In Episode 20 of The Holistic Nutritionists Podcast, Natalie Douglas and Kate Callaghan discuss how to manage menopause symptoms, and navigating the perimenopause to menopause transition phase in your hormonal development.

• What is perimenopause and menopause
• Hormonal changes that happen
• Consequences of these changes
• Boosting progesterone to relieve symptoms 
• Supplements and bioidentical progesterone
• “Estrogen dominance” or imbalance
• How to keep estrogen on your side
• Food, supplement, lifestyle and exercise recommendations for balancing hormones

• Liver detox articles by Nat: here, here and here.

Natalie K. Douglas 0:01
Hello and welcome to The Holistic Nutritionists Podcast. My name is Natalie Bourke, Holistic Dietitian and Nutritionist from HealthByWholeFoods.com.au and with me as always, I have Kate Callaghan, the Holistic Nutritionist from TheHolisticNutritionist.com. Kate, how are you going?

Kate Callaghan 0:18
I’m Excellent. Thanks, Nat. How are you?

Natalie K. Douglas 0:20
I’m pretty good. I’m cooking some lamb shanks and they smell mighty fine.

Kate Callaghan
Oh, I’m cooking beef shin in the slow cooker.

Natalie K. Douglas
You know what I had for the first time I know it’s lamb breast. For the first time. I had oxtail. Oh my God.

Kate Callaghan
The first time?

Natalie K. Douglas
I know. I know. I know.

Kate Callaghan
Oh my god.

Natalie K. Douglas
I understand that it’s weird.

Kate Callaghan
But what recipe did you use?

Natalie K. Douglas
Oh, none. I just chucked stuff in the slow cooker.

Kate Callaghan 0:46
Okay, all right. You need to Google Jamie Oliver’s insanely good oxtail stew.

Natalie K. Douglas
Okay, I’ll do it. I’m gonna Google it after this.

Kate Callaghan
It is actually insanely good.

Natalie K. Douglas 0:54
Oh, it was just like, Oh my gosh, like, I don’t think that I’ve liked anything so much in my life. That’s not true. But it was so delicious. Anyway, so it’s my new favorite cut of meat, oxtail.

Kate Callaghan 1:08
And it’s so good for you.

Natalie K. Douglas 1:09
I know. It’s like, Oh, so delicious. And it smells so good. Probably because of the spices but still.

Kate Callaghan 1:17
Yeah, you need to look up Jamie Oliver’s recipe.

Natalie K. Douglas 1:19
All right, I’m going to do that but you know, what I’m going to do first? I’m going to read our disclaimer for today.

Kate Callaghan
Cool.

Natalie K. Douglas
So the advice given in this podcast is not intended to provide medical advice or to take the place of medical advice or treatment from your primary healthcare physician. The facts and information covered are based on a combination of scientific evidence, clinical practice experience, and personal experience. So today, Kate, we are actually going to answer a question that was written into us about a week or so ago. So it’s kind of surrounding perimenopause and menopause. So we will obviously expand beyond just the, what’s being asked in the question so that a lot more people than just that person can benefit. But yeah, so did you want to first maybe read out the question and explain a bit about what perimenopause and menopause is for anyone who is not aware?

Kate Callaghan 2:17
Sure. Okay. So the question. Can we say it’s from a fan? Do we have a fan now?

Natalie K. Douglas 2:23
Oh, we do. I bet they have pompoms.

Kate Callaghan 2:28
I don’t think she does.

Natalie K. Douglas
No, I think so, either. I have pompoms for you though.

Kate Callaghan
Okay, she said, I would like to know your thoughts on diet and lifestyle in the early stages of menopause. I’m 49 years old this year, always lived a very active lifestyle, have had the odd eating disorders. Now can’t be bothered not trying to eat but the weight is stacking on. I do high-intensity training and would love to listen to your thoughts about this. Okay.

Natalie K. Douglas 2:57
Excellent.

