started taking soy isoflavones and she had the gut microbiome species that enable her to produce equal, she is going to see a huge benefit. I'm not going to see such a big benefit. But that means that I shouldn't be advising her not to take it just because it doesn't work for me.
So it's just giving that kind of, yes, let's be really cautious about menna washing. Yes, there's good evidence for soy isoflavones, but still there is this huge variability. What works for one person might not work for another person.
Give whatever you want to try, but be careful not to compromise on other areas of your life if you're kind of burning massive holes in your pocket with the money that you're spending on them.
That's a great reminder and a great breakdown. So just to make sure that I understand that correctly, there's a lot of supplements that would have evidence base for being helpful for various sorts of things. Like let's take, for instance, fish oil supplements and some of the evidence.
What you're specifically talking about, though, is when people make claims or companies make claims that this particular supplement is going to be helping symptoms of menopause. That's where people should be
extremely skeptical and really ask for the data or you a top nutrition scientist are saying you're not aware of any other supplements that are out there besides these soy isoflavones so that they should be just super cautious because they might be being taken advantage of is that what i'm hearing
Absolutely. And you know what, there's hundreds of studies, actually, randomized controlled trials looking at different supplements. Some show that there is a benefit from this particular supplement. Some show there isn't a benefit.
The weight of the evidence, apart from soy isoflavones, I think shows specifically for menopause symptoms, there is no strong evidence to show any particular supplement exists. is really beneficial. And whilst you're absolutely right, there will be benefits to many of these supplements for other areas of people's life, like fish oil.
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