← BETTER! with Dr. Stephanie Estima | Strength, Body Composition & Perimenopause
BETTER! with Dr. Stephanie Estima | Strength, Body Composition & Perimenopause
Menopausal Nutrition: Improving Belly Fat, Snacking and Heart Health with Sarah Berry PhD
01:22:24
Do you feel like you are being duped by nutrition advice? Sarah Berry PhD is here to break down food myths and reveal how smart snacking and educated eating can supercharge your menopause transition. Watch the full episode at https://youtu.be/zqt3hi-X3Ps
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- [00:00]
A
What I found most surprising is the symptoms that I typically thought about in relation to menopause and this is me as a 48 year old woman that menopause is all about the night sweats, the hot flashes. Actually we found they were the least common symptoms. They were still common in about 50% of women. But the most common symptoms were the symptoms that are related to our brain function. So they were things like brain fog, memory loss, anxiety, depression, mood swings, sleep disturbances. So about 85% of women were having these kind of symptoms, the brain fog, the memory loss, the sleep disturbances. That's a huge amount of peri and postmenopausal women having these symptoms.
- [00:41]
B
It isn't about being perfect, it's about being better. Hello, My name is Dr. Stephanie Stima and I host expert discussions with thought leaders in all facets of health, including nutrition, fitness, hormones. So stress management, performance recovery, longevity, healthspan and energy production. On this show we discuss complex science, but then we also alchemize it into actionable everyday living. The ultimate goal with the show is to assist you in making informed decisions about your health and to catapult you into being the hero in your own life. Hello friends. Welcome back to another episode of better with Dr. Stephanie is me, your host, Dr. Stephanie Estima. And today I am speaking with Professor Sarah Berry, all on nutrition science and how to navigate the online world of social media as well as through menopause. If you have not heard of Sarah, Sarah is a professor at King's College London and the chief scientist at Zoe which is a science and nutrition company. She is an academic leader in nutrition science and she has run more than 35 years human nutrition studies and she's currently leading the world's largest in depth nutrition and research program called the Zoe Predict study. In this conversation we look at the food composition so whole foods versus ground up foods, something that she calls the food matrix. We talk about how we can improve our snacking. It's not something you have to stay away from, but just improving the way that we snack and the composition of our snacks. We talk about something that she calls nutribolics. So some of the things that we see in the online space, we do talk about seed oils, we talk about oats, we talk about dairy, we talk about fats, saturated fats and mono and polyunsaturated fats. And then of course we talk about nutrition through menopause. Now I really loved this conversation and I am going to encourage you to listen through all the way to the end because I have an Easter egg there for you now and going forward where I'm gonna tell you what I really thought about the Episod Listen to the episode, listen to my after show comments at the after party at the end and please enjoy my conversation with Professor Sarah Berry. If you're looking to sleep better, recover faster, improve your skin's appearance and thicken your hair, you are going to love the Bon Charge Red Light Therapy Panels. Red light stimulates something called cytochrome C oxidase is a protein that enhances energy production in human cells. This essentially boosts mitochondrial efficiency in breaking down nitric oxide and gener more energy that helps the body's healing process. Red Light therapy has been shown in peer reviewed clinical trials to help with improved collagen and elastin production in the skin, thereby reducing the appearance of fine lines and wrinkles, improving skin blemishes roughness and reducing scars, supporting recovery for better sleep, promoting muscle relaxation, AKA soreness and stiffness. And this is also FDA approved for hair loss, which is something that many women in their 40s and 50s deal with. The bon charge red light therapy device uses the most bioactive frequencies of red and near infrared light at 630 nm, 660 and 850 nm. I personally use the full length panel after a long bike ride. I typically like to do my mobility and stretches in front of the full length panel for about 10 minutes a day. If you want to get these benefits, head over to boncharge.com better and use code better at checkout for 15% off your purchase. All right, Dr. Sarah Barry, welcome to the Better Podcast. I'm delighted to welcome you today.
- [04:30]
A
Thank you for having me, Stephanie.
- [04:32]
B
Well, I've been looking forward to this interview actually for a while. You and I have very similar views on a variety of topics that we are going to cover today. We're going to talk about nutrition, specifically some of the ways that we can think about nutrition over the course of a woman's life, especially through menopause. Yeah, before we get there though, there's something that I In preparation for our conversation today, I've heard you talk about the food matrix and this is something that I have never I'm always reading back of the label, looking for the protein, looking for how much fat, how much carbs. But the food matrix is something entirely different. So can we start maybe just by way of background, what is the food matrix and why do we need to be thinking about this? In addition to, you know, macronutrients Total calories, et cetera.