Kate Callaghan 3:00
So, perimenopause. So perimenopause is prior to menopause and usually it’s defined as kind of the, the 10 years before going through menopause. And menopause is really when, they defined as over one year without a period. So perimenopause can start to kind of around early 40s. Some people it can start in the late 30s. Some people can start even earlier and it really can go for, for quite a long time. Or it can go for a short amount of time. I think the average time is around four years, but yeah can go up to 10 years. And this is really a period of time where your hormones are wildly fluctuating, going on a bit of a hormonal roller coaster, which is why you’ll often see those, the symptoms that are associated with perimenopause such as heavy periods and hot flashes, breast tenderness, worsening of PMS, low sex drive, headaches, migraines, fatigue, increased depression or just not feeling yourself, irregular periods, brain fog, not able to think straight, vaginal dryness, mood swings, and trouble sleeping. So it sounds really delightful. Doesn’t it?

Natalie K. Douglas 4:17
Yeah, I can’t wait.

Kate Callaghan 4:18
Yeah. And you know, I, we’re going to talk about how to manage it as you go through it. But I think the best way to set yourself up for smooth sailing perimenopause and menopause was best as possible is to get on track with your health and your lifestyle behaviors now, as early as you can, if you’re in your 20s, you should start getting on to it then. Really.

Natalie K. Douglas 4:42
I agree, and not kind of think, Oh, I’m young, I don’t have those problems yet because you you’re still right in that. What we’re doing now is absolutely going to affect how we feel going through that rocky periods later on.

Kate Callaghan 4:57
Yeah, yeah, definitely and again looking at things is more of prevention rather than cure.

Natalie K. Douglas 5:04
Yeah, definitely.

Kate Callaghan 5:05
Yeah. So during perimenopause, the things that are causing these symptoms are the fluctuations in the hormone levels. And so when you go into actual menopause, that’s when your estrogen levels essentially will decrease a lot, so your ovaries are essentially shutting up sharp in menopause. And our ovaries are responsible for producing a lot of our estrogen for encouraging, well, getting our bodies to ovulate and when we ovulate, we produce progesterone. So when we go into menopause, both of these hormones go down a lot but in perimenopause, there is more of an imbalance with these sex hormones. So progesterone will decrease because your ability to ovulate during perimenopause decreases. So an ovulation is the best way to produce progesterone. So you’re going to be decreasing progesterone that way. Simultaneously, you’re going to get a bit of an increase in estrogen, and all relative increase to progesterone. So some people might refer to this as estrogen dominance, it’s just more of an imbalance of estrogen and again, that can contribute to these rocky symptoms. And when we go into menopause, our adrenal glands then can take over our production of estrogen and progesterone, which will come into what we’re going to talk about soon in terms of treatment or management of these menopausal symptoms.

Natalie K. Douglas 6:41
Yeah, so that raises I guess, a couple of questions already when just thinking about treatment there. So obviously, with a decrease in progesterone going through perimenopause, there are things that we can do to still promote progesterone and ovulation of what we, of the ability we have left to do that we can still promote that. And as obviously, the topic of progesterone, natural progesterone replacement, which, obviously, we’re not prescribing, but we’re happy to give a bit of, or an opinion on, I’m happy to share my opinion on that. And then as you mentioned, Kate, going, like realizing that estrogen can become, I guess dominant in, in this period and looking at ways. Well, if that’s the case, how can we best mitigate that? How can we promote removal of that from our body as quick as possible? So I think they’re to really, I guess, first strategies that you can go into and, and look at. So just on the progesterone front, I was going to suggest things like magnesium would be really beneficial, B6, zinc, as well as managing stress. Kate, is there anything else that you commonly recommend when you’re trying to boost progesterone in someone?

Kate Callaghan 8:13
Yes. So one of my favorites, and it’s really, really easy is vitamin C. So vitamin C has been shown by the research to help boost our progesterone levels and help with things like luteal phase defect, which is often contributed to by low progesterone levels. And it just means your luteal phase isn’t long enough to sustain a healthy pregnancy and vitamin C, generally in the range of one to two grams per day, it can be beneficial in increasing progesterone levels. I think partly the reason is, it support of the adrenal glands. And as you said, Nat, stress management and anything you can do to support your adrenal glands, production of progesterone, but also decreasing those stress hormones, which are going to signal to your brain to stay in that fight or flight, not, not ovulate perhaps is going to be beneficial. So anything you can do to reduce stress is going to be beneficial, not just for improving progesterone levels, but for improving overall management of perimenopause, menopause, pretty much any health condition in the world.

