Registered Dietitian Dr. Jenn Salib Huber joins series host Dr. Mary Jane Minkin to discuss the vital role that nutrition plays during menopause and dismantle common misconceptions around diet, supplements, bone health, and more.
In the first of our new bonus episodes, host Dr. Mary Jane Minkin is joined by Registered Dietitian and Naturopathic Doctor Dr. Jenn Salib Huber to discuss diet and nutrition during the menopausal transition. Jenn shares her extensive knowledge of how diet interacts with body weight and shape, and bone and cardiovascular health. The conversation also explores the deeply complex relationship between food and women’s bodies, and how women can help heal this relationship during midlife. Jenn tells us, “We need to shift our frame of reference and move away from the idea that we should only have one body shape and size for the rest of our life.” Jenn also shares her love for food and packing her recipes with healthful ingredients that feed the soul, such as her favorite autumn go-to dinner, Tortilla Soup:
Jenn’s Tortilla Soup Recipe:
Ingredients:
1 Tbsp of olive oil
1 medium onion, diced
2 cloves of garlic, diced
1 red pepper, diced
1 can of black beans
1 can of kidney beans
1 cup of corn kernels (canned or frozen)
2-3 chicken breasts
4 cups of chicken broth
1 can of diced tomatoes
1.5 Tbsp of taco seasoning (1 sachet)
½ tsp of smoked paprika (optional)
Toppings: tortilla chips, avocado, cilantro, sour cream, jalapenos, green onion, etc.
Directions:
Notes: This is a perfect soup to throw in a slow cooker on a busy day! It also freezes well, so make more and save for a busy week! If using a slow cooker, cook for 4 hours on high.
About Dr. Jenn Salib Huber:
Jenn is a Canadian Registered Dietitian and Naturopathic Doctor with a mission to help women thrive in midlife. With over 20 years of experience in the field of health and nutrition, she educates and inspires women to be informed about food choices, harness the practice of intuitive eating, and regain confidence throughout the menopausal transition. Jenn arms her audience with information through her platform on Instagram (@menopause.nutritionist) and her podcast (The Midlife Feast).
Disclaimer:
menopause: unmuted is designed to raise awareness, encourage communication, and share information. It is not designed to provide medical advice or promote or recommend any treatment option.
Useful Links:
Jenn’s Instagram: https://www.instagram.com/menopause.nutritionist/
Jenn’s Website: https://www.jennsalibhuber.ca/
Mary Jane Minkin
It's time to unmute menopause. Hello, and welcome back to menopause: unmuted, a podcast series sponsored by Pfizer. Menopause is a major transition in life with many changes and a lot to learn. I'm your host, Mary Jane Minkin. I'm an obstetrician gynecologist and clinical professor at Yale University School of Medicine. The stories from the four fabulous women in season three raised some common health concerns for women in midlife. So today, we are bringing you the first of our bonus episodes, where I invite an expert to talk with me so that we can shine a light on a particular aspect of menopause that has come up in our episodes, and I also deal with a lot in my practice. Today, we're going to focus on a nourishing menopause. How good nutrition can help promote wellbeing, help strengthen our body image, and help protect our bones and heart. My guest today to focus on this topic is Dr. Jenn Salib Huber. Hello, Jenn.
Hi, Mary Jane –
Jenn, could you please tell our listeners a bit about yourself and your work with nutrition?
Jenn Salib Huber
Yes, thanks. And thanks so much for having me. I'm really delighted to be here today and to be having this conversation with you. I'm a Canadian trained registered dietitian and naturopathic doctor, and I'm currently living in the Netherlands. But I am Canadian, proudly. And I work primarily in the area of women's health and especially around midlife. As a menopausal woman, myself, who is in early menopause, I went into menopause at 44, I became really interested in the relationship between food and nutrition and how it could impact my own experience of being in this age and stage. And it really became the focus of my work about five years ago.
Mary Jane Minkin
Thanks, Jenn. I wondered if we could start by asking a pretty broad question. Why is it a good idea for women to pay special attention to their diet during perimenopause and beyond?