- [05:18]
A
So, in simple terms, the food matrix is the structure of a food. And it's really important because I think that we now realize as nutrition scientists that we can no longer think of food in terms of its nutrients, in terms of its fat, protein, fiber, carbohydrate. We know that actually what impacts how healthful a food is is so much more than that. It's the thousands of other chemicals. And we know that food, on average has about 25,000 chemicals, and these are, you know, bioactive chemicals like polyphenol, et cetera. But we also know these chemicals and these nutrients are encapsulated within a very complex structure, which is this food matrix. And every food has a different structure, and this structure modulates the health effects of these nutrients. And the reason it's so relevant now is because processing changes the food matrix. It changes the structure of food, sometimes beneficially, but mostly unfavorably, to have detrimental health effects. And I think, as well, Stephanie, what blows my mind in terms of the research I've done around food matrix and food structure is the fact that you can have two foods that have exactly the same backup pack, labeling exactly the same ingredients, exactly the same nutrients, but just differ in terms of. Of their structure, and by just differing in terms of their structure can result in an entirely different impact on our health.
- [06:50]
B
Is this like the difference between maybe a whole apple and applesauce? Is that sort of. Would that be like a comparison in terms of, like, it has the exact same ingredients, but it's just a different structure? Is that what you're referring to?
- [07:01]
A
Yeah, I mean, that's a great example. And actually, it's a really pertinent example for us in nutrition science, because there was a study that was published in 1977 in the Lancet, was actually one of the first nutrition studies ever to be published in the Lancet. Because nutrition science has always been considered kind of the poor man. Science still is sometimes. And in this study, they looked at how we process whole apples versus apple puree, where all they did was mix up the apples that had exactly the same nutrients versus apple juice, which did actually have the fibre removed. And what they found was that it had a different impact in terms of the speed at which we're eating. So you ate the calories two to three times more quickly when you had the apple puree versus the whole apple. It changed your hunger levels, so you were hungry a lot more quickly after having the apple puree. You felt less full, and it also changed those glucose dynamics so that the rate at which your blood sugar increased and the rate at which it dropped. And we've since, in my own research, done very similar studies where we've looked at how feeding nuts or feeding oats that have either been fed whole or finely ground can impact how many calories you absorb from that food, how fast you metabolize that food, and knock on effects on hunger and satiety.
- [08:27]
B
Yeah. And anyone who's ever made nut butter at home, you realize how much nuts go into one, you know, one tablespoon, let's say, of peanut butter or almond butter or whatever, nut butter, how much nuts actually go into that. And even the experience of, you know, apple versus, you know, apple puree or nut versus nut butter, there's. It's an entirely different sensorial experience too. Right? There's like the mast, like for, for apples you have to chew and, you know, you have to chew however many times before you swallow. And then there's like different textures. It's almost an entirely different experience. Would you, Would you.
- [09:05]
A
Oh, totally. There's different number of chews, there's different speeding of eating, there's different texture. And we know that texture is really, really important. There's some fabulous research coming out now from a group in the Netherlands looking at how texture can impact the speed at which you're eating. And so again, going back to food processing and ultra processed food, there's been so much emphasis on ultra processed food is bad for us because it's got this additive or it's got this emulsifier. But actually what we know is that processing impacts the structure of the food, to change the texture of the food. And changing that texture can have a big impact on our health. And there's work that's done that's found that changing the texture of a food is probably one of the most important things in term in terms of how food processing impacts how much energy we consume. And that if you eat your food really fast, which is what happens when you have soft textured food that's been heavily processed, you eat a lot more calories, up to about 50% more calories than if you were to eat a similar meal that has a harder texture.
- [10:16]
B
So I'm thinking about all the women that are like, but wait, I have a smoothie every morning and I throw blueberries and spinach and I throw all the things in. There are smoothies because of, you know, things have been ground up and it's in liquid form and it's very easy to sort of throw back a lot of it. Would you prefer, prefer someone have the whole blueberries and maybe the sauteed spinach in the egg omelette versus throwing it all in a smoothie.