Natalie K. Douglas 9:21
Yeah. No, I agree. And look, you know, working in the area of quote unquote, adrenal fatigue, or HPA axis dysregulation, or just people being burnt out, those, those exact nutrients are what would be recommended, so that just kind of reaffirms the point of, you need to support the adrenals, to support progesterone, and, you know, all these nutrients are doing multiple things in your body, so they are good ones to start with. Now looking at natural progesterone replacement, I know that there is plenty of research around the safety of natural bioidentical progesterone, and that is an option for some people. However, it’s not to be confused with synthetic progestins, or the pill, or standard HRT, because they are completely different things and they’re going to do completely different things in your body. So that’s something that I think is important to make people are aware of, especially if they’re going to their doctors, and they’re discussing this kind of approach with their practitioner, it as I said, natural progesterone replacement can be beneficial if all else fails. And you know, you’re doing it under the guidance of the practitioner, that’s dosing it right and monitoring you. But it is important to differentiate between those two. Kate, do you have any thoughts around that, whether they’re different or the same?

Kate Callaghan 10:52
In terms of the progesterone as in the synthetic?

Natalie K. Douglas 10:55
So, just the use of natural progesterone, if someone chooses to go down that, go down that path.

Kate Callaghan 11:00
I think it can be completely a viable option. I would try the other paths first.

Natalie K. Douglas
Yeah. Definitely.

Kate Callaghan
But if you want to get on that path, and you have a practitioner that is willing to help you on that path, definitely do. So I probably wouldn’t advise doing it yourself always be monitoring these situations and get your hormones tested and just be smart about it.

Natalie K. Douglas 11:25
Yeah. Now let’s address a bit of the estrogen dominance quite the type situation. So as you mentioned before, that can happen and often does happen and is causing a lot of symptoms in these people going through perimenopause. So, from, from that point of view, what would be a few of your recommendations to address estrogen dominance?

Kate Callaghan 11:51
Yeah, so, we don’t want to get rid of estrogen, with estrogen, is a lovely, lovely hormone but we want to help support our body in its detoxification of it. So we make estrogen, we use estrogen throughout our body, and then we want to get rid of any estrogenic byproducts via liver detoxification, and then via the gut. So in order to support this, we need to support overall detoxification and, and we can talk a little bit about it. But I would recommend people go back to our podcast on detoxification, and both of us have posts on our blogs that go into detail about how to detox effectively. And no, it is not a juice cleanse.

Natalie K. Douglas 12:34
Oh, my God, what? I can’t just drink green cucumbers and the detox.

Kate Callaghan 12:40
Oh, I was listening to a podcast the other day, actually, that said, the most important nutrient or one thing that they would recommend for supporting your liver in detoxification is lemons. And I love lemons, and it’s so much more than that. This was, this was like a health educator or something. The people listen to and so it was quite concerning and I wanted to actually throw my phone. Love lemon, and don’t get me wrong, have all the lemons that you want. But don’t expect lemons to do what you need your body to do on a daily basis in terms of detoxification. So go back and have a look at that post. Basically, it comes down to eating real food, whole food diet, all day, every day, not skimping on foods, especially not skimping on proteins our body needs proteins, our liver needs proteins for packaging up the toxins. So when we detox, when we fast, when we, we push these toxins out of our fat stores, and into our bloodstream, and if we don’t have the appropriate materials in terms of proteins, and vitamins, and minerals too, then package up these toxins to get rid of them, they can actually do more harm than they would have done, initially stored in your fat.

Natalie K. Douglas 13:59
Yeah, I think that’s a very good point. And you know, as Kate said, we will link to, well she didn’t say I will link to them, but we will link to the post. So we do it in the podcast because that does like, otherwise, we’ll turn this into a whole another liver detox podcast. So do know that that’s where that information is. And it definitely is not as simple as eating lemons. And I’m really glad because that’s, I think I’d get bored.

Kate Callaghan 14:26
But in terms of specifically supporting the detoxification of estrogens or excess estrogens, there are a couple of nutrients that can be beneficial. So one is called DIM or Diindolylmethane, and this is an extract that’s found in broccoli. So you’re going to eat a crap ton of broccoli, if you wanted to, that would be great, or you can take the supplemental form that can help to get rid of excess estrogens. The other one is calcium D-glucarate, which can get rid of any excess estrogens, then love cruciferous veggies, dandelion tea. And as I said, supporting detox pathways, so decreasing alcohol is a big one not just for helping with this estrogen dominance, but for helping with all of your menopausal symptoms, alcohol has a huge influence on gut health as well. So just keep that in mind.

