Tales from our Women's Health Hub
Women’s Health GP Specialist Dr Victoria Fielding shares her expertise in the latest blog from our Tales from our Women’s Health Hub.
“We are what we eat!” popularised by Jean Brillat Savarin, who actually wrote back in 1826, “Tell me what you eat and I will tell you what you are!” And how true this is.
More and more, we are understanding the role our diet has in our health and wellbeing. Whether it is our growing knowledge of the role our microbiome and health gut bacteria play, or our awareness of the dangers of over-processed foods. I also feel that it is becoming even more complicated somehow, and we are bombarded with information regarding diets and the right and wrong foods, which only adds to the confusion about what we should be eating.
Personally, I am a strong advocate of focusing on home-cooked, balanced meals, and that no food should be excluded, but that some foods should absolutely be eaten in moderation. A whole foods, healthy, balanced diet should provide you with all the vitamins and micronutrients that you need.
Essential Nutrients Every Woman Needs Across All Life Stages
Iron
Absolutely key if menstruating. Good sources of iron include liver (not if pregnant), red meat, beans, nuts, dried fruit, fortified breakfast cereals
Calcium
Very important in our bone health especially as a woman as we age given we are more at risk from osteoporosis compared to men.
Good sources of calcium include dairy products, fortified cereals, fish such as sardines/ pilchards. I love using the calcium calculators online to work out whether patients are getting enough in their diet.
The International Osteoporosis Foundation has a great calcium calculator available online.
Vitamin D
Again, very important in our bone and muscle health, as well as growing evidence that deficiency makes you more prone to upper respiratory tract infections. In the UK we should all take a vitamin D supplement from October to March and if you have black or brown skin year round!
Omega-3 fatty acids
Help build cell membranes and the starting blocks of how our bodies make hormones! The strongest evidence is around their role in heart health and our children's brain development. Good sources are fish essentially, especially oily fish. Plant based options are not as rich in omega-3 but do include flaxseeds, walnuts, chia seeds and seaweed! Currently it is not advised we take a omega 3 supplement as the evidence is not there however it is something we should all focus on in our diets.
Fibre
Essential for the health of our gut and reducing the risk of bowel cancer as well as ensuring a healthy microbiome. Evidence shows we should eat a variety of dietary fibre with good sources including fruit and vegetables, seeds/nuts and wholegrains.
Key Nutrients for Women at Every Life Stage
Teenage girls and young women
Evidence estimates 40% (!!) of women <22 years in the US/UK are iron deficient!
That's huge and can have varied symptoms such as tiredness/ muscle aches . Getting enough iron in your diet if you are menstruating is key. Focusing on iron rich foods or taking an oral supplement can be really helpful here. If your periods are heavy and/or you are feeling tired a lot then consider seeing your GP/ arranging for a blood test. Women under 50 years are aiming for 14.8mg of iron per day (almost double what men need).
Low doses of a supplement containing vitamin B6 has some evidence that it maybe beneficial in PMS especially around mood. Although the evidence is not clear it is unlikely to do harm and so maybe worth trialling if you are struggling with premenstrual symptoms.
Peri-menopausal and Menopausal women
Focusing on a really healthy well balanced diet is absolutely key during this time especially if it enables you to maintain or reach a BMI. We know that women with a normal BMI are less likely to struggle with severe menopausal symptoms. There is evidence for a mostly plant-based diet being helpful in the perimenopause as well as a Mediterranean diet. Avoiding excessive sugar, alcohol, caffeine and spicy foods can help with menopausal related flushing symptoms as well.
Plant estrogens are an interesting topic as there is evidence that women who have a high levels of soy isoflavones in their diet have less menopausal symptoms. The evidence is not clear however and scientists suspect your microbiome may determine how you absorb these. I would say that including these products in your diet in moderation is a good idea as they may help menopausal symptoms, are a good source of calcium and there is evidence they may improve heart health.
Protein is key to help with muscle and bone strength as we age. Current guidance suggests we should ear around 0.75-1g/kg/day of protein making up around ¼ of our meals. This can also help to prevent menopause related weight gain which is very common, as ensuring enough protein in your meals can help you feel fuller for longer.
Post menopausal women
Calcium is so important as we age, especially as a post-menopausal woman, as when our estrogen levels naturally decline, so too does our bone strength.
As part of bone health, vitamin D supplementation over winter months is also key.
Heart disease is the second most common cause of death for women so considering your heart health as you age is key. Having a cholesterol check and following a cholesterol lowering diet is an important part of this. Gone are the days where we said “just eat less fat” as we’ve learnt it is more nuanced. I’m a fan of the website “heart uk” which is the uk cholesterol charity and has some excellent information of good and bad fats, what to eat to naturally lower your cholesterol and more!
Dietary Supplements for Women: What You Need to Know
I’m often asked, “What supplements should I buy/take, especially around the menopause?”
The truth is the medical evidence for many dietary supplements just isn’t there. If someone has found a benefit from taking a supplement, as long as it is not doing harm, they should, by all means, continue it. The only supplement I can be confident in the evidence in behind taking is vitamin D. I think if you do follow a restricted diet or a vegan/ vegetarian diet, it is a little harder to ensure you are getting enough of the vitamins/ nutrients your body needs (not impossible but does needs some sensible meal planning!) in which case taking a multivitamin maybe worthwhile.
Remember, taking vitamin A when pregnant or planning to be is not advised. Always stick within the recommended daily intake guidance for vitamins, as you can overdose and cause harm, e.g hypervitaminosis D.
Probiotics are another fantastic area of growing research and many people are becoming more aware that they should be improving their microbiome. Ideally, a healthy, balanced diet should provide us with a fantastically diverse flora of good bacteria. If this is difficult to achieve, however, whether it be due to lifestyle stressors or dietary restrictions, taking a high-quality probiotic would be worthwhile.
How to Build a Balanced Plate
Making up a plate of food need not feel overwhelming. I love this Harvard Health Publishing Healthy Eating Plate as a good place to start. It differs subtly from the NHS guidance.
It states:
- A quarter of our plate should be made up of carbohydrates (mostly, if not all wholegrains)
- A quarter of our plate should be protein
- Half should be made up of vegetables and fruits, the varied the better!
- It also mentions the importance of our healthy fats in our diet.
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