- [10:41]
A
So look, Stephanie, I think we have a huge problem in the uk, in the us, in Canada, you know, worldwide, where most people aren't consuming enough fibre, aren't consuming enough plant based foods, aren't consuming enough fruits and vegetables. If a smoothie is the way for you to eat more of these helpful foods, absolutely it's going to improve your health. However, if we were to want to go for optimization, then I think it's better to eat the whole food because you will eat it at a more healthy pace because I think it's easy to glug down that smoothie and therefore over consume. But if the smoothie is basically lots of fruits and vegetables and healthy ingredients, then it's still going to be beneficial. But I think there's some work that we did with almond nuts that's a great example of showing how you can have two foods with identical ingredients, but actually just by grinding them or processing them like you would, for example with a smoothie can change how much calories are released and how much you absorb. So we did the study where we fed individual either whole almonds or we fed them really finely ground almonds using industrial processes. So not the kind of grinding that you would typically do at home, but using industrial kind of grinding. And we fed these to individuals. And what we found was that there was a huge difference in the amount of energy that people were absorbing, absorbing from the whole almonds versus the ground almonds. And this has also been shown by other researchers where we see that there's about a 20 to 30% difference in terms of how much energy you absorb versus what's on the back of pack labeling. So on the back of pack labeling, typically it says that a portion of almonds has about 160 calories. But if you consume those almonds as whole almonds, you actually only absorb about 120 calories. If you consume them as finely ground almonds using these industrial processes, you will absorb all of the calories. And this is because of that food structure, because of that food matrix. So almonds, just like all plant foods, have thousands and thousands of cells making them up. These cells are tiny. So for example, in nuts that smaller than a grain of sand. So when you chew your food you're swallowing particles that are normally about say 1 millimeter. So within those 1 millimeter particles you've got thousands and thousands of These cells that are still intact, that have these rigid cell walls, that within these rigid cell walls you've got all the fat and other nutrients still encapsulated, still trapped. Now some of it is digested as it passes through the gut, but actually a lot comes out the other end. So anyone who's got kids who's listening to this, who will have, I'm sure doubtless time looked at their poo and given them nuts, you'll be aware, or even from your own poo, that after you, you see whole like particles of nuts in your poo. And that's because of this cell structure, because of the matrix, because of the structure of the almonds. If, however, you finally grind them so you break up the cell walls, you're releasing all of the fat, therefore you're absorbing all of the fat and all of the nutrients. But Stephanie, it's a double edged sword because for people who want to reduce their energy intake, who want to go on a weight loss diet, yes, it's beneficial that the fact that whole almonds are less calorific, less energy dense when you eat them because a lot's coming out the other end. But what you've got to also remember is there's lots of other nutrients that are within those cells, like vitamin E, for example, and other micronutrients that we know are also excreted together with the fat. And so I think, therefore it's oversimplifying things by saying, oh my gosh, you mustn't blend your fruit or you mustn't blend your nuts. I think you need to look at an individual basis.
- [14:38]
B
Yeah. And to your point, around the smoothies, it's like if that's how you're getting the vegetables in and it's convenient and it works for you, wonderful. Like I've said many times on the show, you know, the ideal time to work out, if you look at the literature, is somewhere between 10:00am to 2:00pm you know, your core body temperature has risen, you've likely had a meal, you've lubricated the joints. But not everybody can work out at that time. I, I myself cannot work out at the, I work out usually somewhere between 5 to 7 in the morning before the school run and all the things.
- [15:08]
A
Wow, well done you.
- [15:09]
B
Yeah, well, it's like otherwise it doesn't get done right. So that's what works for me. It's not ideal, but it's still, I still get her done right.
- [15:17]
A
Yeah.
- [15:18]
B
And in the same vein, I think what you're saying is, hey, the literature suggesting that whole foods, you're going to have this whole food matrix where maybe there's a reduction in terms of the total calories that you absorb, but you're also losing out on some of the vitamins and things that are encapsulated in these cells. So it's like you have to figure out, I mean, I think the ideal is like whole foods. Yes. And we can also have our nut butters as long as, you know, we're thinking about portion control, let's say, and our smoothies, if they work for us.
- [15:48]
A
Absolutely, totally agree with that. You know what, as a mum of teenage kids, if they're happy to have a smoothie every morning, I would be singing from the rooftops with joy.
- [15:59]
B
You're like, where's my award? Where's my mum award? Because it's great, right? I love that.
- [16:06]
A
Sadly they don't. But if they would, you know, if.