Natalie K. Douglas
Yeah.

Kate Callaghan
When you were feeling moody and cranky and at the end of the day, you just want to get boozed. Don’t do it because it’s going to make your moodiness and crankiness even worse.

Natalie K. Douglas 15:24
Have a lemon juice instead.

Kate Callaghan 15:28
Have a lemon juice because it’s going to solve all of your problems out.

Natalie K. Douglas 15:31
You can have a lemon if you want. But what I was going to add to that was the gut health side of things. So making sure as well before you are adding in lots of detoxification supplements or foods that your, your gut is moving that you are actually going to the bathroom regularly because if you are not eliminating these toxins, then they are going to recirculate. So I would encourage you if you do have any gut issues at all if it’s particularly if you’re constipated, make sure that you sort that out, before you start to go down the path of pushing your detox pathways because you will make yourself feel worse as opposed to better. So making, making sure that’s addressed. And the other supplement that I would probably add into the liver detoxification would be liposomal glutathione which, again it can be really helpful in detoxification as well.

Kate Callaghan 16:32
What are your thoughts on liposomal glutathione versus N-Acetyl Cysteine?

Natalie K. Douglas 16:39
I think that there’s research on both. And I think that you could also use both and still have like as in you, you would get benefit from using both as well, you’d obviously adjust the dose because you probably don’t need a high dose of both. But I think there’s plenty of research on liposomal glutathione when the liposome is created correctly, which isn’t always so if we can go into that on another podcast if you like it to be complicated, but making sure the liposome that you, liposomal glutathione that you’re getting is actually in, packaged in a way that is going to be absorbed by your body. So there are certain criteria that it needs to meet in order for that to happen. But if you’re, if you don’t have access to liposomal glutathione, or you just don’t want to use it and you’d prefer to use Nac, then definitely Nac is a good option. And that is kind of like, I guess you could say a precursor to glutathione so can be a really good option. It’s also really quite good for mucous membrane. So if you’re suffering from any kind of vaginal dryness, it could potentially help with that as well.

Kate Callaghan 17:54
Perfect. Yeah, so just to clarify, for those who are wondering glutathione is our bodies major antioxidant and one of its big roles is in phase two liver detoxification and something called glutathionylation. Just in case you’re going, What the heck is this glutathione, and Nac, and what?

Natalie K. Douglas 18:11
Yeah, sorry, sorry, peeps, we forget, I forgot to talk about it too much, get a glutathione. Now, I was going to move on to any additional lifestyle recommendations. Now the question that we got, that was written into us did mention that she’s doing high-intensity training. So do you have any thoughts around, that should exercise change it or when they’re going through perimenopause or menopause?

Kate Callaghan 18:45
Yes, so I’m just going to take a step back. So one thing that’s really common with menopause and perimenopause, due to this whole hormonal fluctuation going on, and which contributes to this, you know, weight gain, especially around the belly, but just one shift no matter what you do, is a little bit of insulin resistance. So your body is no longer able to respond to insulin as well anymore. So you eat carbohydrates, your insulin levels are raised to get those carbohydrates in the form of glucose into your blood cells, sorry, into your cells from your blood, but your body’s just not hearing that message as well. And these can create inflammation, and it can create increased fat storage, especially around the belly. So in terms of improving insulin sensitivity, there are a few things that you can do. Now, one thing that can be beneficial for women going through this period of life, even if it is just a temporary, I’ll try it for 60 days and see how I go or even 90 days and see how I go is to remove dairy. And I don’t have an issue with dairy, per se, I think it can be a really nutrient-dense food for those who tolerate it but I think because some of the factors in dairy, something like they have things like insulin-like growth factor, and some of the hormones in there in non-organic dairy, and just the pure nature of it can create issues with this insulin resistance for some people and can contribute to weight loss resistance. So I would suggest removing it for a period of time, not for forever, not necessarily forever, and just seeing how you go and see if that improves things. You may also want to try a bit of a lower-carb or a cyclic lower carb approach and I don’t mean low, low ketogenic diet. I mean, you know, maybe have most of your carbs at night and gasp. I’m saying carbs at night is that the devil.