Jenn Salib Huber
That is a really great question. And I always say that, fundamentally, our nutrition needs don't actually change all that much. But it is a time of life when we start to notice the relationship between food and how we feel and how it affects how our body looks and feels. And there are a few hormonal changes that happen that really affect I think, for many women, what they see on the outside, but also are starting to affect how they feel on the inside. So, one of the main changes, as you know is that as we get closer to that last period, our levels of estrogen that we have had for 20, 30, 40 years of our life really start to change and drop, they're on a roller coaster. So, you know, they don't go quietly, and they don't go calmly out the door, but they're all over the place going up and down. One of the things that the estrogen changes lead to is what I call a redistribution of our assets.[1],[2],[3] So where our body likes to be soft and round, may look a lot different than it did when you were 20 or 30. And for many women that can be a disconcerting part of menopause, that what they see in the mirror isn't what they've seen reflected back to them for most of their adult life. And we also know that the lowering of estrogen or the lower estrogen state that we're in in menopause affects how our body uses insulin and blood sugar.[4],[5] And that can also lead to changes in how our body looks, but can also have an impact on some of the more important health considerations as we go through this age and stage of life, primarily the increased risk of diabetes4 and heart disease3,[6] that we really need to be thinking about a lot more as we get into menopause.
Mary Jane Minkin
You describe these things very similarly to the way I do, sounds much more eloquent than the way I do it. But I just tell people, it's a centripetal distribution, it goes from into the middle, straight to the middle. And that's what they're all concerned about. Now, talking a little bit more about the weight issue. So, staying within a healthy weight range can lead to better health outcomes Jenn, but it isn't just about number on the scale or maintaining a certain dress size. And I know you're a big advocate of that thought.
Jenn Salib Huber
Yeah. And this is really what I call kind of the passion part of my work, is that for many women who get to midlife, and I was one of them, I'd spent a lot of time trying to control the number on the scale and all of my decisions about food and movement - if I'm being honest - were based on trying to control that number. And what we know is that yes, it is harder to control that number as we get older. But also, that weight isn't a proxy for health.[7] And I think that that's such an important shift that women can really embrace as they get into their 40s and 50s and beyond, so that more of their relationship with food becomes about supporting their health, about increasing their strength about maintaining muscle, and for reasons really that are beyond the scale. Really kind of shifting your relationship with food to be based on how you want your body to function, and not just how you want your body to look, is one of the mindset shifts, I think that can help people to have a healthier relationship with food.
Mary Jane Minkin
Certainly very important, and indeed one of the changes that I've noticed at our menopause meetings annually, is that we've of course talked about osteopenia and osteoporosis for many, many years. But the trend is now to talk about sarcopenia, and for our listeners, “sarco” is muscles. So, we're talking equally about sarcopenia, as well as osteopenia, and that's really important.
Jenn Salib Huber
Absolutely, and sarcopenia is one of those things, it's a medical term that many people don't know about. But I think that when we look to people who are older than we are, we can see that you know, we become weaker as we get older, and it's much more difficult to build and maintain muscle. So that really should be the focus of or at least I think should be the focus of how we move our bodies and what we eat and just how we're playing the long game when it comes to nutrition.
Mary Jane Minkin
Jenn, could you please talk a little more about protein, people wonder about amounts of protein, types of protein they should be consuming, particularly at the menopause transition.
Jenn Salib Huber
Protein is definitely a hot topic when it comes to menopause nutrition. And there is good reason to include it more often and to maybe pay a little bit more attention to it. But the data that we have about protein is that everybody needs to get a minimum amount. And there is also some data that in menopause and post menopause getting more than the minimum may be helpful at building and maintaining muscle,[8],[9] it may also be helpful in keeping blood sugar[10] and you know in control and those kinds of things. I think it's important for people to realize that yes, protein is absolutely important and including it at most meals is I think a very natural way for us to want to eat it. But I think a lot of people get really caught up in the numbers and how much and how often. And we don't really know exactly how much more we should have. So, I like to, use that add in approach of just make sure that you're having regular amounts of protein, whether that be animal protein or plant-based protein. And you know, try not to skimp on it is kind of a good way. So maybe have a little extra if you're portioning out a piece of chicken or if you're adding shrimp to a salad have a little bit extra, if you're going to have beans in a soup, add a little bit of extra. So again, focusing on that add in instead of taking away. But protein is important, because it does primarily help to build muscle. But more important than protein is actually eating enough. Because if we're not eating enough, which is you know, something if someone is trying to be in a caloric deficit, your body will actually burn a lot of that protein for energy, meaning that it's not going where you want it to.[11] So, making sure that you're eating a balanced nourishing diet that has a little bit of an extra focus on protein, I think is a good way for people to think about it.