- [16:09]
B
They did hand them out, you would get one. I love that. So I recently did something that helped me easily feel 10 years younger in just a couple of months. And it's called qualia senolytic. And if you care about aging well, you are going to love this. We all have cells in our body called senescent cells. Sometimes they're called zombie cells. They're basically worn out cells that don't really provide any useful health benefit anymore. They're just kind of hanging around, not quite dead, not quite alive. And they cause a lot of inflammation and divert our energy and nutritional resources to them. As we get older, our body accumulates more and more of these zombie cells and they're linked to declining physiology, physical and mental energy and slower workout recovery. Basically the stuff that kind of makes us feel old. Qualius Analytic is a new formula with nine of the most research backed analytics that actually help our body naturally eliminate senescent cells. So let's enjoy the wisdom and perspective that our years have earned us while having the physical and mental energy of someone half our age. We want to have the privilege of aging right? And this is going to help us age well. Take control of your aging with Senolytic. Visit qualiolife.com better and use code better to get 15% off. That's Q U A L I A l I f e.com better and use code better at checkout. You know, building on this almond. Because almonds are often consumed, if they're not in a smoothie or even maybe in a smoothie, they're often consumed as a snack, right? So it's like I'LL just have some, maybe some almonds in an apple or I'll put it in my post workout shake or whatever. So it's not necessarily being consumed as a whole meal. And I think you have some really interesting talking points on snacks. So let's talk a little bit about snack, maybe quality and also snack timing on the impact on body composition.
- [17:59]
A
Yeah, absolutely. So we've done quite a bit of research on snacking, firstly looking at snacking habits, because I think this is really important because I think snacking is one of the single simplest dietary strategies that we can implement to improve our health. And that's because on average we get between 20 to 25% of our calories from snacks. So that's a huge amount of our energy. A quarter of our energy is actually coming from snacks. The other important thing around snacking is generally it's under our own self control. So for many people what they have for lunch might be dictated by where they're working that day, what they're having for dinner might be dictated by what their kids. So in my instance my fussy kids will eat, but snacking is under my control. And I think therefore, given that it accounts for a quarter of calorie intake, given that it's under most people's self control, I think that it's a really important strategy we can use to improve people's health. And what our research showed is that if you snack on healthy snacks that it can improve your health. So we did a clinical trial, for example, where we had people who were randomly allocated to either consume the typical UK US snacks, very similar to the snacks that you in many populations, or consume almond nuts. So what we would consider to be a healthy snack and they were asked to have 20% of their energy as either the typical UK US snacks or US almond snacks. And we told them keep everything else the same, don't change anything else, just change what you're snacking on. We did recruit people that are typical of us Brits or Americans. So people who did typically snack and what we found was at the end of the six week period where we had changed, where we had modified either the typical UK snack or the almond snacks at the end of the six week period, we found that those who were snacking on healthy snacks, in this case almonds, had significant improvements in whole host of different health outcomes. And importantly, when we looked at blood vessel function, this equated to a 30% predicted risk reduction in cardiovascular disease. What that 30% red a ball that's after six weeks and that's just changing of snacks. And that's because most people are snacking on unhealthy snacks. Most people are snacking on snacks that are higher in salt, higher in saturated fat, higher in refined carbohydrates, higher in sugar than what is recommended, and typically very low in fiber. And so they're a really easy switch to make. What we've also seen from the Zoe predict research that we've done that looked in over 1000 people at snacking habits and looked at one point in time. So cross sectionally how snacking habits relate to different health outcomes, we also see that if you're snacking on healthy foods versus snacking on unhealthy foods, as you would guess, it's associated with improvements in a whole host of different health outcomes. So it's associated with a better body composition, a better blood lipid profile. So cholesterol, triglycerides, et cetera, better insulin control, better levels of inflammation, better gut microbiome, etc. What we also found, which is a question that I don't think has ever been properly answered before, is that the frequency of snacking wasn't important. So there's this idea by some people that, oh, we should all return to the traditional pattern of eating where we just have breakfast, lunch and dinner, that becoming these nations of grazers where on average we know in many countries we're having two to three additional eating events on top of our breakfast, lunch and dinner. So we're having like six eating events on average as a population throughout the day, that this might be bad for us because we're constantly exposing ourselves to food, we're not giving our metabolism a rest, we're not giving our microbiome a rest. What our research showed, as long as you're snacking on healthy foods, the frequency of snacking doesn't seem to matter, except if you're snacking late at night. And this was really critical. We see that over 50% of people snack after 6 o', clock, 30% of people snack after 9 o' clock at night. And what we found was people who were snacking after 9 o' clock at night, even if they were healthy snacks, had higher bmi, higher levels of inflammation, higher level of blood lipids, higher blood pressure, et cetera. And so this kind of fits in with our growing understanding anyway in the nutrition community around chrono nutrition, which is the timing of eating. So I think the top line on snacking is, look, I think that if you are a snacker, I wouldn't say start snacking But I would say if you are a snacker, great. Use as a way to improve the healthfulness of your diet. Know that it can have significant impacts on improving your overall health, but avoid snacking after 9 o' clock at night.