Natalie K. Douglas 20:48
That’s it, you’re, you’re gonna go on that lemon podcast instead, next week.

Kate Callaghan
Lemons in the morning, all right.

Natalie K. Douglas
Anyway, let’s clarify. So why are you promoting carbs at night?

Kate Callaghan 21:00
Because I just like to be controversial. So, I’d like to, I like to recommend some carbohydrates because I think if we go to low carb, then we’re going to potentially be affecting our gut health because our bacteria need some carbs to eat, and potentially impacting our thyroid health as well because we need a little bit of carbohydrates to release, a little bit of insulin to convert the inactive hormone thyroid to the active hormone thyroid to control our overall metabolism. And we do need carbohydrates in our body for mucus production as well. So coming back to that vaginal dryness, you do want a little bit of carbohydrates, but why at night? So if you keep it to at night, I mean, you could have a little bit through the day, don’t panic, if you have a bit of sweet potato or you know fruit through the day, don’t panic. But I would say you want the bulk of your carbohydrates at night to benefit your sleep. So when we have carbohydrates at night, that helps us with the production of melatonin, which is our sleep hormone and one thing that is really common during this period of life is sleep issues with those fluctuating hormones. So anything that you can do to support sleep is going to support your overall hormone balance and ability to lose weight and insulin sensitivity. So we do know that research has shown that just one night of poor sleep can make you as insulin resistant as a diabetic, and which is pretty scary. Which is why you might notice that you get increased cravings for sugar in food, in general, the day after you have a poor night’s sleep. It’s not, it’s not a permanent thing. It’s like a temporary you will have, you’re less insulin sensitive that day but if you can support sleep, you’re going to be on to a winning number. So carbs at night can help with this. We’ve done a podcast on sleep, haven’t we?

Natalie K. Douglas 22:50
I don’t know.

Kate Callaghan
Or do we just don’t waste to talk about it?

Natalie K. Douglas
No, I think we always just talk about it, we should actually do a podcast on sleep.

Kate Callaghan 22:55
Okay, so my big things for supporting sleep would be things like magnesium, passionflower, sometimes 5-HTP. Don’t take that willy-nilly though. Maybe speak with someone before you just take that and lately, I’ve been using a lot of essential oils. So I use a bit of a lavender blend on my feet at night, which really wonderful for winding down.

Natalie K. Douglas 23:20
Yes, I do the same I also use, I diffuse the lavender. And I also have been using L-theanine, with myself and with some clients. GABA can also be an option, it doesn’t work well in everyone. So just be wary of that and more is not better. If you have too much GABA, you will get the opposite effect from calming, you will actually stimulate to yourself so making sure you’re doing that under the guidance of a practitioner. You said magnesium, didn’t you?

Kate Callaghan
I did say magnesium.

Natalie K. Douglas
And then the other thing I was going to say is creating a bedtime routine and relaxing before bed, limiting screen time. If you don’t, if you aren’t quite at the meditation kind of side of things yet, then simply lying down with your legs up a wall and taking some big belly breaths is a really good option to activate your parasympathetic nervous system and just calm down before bed. So we potentially can expand and do a podcast on sleep at some stage. But I think there are a bunch of really, really helpful tips. Kate, I just wanted to get back to you before we…

Kate Callaghan 24:37
The lifestyle which I deviated from.

Natalie K. Douglas
Yes.

Kate Callaghan
The exercise.

Natalie K. Douglas
Yes, the exercise. So…

Kate Callaghan
I was getting there.

Natalie K. Douglas
You were, it’s okay.

Kate Callaghan
It’s got the time to it. So insulin sensitivity is what we want to improve.

Natalie K. Douglas
Yes.