Mary Jane Minkin
Absolutely. I agree completely Jenn and being proactive with what you eat may help manage some menopausal symptomatology. I've certainly had conversations with my patients over the years about hot flashes and alcohol, for example. Why is that?
Jenn Salib Huber
That's a great question. And the data around alcohol and hot flashes can actually sometimes be mixed.[12],[13] But when you speak to women about their experience, and I'm also one of them, that even small amounts of alcohol seem to prompt hot flashes make them worse, and especially those night sweats through the evening. And one of the leading theories is that it's a vasodilator.[14] Of course, we know that and anything that increases your skin's temperature is much more likely to contribute to hot flashes,13 which is why spicy foods,[15] even just hot beverages.15 Anything that makes your skin and body feel warm is likely to confuse the part of your brain that's trying to regulate temperature.
Mary Jane Minkin
So, Jenn, can we now talk about some of the health issues that are particularly relevant about menopause? In Episode Two, we heard about Mary Beth's efforts to protect her bone health. And in episode three, Barbara, despite being extremely fit, suffered a very serious heart attack. What food choices can women be thinking about when it comes to our bones and our hearts?
Jenn Salib Huber
The good news is that a lot of the things that we can do to support our overall health will also help to contribute to heart health. But some of the more important nutritional influences on heart health, of course, are going to be the types of fat that we are eating. So, when we're talking about fat, we're usually talking about either saturated fat which we get from animal foods, or the unsaturated fats, which we get from plants and fish. And it's very clear in many decades of research that putting more emphasis on getting your fats from plants and fish over what you get from animals, is going to help to reduce your risk of heart disease contribute to overall heart health, including lowering cholesterol, and things like that.[16] But that doesn't mean that saturated fats are bad. So of course, you know, cheese, and eggs, and meat can all be part of a heart healthy diet.[17] But it's really about what we want to add in: adding in fish more often, adding in nuts and seeds more often, and maybe placing a little bit less emphasis on having, you know, meat at all of our meals. The other component of heart health that is, you know, really being emphasized in the last 10 years or so is fiber. So we know that fiber, which is you know, the indigestible carbohydrate that we get from most plants, and also whole grains and things like nuts and seeds, does seem to help to reduce the risk of heart disease, can help to balance blood sugar.16,[18] So those are two of the more important food add-ins that I like to focus on. But we can also talk a little bit separately about omega-3 fats, which are the type of fats that we get from fish in particular coldwater, fatty fish like salmon, and mackerel and herring. These are fats that have been associated with reduced risk of cardiovascular events, and including them two to three times a week, usually, you know, seems to be the right amount.16 And then people can always talk to their healthcare providers if they wanted to think about supplementing because some people don't love fish.
Mary Jane Minkin
So, Jenn, can we talk a little bit more specifically about bone health, because I think most of our listeners do understand that a bone loss is a major issue for postmenopausal women. And where do things like calcium, vitamin D, soy fit in for our listeners.
Jenn Salib Huber
Absolutely. So, calcium and vitamin D have been the darlings of bone health for really probably the last 30 years. And we used to tell women that this was the most important thing to make sure they were getting enough calcium, and we used to think well, more is better, so get as much as you can, supplements, food, it's all doing good things. But what we've really learned in the last, you know, 10 years is that calcium and vitamin D are extremely important for building bone. And in those first, you know, 20, 30 years, you know of our life, we need to be focused on building bone and getting enough calcium and vitamin D is critical to that process happening. But as we get into menopause and into our 40s and 50s and 60s, taking supplemental amounts of calcium and vitamin D isn't as strongly supported by the research anymore for helping to prevent fractures.[19] So they're still important, don't get me wrong, and we do want to be including them and likely in food amounts.[20] So, whenever I'm talking about food, I really like to use that language of let's try it on. Because not everybody needs to do the same thing. And for some people, if they really don't enjoy something, you know, we don't want to tell them that they have to do it because then our toddler brain kicks in and kind of kicks up a stink and doesn't want to.