- [22:55]
B
All right, so just some parameters here. Snacking. Would you say like a total calorie intake of snacking is maybe no more than. What would you say, 300 calories for? Like, what would, what would be like the. What defines a snack versus versus a meal?
- [23:11]
A
So there's actually no definition globally accepted regarding a snack. Some people talk about snacking in terms of what it is the person's consuming, I. E. Is it some crisps or is it a bar of chocolate? Other people refer to it as an eating event between a main meal. Typically the accepted definition now is that it's an eating event between a main meal. But again, there's no cutoff. That is something that's above 50 calories is a snack. There's no clear definition on that.
- [23:39]
B
Okay, so it's some type of food event in between the main meal and maybe just as an action item for the listeners. So we've talked about healthy versus unhealthy snacks. So. And you've said a couple of examples of unhealthy and redirect me here if I've misinterpreted it, but, but like something like a crisp or a chocolate bar, these would be, you know, just naked, just sort of by themselves maybe would be considered unhealthy. Would you, would you agree with that or not?
- [24:05]
A
Yeah, absolutely. So I think many of the foods that we typically think of as snacks we would consider unhealthy. So crisps, chocolate bars, pastries, sweets, candies, those kind of things. Absolutely. You know, they're high in refined carbohydrates, they're high in sugar, low in fiber. So on their own, yes, we would consider them unhealthy snacks.
- [24:26]
B
Yeah. And it's usually the carb fat combo. It's usually when they're high carb. High fat. Right. Which are things that don't typically occur very often in nature anyway. Okay, so just on the flip side of that then, so we can all say, okay, candies and bon bons and the chips and the cookies and the crackers, all the stuff. Not good. What are some examples of healthy snacks? So you've mentioned the almonds. Give us a couple of examples, a couple of action items and maybe just to think about this in terms of layering it on with the food matrix that we've been talking about. As well. Is it whole almonds with some, with an app, with a whole apple or some, some other variation? What are some examples from your literature and some of the recommendations, maybe from Zoe, in terms of what a healthy snack might be or might look like.
- [25:06]
A
So I think the ultimate healthy snack is a mixture of seeds and nuts and actually getting a mixture of different types of nuts, different types of seeds. Because every nut, every seed has a different chemical makeup, has different micronutrients, has different fibres. And we know that the diversity of fibres, the diversity of bioactive chemicals, etc. Is so important. So I'd say that that should be the foundation for people who can consume nuts. I know that many people have nut allergy. People who can consume seeds, having them in their whole form is absolutely great. It will keep you full for longer. But nut butters also are great. Nut butters spread on, you know, rye bread or something. You know, a whole grain is also good for us, obviously. Fruit is great for us. It might not keep you as full for as long. So I think trying to select a snack that has a balance of nutrients, just like you would for a main meal that has an adequate amount of protein and healthy fats in it and fibre is really important. And the other thing I think, Stephanie, that we can also think about is having snacks that we might not necessarily typically think of as a snack. So things like a hard boiled egg, that's a great snack to have if you're, you know, if it's accessible, I. E. You're working at home and you know, you can have one in the fridge ready to go, for example. These kind of things that maybe you wouldn't typically think of, I think are also great. So also thinking of kind of almost mini meals or even having leftovers from. If it's a healthy meal that you've got in the fridge and you really need that mid morning snack because you are someone like myself, I need to snack. So thinking a little bit outside the box of what a typical snack would be if you're snacking on the go, that's where I think hammering around nuts or seeds or fruit, you know, a little pot of nut butter, that kind of thing, you know, is also really good to have on the go.
- [26:55]
B
I love beef jerky.
- [26:57]
A
Okay, that's not so great.