Kate Callaghan
And you can do this with exercise. So we do know that more muscle mass helps to improve it from sensitivity. Now, I’m not saying necessarily become a bodybuilder when you turn 50. But regular resistance training, regular resistance exercise, strength work, can help to build that muscle mass, along with good quality protein and your lemons, is going to help. So, you know getting into certain resistance exercise a few times a week. I think she’s saying that she’s doing some high-intensity interval training. I think the high-intensity interval training is wonderful but I wouldn’t do it every single day. So again, coming back to that stress management. If you’re going hardcore in terms of high-intensity interval training and too much exercise, then that’s going to be a stress on your body and going to be counterproductive. So a couple of times a week, do some high-intensity interval work and keep it short and sharp, high-intensity interval training for an hour is not.

Natalie K. Douglas
No, that’s not.

Kate Callaghan
Not my idea of high-intensity interval training.

Natalie K. Douglas 25:51
Fades the purpose. I would say like 15 minutes, like interval, like high-intensity interval training would be fine. Like…

Kate Callaghan
Yeah.

Natalie K. Douglas
You really don’t need to push too much more than out of it just becomes chronic after that and you, you missed that window of benefit.

Kate Callaghan 26:06
Yeah, walk as much as you possibly can, outdoors, not on a treadmill get out in nature.

Natalie K. Douglas 26:12
Yeah. And yoga, I think would be another good one from a stress management flexibility. That kind of point of view. My mom does yoga and she’s so adorable. I just love it. She’s really clumsy though. And she, she really liked the teacher but she never wears glasses. So she, she’s like I don’t know what he looks like but I really like him and I’m like, okay, mom.

Kate Callaghan 26:33
I like that then she can stay in her zone a little bit more, not.

Natalie K. Douglas 26:36
Once, her false teeth fell out in when she was in down with dog. It was so funny.

Kate Callaghan 26:41
Oh, that’s not funny, don’t laugh at your mom. Probably it’s nice if you can’t see anything, then you have to focus on yourself. You can’t focus on all that person, you can do that. Why can’t I do it? You just can’t see. So you have to just focus on yourself.

Natalie K. Douglas 26:54
So really, she’s onto a winner.

Kate Callaghan
She’s onto a winner. I think everyone should just wear blindfolds when they’re doing yoga.

Natalie K. Douglas
That would actually be pretty cool.

Kate Callaghan
Now you pull over?

Natalie K. Douglas
Yeah. I pull over with that one.

Kate Callaghan 27:05
But the last thing I would suggest for anyone struggling with weight issues going through menopause and perimenopause, or fatigue, or depression, would be getting your thyroid checked.

Natalie K. Douglas
Yes.

Kate Callaghan
We can play up with these hormonal fluctuations as well. So get that checked out. All the tests TSH, T3, T4, thyroid antibodies.

Natalie K. Douglas 27:28
Yeah, I’ve got it actually, a good. Don’t mind if I do, a good blog post on that, on actually what test to order because getting your TSH measured is not enough and is not good enough. And if that’s what the doctor does, you should find a different doctor. And I may not in the nicest way possible, but I’ve just seen way too many times that miss, huge thyroid issues, and people suffer. So we will link to that one as well. So I think we did pretty well. Again, I love complimenting ourselves on this, I’m reading Louise Hay’s, like an affirmation book. So I’m just like, Yes, Natalie, you’re amazing. You did a great job today. Well done. I love you. Anyway, we did do a good job. And please keep sending some questions in because as you can see, we do answer them. And we really like talking about things that you’re interested in and chances are, we have some kind of interest in it, too. So Kate, just before we wrap up, did you have anything else you wanted to add?

Kate Callaghan 28:32
If you want more information on this, I actually haven’t done a post on my blog about menopause and perimenopause. But I have written a bit about it including some suggestions in my book, Holistic Nutrition: Eat Well, Train Smart and Be Kind to Your Body in terms of how to nourish yourself in with food, and with exercise, specifically for menopause.

Natalie K. Douglas 28:53
Awesome. That’s great and where can they find that book?

Kate Callaghan 28:58
Anywhere? Most bookstores and Amazon.

Natalie K. Douglas 29:01
Okay, awesome. Alright, well, everyone should definitely go out and read that not just for the topic of perimenopause and menopause because there is so much in that book and it’s a really great resource. So I will also link back to anything we mentioned in the podcast that I would look back to because I did keep some notes and other than that we will catch you all in a fortnight’s time. Have a lovely day, Kate.

Kate Callaghan
You too, Nat. Thank you.

Natalie K. Douglas
Bye.

Kate Callaghan
Bye.