Mary Jane Minkin
Jenn, we know that the food we eat has got to be one of the areas of health most plagued with misinformation.
Jenn Salib Huber
My favorite myth to bust in midlife is about carbohydrates. So, many people have gotten many mixed messages about carbohydrates, but especially in midlife, and the discussion around carbohydrates causing weight gain or causing diabetes or causing insulin resistance. And I think it's important to recognize that carbohydrates are actually considered an essential nutrient. Our brain and our red blood cells really function best when we are eating carbohydrates, and they're getting their fuel from glucose.[21],[22],[23] And so for people who are choosing lower carbohydrate diets, they may actually be you know, underperforming, so to speak, because we need those carbohydrates not only for energy production,11 but also to help to support mood.[24] We know that carbohydrates contribute to serotonin production,[25] there may also be a relationship with sleep, and possibly serotonin and melatonin.[26] But people really fear carbohydrates. So, I always like people to know that the conversation around carbohydrates can be a bit nuanced, and that some people do better with less. Some people do better with more, but there's absolutely no reason to avoid them, and many, many reasons to include them.
Mary Jane Minkin
Jenn, you've been talking about carbohydrates, and we've talked about simple carbs versus complex carbohydrates. Can you explain to our listeners exactly the differences between these two?
Jenn Salib Huber
Absolutely. So simple carbohydrates usually refer to carbohydrates that have short chains of sugars attached to them. So, this might be what we tend to think of as white foods, but not exclusively. So, this might be things like white rice, or white bread, or you know, sugar, things like that. But even if you look at something like you know, fruit sugars, those would technically be classified as a simple carbohydrate just because of their chemical nature. Complex carbohydrates tend to be these longer chains of carbon glucose molecules or sugar molecules that are strung together. It takes longer for our body to chop them off one at a time, so, they're digested more slowly.[27] And they tend to have a more balanced effect on something like blood sugar,27 for example, if somebody's watching their blood sugar. But what I you know, coming back to my add-in approach and what I like to talk about is that we can, we can add something to a simple carbohydrate, we can add protein, we can add fiber, we can add fat to that, if that's a food that you enjoy and want to include.
Mary Jane Minkin
Thank you, Jenn. You're listening to a nourishing menopause, the first of four bonus episodes to accompany season three of menopause: unmuted. I'm your host Mary Jane Minkin and today I'm joined by registered dietitian and naturopathic doctor Jenn Salib Huber. You can listen to all our previous episodes and find more information at menopauseunmuted.com. For this final section of our bonus episode, I'd like to talk about our attitude to food and how we eat, because it has an impact on what we eat. I'm sure a lot of listeners will have heard the term “intuitive eating” without knowing really what it means. But there is a framework around the concept of intuitive eating. Jenn, could you please explain?
Jenn Salib Huber
I'd love to, Mary Jane. Intuitive Eating is a framework based on 10 principles that includes an anti-diet mentality, that focuses on attunement, which is learning to tune into our hunger cues and our fullness cues.[28] It helps us to pay attention to the different types of hunger, so are we experiencing physical hunger or emotional hunger or taste hunger. And it also emphasizes that body respect of working with your body instead of against it, moving for reasons other than just burning calories, and really incorporating joyful movement. So, I always say food matters, just maybe not in the way that you’ve been led to believe. And having a relationship with food that nourishes not just your health, but how you feel about your body is really important.
Mary Jane Minkin
That’s terrific. Jenn, could you also talk to me about body image and how assessing our relationship with food might contribute to a better body image.