- [26:59]
B
It's not so great. Okay, so I love beef jerky when I'm traveling because it takes me forever to get through the bag because it's so hard to chew and it's higher in protein and it's okay, so maybe the salt is not, not the best, but I find that the beef jerky kind of keeps me satiated. It's not perfect, but for traveling, like, you can usually find beef jerky in, in little kiosks, like where they're selling the chips and the cookies and the crackers. And then I'm like, okay, so if I want my protein, beef jerky is usually what I go to. But you don't think that that's a great option.
- [27:26]
A
So we don't have beef jerky in the uk, which is interesting. No, I think there's some, some retailers you could find it in, but it's certainly not like it is in North America where it's, you know, where the snack section is. But I think that the evidence around processed meat and I would put beef jerky in that category. I think regarding links with colorectal cancer, with heart disease is quite strong. Now, I would say everything in moderation. And as long as you're not snacking on it every day, I think in moderation, it's absolutely fine.
- [27:58]
B
I'm not wrong. I'm not having like pounds of beef jerky every day. It's like when I'm on a plane going to Heathrow or I'm on a plane going wherever and I'm hungry and I need a snack, usually that's where that's what I'll go to.
- [28:08]
A
Yeah. And I mean, you know, it's a great example of how having a mixture of fat, but most importantly also protein improves our satiety, so improves our fullness. And yet if you were to go for a refined carbohydrate instead, that, well, it would also not be a health. The healthiest option, but also you would feel really hungry very quickly later. Yeah.
- [28:30]
B
And that's sort of why I typically when I'm traveling, I try to. Again, not perfect, but I try to up my protein wherever I can. Because I do find when you travel specifically, this is where a lot of people struggle because it's so easy to find the combo of the high fat and the high carb. When you're in those little convenience stores at the airport or, you know, you're driving and you stop off at a rest stop or what, it's very easy to find these, like, processed foods that give you that sort of bliss point. It's like the high fat, the high carb stuff. So beef jerky, interesting that there's not, it's not very prominent in. I wonder if that's true for Europe in general. And I wonder if that's just like a North American cultural thing, I don't know. It's a very interesting observation that you make that it's not really available in the uk but that is usually my go to because you can always find it. I don't have to pre pack. I mean I typically will try to pre. Like I'll bring some macadamia nuts, that's like my favorite nut to bring. Or some beef sticks, that kind of, that kind of thing. If you have. I love the hard boiled egg option if your co workers are fine with sulfur containing foods or cheese.
- [29:33]
A
You know, cheese is another great one.
- [29:36]
B
Yeah.
- [29:36]
A
That you know, is really healthy for us. And there's this myth, you know, one of the big myths around dairy being so bad for us because it raises our cholesterol. Well, actually fermented dairy like cheese and yogurt, for people who have normal cholesterol, it doesn't raise your cholesterol obviously in moderation. So cheese is another great snack. That doesn't smell like eggs.
- [29:57]
B
Yeah, it doesn't smell like eggs. But what I was going to say is you can make an egg salad. You can make an egg salad, right. And you can put some mayo in there. So now you have like the protein, you get the choline and everything from the yolk and then you're getting maybe or some olive oil let's say and you're adding a little bit of fat on top of that. You can throw in some celery or whatever you're putting in the, whatever you're putting in the salad, in the, in the mix and then you sort of can. What am I trying to say? You're trying to, you're, you're masking the sulfur contain, you know that, that smell, that like, like non pleasant smell or that unpleasant smell that people might complain about with hard boiled eggs as well. There's always a way. There's always a way. Okay, so you mentioned dairy and you sort of offhandedly a few moments ago mentioned oats. And I will give you my best English imitation here. But I've heard you say, I've heard you use the term nutribullux. So I don't know if I'm saying that correctly, but basically where we see, and it's in the nutrition space where we see people become zealots, they become absolutely incensed that the carnivore diet is the way to the promised land. Or you know, seed oils as we mentioned, seed oils are definitely going to kill you oats. I want to make sure that we talk about oats because I've sort of gotten into arguments with people online around I call them protes, my protein and my oats, my pre workout or my post workout meal. So can we dive into. And I'm, I apologize, I'm sorry to all my UK listeners for my terrible accent. But nutribullets or you know this idea that we can pull out one little mechanism, let's say like, like with seed oils and say, oh my gosh, look, it's inflammatory in this specific case, therefore all seed oils are bad. Let, let's start with seed oils because we want to get the most people upset at the at as possible.
- [31:43]
A
I've already done that on a previous podcast and the amount of hate mail I got was actually shocking at first. But do you know what that's with seed oil?
- [31:52]
B
My audience, I have to say my audience, I love my Betties. They are primed for this. We've had people on the show talking about the value of seed oils in terms of healthy outcomes with body composition. So my Betties are not gonna send you hate mail, but they do want to understand. My Betties are very, my community is very smart. So they want to understand why is it that people literally are losing their knickers. There's my British reference for you. They're losing, they're, they're marbles around this idea that seed oils are, are killers. Why do people, why do people think that? First of all, let's talk about why that idea is so pervasive and then let's actually talk about what's actually happening.
- [32:33]
A
So I don't know why it's so pervasive. And it shocks me why it's so pervasive. And I think it's one of the many myths out there, but it's one of the really polarized myths out there. And my experience as someone that's relatively new to social media has been eye opening in terms of, wow, there are these influences that aren't necessarily trained in nutrition science in the way that I have had the traditional training, in the way that I also run my own clinical trials, etc, but have these cult like following of people that hang off their every word. And many of them have good things to say, many of them interpret the evidence well. But there are many out there that I think are spreading misinformation. Whether it's intentional or unintentional, it does the same thing, it does harm. And I think at the end of the day, as humans, we're hardwired to avoid harm. And so when you see some, you know, Instagram, Facebook, whatever headline that says X is toxic, that will get a click.
- [33:44]
B
And they're so confident.
- [33:46]
A
Yeah, yeah. And they talk in such a certain language that will get a click. Because we are hardwired. There's something to fear. What do we need to fear? Yet if you get a more balanced scientist like myself who says, oh, something is good for health or something might be good for health, firstly, it's a boring message because there's no risk, there's no fear. So it's not kind of stimulating that part of your brain. But also, as a evidence based scientist, you know, we are always taught to self doubt, to doubt the evidence, to question the evidence, to caution the evidence. So often we don't talk with assertiveness in the same way. We often caveat our arguments and that doesn't make such good clickbait. And so I think that's part of the problem that. But I'm just not as exciting as someone that's like, wow, this is gonna kill you. Watch out.
- [34:40]
B
And they're shirtless in a grocery store. That's the other component.
- [34:44]
A
I'm not going shirtless.
- [34:45]
B
You would not go shirtless in a grocery store being like, look at this canola oil. It's gonna kill you. Right?
- [34:52]
A
Or bikini or whatever, you know, not at my age.
- [34:54]
B
No. But that's, but that's the formula. And I would actually say that the way that you speak actually for me makes me more drawn to what you have to say just because I see this extremism. And we were actually talking about this just before we got, I was talking with my AV producer before. We cannot have this topic on this show because there's so many holes in the theory. And even just the word seed oils, like which seed? Which, like sesame seed. Like you're not going to use like, like to he, like what. What seed is? You know, it's, it's almost like saying woman. It's like, what woman? A perimenopausal woman, A woman with autoimmune conditions, a pregnant woman. Like what woman? You know, you have to be specific. So seed oils as this umbrella term, calling all seed oils bad. First my first red flag goes up and then it's the grocery store situation. And then it's the very affirmative, confident language. Like I will always listen to someone like you more than someone who's like holding up, you know, like in the grocery store at whole, at Costco or something. And it's like look or Tesco or whatever. It is and they're like, look at this. Can you believe they're selling this? And it's like, yes, I can. You know?
- [36:08]
A
Yeah, 100%.