Jenn Salib Huber
What we know about body image is that weight loss doesn’t protect us from a negative body image.[29] And the example that I use to illustrate this is most women who have you know, tried to lose weight or pursued weight loss, have probably found an older picture of themselves in a smaller body and looked back and thought, “Oh, why did I think there was anything wrong with me?” But at the same time, can recall feeling the exact same way that they do now. So, we know that weight loss isn't the ticket to feeling better in our bodies.28,29 And so, I like to describe it as how you feel about your body shouldn't be the determining factor of how you feel in your body. And the analogy that I like to use is that of a bus. And so, if how you feel about your body, meaning your body image is driving your self-esteem bus, if you have a bad body day, all of the other passengers get taken for a ride. Whereas if you have some resiliency and some flexibility in how you feel about your body, because you trust your body, to know when to eat and what to eat and when to be full and how to move, it becomes a lot more of a give and take relationship instead of a one-way ticket. The other thing is that we actually do have some data and some research from looking at women who score higher on the intuitive eating Assessment Scale, which is a validated tool that we use, that women who have higher, you know, who score higher on this intuitive eating Assessment Scale, actually feel better about their bodies.[30] And in general, just describe a more peaceful relationship with food. And at the end of the day, I think that's what all of us want is a peaceful relationship with food.
Mary Jane Minkin
Excellent. One other area that I know you're interested, are the issues involved in eating as a sort of a social and eating as a get together? Can you comment on them?
Jenn Salib Huber
Yeah, and one of the really interesting things about eating is that it's not just about the food, it's not just about the nutrition that we're getting from the food, the vitamins, and the minerals. It's also the experience of eating, and eating with people at a table has been shown to help kids to make you know want to eat more fruits and vegetables.[31] We know that older people who eat together you know, especially if they live alone, are less likely to suffer nutrient deficiencies, are more likely to be you know, well-nourished versus undernourished.[32] So I think that we need to really place value on the act of eating together and not just the act of eating.
Mary Jane Minkin
Again, very well said. And of course, I do love the thought that about social eating actually being good for you and nourishing meal with family and friends sounds like a pretty great element of self-care. With that in mind, Jenn, I wonder if you could share an idea for an easy meal that listeners could make, perhaps to be shared with friends or family?
Jenn Salib Huber
Absolutely, and I will share this recipe but one of my favorite, our family's favorite, recipes is what we call tortilla soup. And I like it for many reasons. One of them is that it can be cooked in a slow cooker or crock pot. So, for busy days it can be thrown in. It includes some chicken, so it's not completely vegetarian, but also includes things like black beans, and kidney beans and it’s in a base of tomato sauce and tacos or taco seasoning and lots of vegetables. So, it's, it's a one pot meal, but then you can make it a little fun and customized by having lots of different toppings. So, you can have guacamole, or you can have tortilla chips, which is how my kids love to eat it. But it's just a nice way to have a meal that is, you know, can be cooked on a variety of schedules with you know, lots of flexibility built in, but that generally is a taste that most people like. And that can appeal to both the meat eaters and maybe people who are trying to eat more plant-based protein.
Mary Jane Minkin
Jenn, that sounds terrific. And we are going to have the recipe in our show notes. So, take a look for them there.
Well, Dr. Jenn Salib Huber, thank you so much for joining me today. I've really enjoyed our conversation, and I'm sure you've given plenty of food for thought to our listeners.
Jenn Salib Huber
Thank you so much, Mary Jane, I've loved talking with you.
Mary Jane Minkin
And thanks to you for listening to a nourishing menopause, a bonus episode that's part of menopause. unmuted. I'll be back for more bonus episodes where I'll be talking to experts to bring you information about fitness, looking after your emotional wellbeing, and fostering a healthy and enjoyable sex life through menopause.
There's more information in our show notes at menopauseunmuted.com. And if you have any questions about your own menopause, talk to your health care provider. That might be your OB/GYN, primary care provider, nurse practitioner or midwife. There are even designated menopause practitioners that a woman can visit if she needs more information.
Special thanks to the women's health team at Pfizer, and to Studio Health for producing this series.
Talk soon.
Disclaimer
Ident: This podcast is powered by Pfizer.
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