- [36:10]
B
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- [37:23]
A
You know, there's so many nuances to the argument and I'd love to kind of myth bust some of the points that, that people make in relation to seed oil. So one of the points that people make is that well, over the last 50 years, our intake of seed oils has increased 20, 30, 50, you know, 200 fold. And so has our rates of cardiovascular disease, type 2 diabetes, cancer. So obviously it's the seed oil as well. What else has changed in that last 50 years? So much else has changed around the food that we eat, the lifestyles that we have, the environmental exposures, et cetera. So much has changed. So just because you can produce this beautiful graph that shows the rates of chronic diseases going up as our intake of seed oil is going up, that doesn't show causality. And I think something to remember as well is that or to think about is how are we eating seed oil? So about 60% of seed oils we estimate to be eaten in heavily processed, unhealthy foods. So ultra processed foods, which we know have the food matrix as we've talked about destroyed, have many additives, emulsifiers and other components that are not healthy. And so what we need to do is we need to look at research related to seed Oils rather than the foods that they're in. So if we want to talk about generally, you know, foods containing seed oils, fine, let's look at ultra processed foods. But if we really want to answer the scientific question, do seed oils cause health? Are they toxic, are they inflammatory? We need to look at clinical trials that have specifically fed individuals seed oils and different types of seed oils, because they're a really diverse food group versus suitable functional controls. And when I mean functional controls, I mean as a control group, a food that would be used in an equivalent way to seed oils. There's no point comparing a seed oil to an apple because you're not going to use a seed oil and an apple in the same way. You want to compare it to a functional equivalent like butter, like beef tallow, like lard, for example, or olive oil. And so that's the first thing, that just because chronic diseases have increased at the same time, that seed oil intake doesn't mean that they're causal. The second argument that many people use around seed oils being toxic is around this theoretical inflammatory pathway. And what we know is that if you incubate seed oils in a test tube, for example, under certain conditions, exposed to all sorts of things, you might increase in certain situations some inflammatory measures, or if you feed them in super physiological amounts to mice under certain conditions. But what you see in animals, what you see in a test tube doesn't play out in humans. And there's this theoretical pathway that one of the main fats in seed oils is called the omega 6 linoleic acid. It's a particular type of polyunsaturated fatty acid. And what we know is that in the body this can undergo changes to become another fatty acid called arachidonic acid. And upon appropriate stimuli, arachidonic acid releases certain chemicals which we call eicosanoids that can have pro inflammatory effects, pro coagulation, so involved in clotting, et cetera. And this is really important because if we cut our finger, we need to have local inflammation, we need to have local clotting, because otherwise how will we ever heal ourselves? So actually inflammation is a really important physiological process. It's only if it's excessive, repeated in the wrong place at the wrong time that it starts to become a problem. And hence why it is linked to some chronic diseases like cardiovascular disease. But our bodies are so, so clever at modulating how much inflammation happens and where it happens. And what we actually see from clinical trials is whilst there's this theoretical pathway, actually an increase in seed oils which causes an increase in this omega 6 linoleic acid does not bring around a increase in this arachidonic acid that's associated with the inflammation in our tissue. So there is no increase in tissue levels of arachidonic acid in humans when you increase your seed oil intake. Conversely, what many of the human studies show is that actually there's a reduction in inflammation when you increase your seed oil intake or omega 6 intake. And what they also show is that there's a significant reduction in cholesterol. We know that omega 6, so linoleic acid is a really powerful cholesterol reducing component of our diet. And so that's why all of the epidemiological data that does look at association and not causation. And I need to caveat, that shows that people who have a higher intake of seed oils have lower risk of cardiovascular disease, lower risk of total mortality. And there was a study out only two days ago that came out from the Harvard group. It was epidemiological study. So it did look at association rather than the causal link. They found that those people who had higher intakes of soybean oil versus butter had lower rates of total mortality, cardiovascular disease and so forth. But their clinical trials, these randomized control trials that specifically look at intermediary measures like inflammation, like cholesterol, will show that actually they have a beneficial effect. And the another reason that people say that seed oils are bad for us is that they're processed. So obviously they're bad for us. Butter's natural, lard's natural, beef tallow is natural, so it's better for us. Well, just because it's natural doesn't mean it's good for us.
- [43:20]
B
And cancer is also natural.
- [43:22]
A
Exactly. I mean, so many things. Mercury's natural, you know, and so that's another argument that's used a lot, which given the current food landscape, where we are consuming too many unhealthy processed foods, I can see why people, you know, jump onto that. But actually, just because it's natural doesn't mean it's better. And again, studies consistently show if you compare seed oils or oils rich in omega 6 with other natural oils like butter, like beef tallow, like lard, that the seed oils result in more favorable health outcomes.
- [43:57]
B
You bring up a really important point with the linoleic acid and reduction of cardiovascular disease and improving cholesterol and generally dyslipidemia. And this is something I want to talk to you about as it relates to menopausal women, because we do see with the loss of estrogen I've had guests on the show before calling estrogen sort of like the, you know, the female superpower. Right. It's very cardioprotective, helps with the, you know, vasodilation and constriction of our capillaries and our arteries, etc. And when we lose that in menopause, we do see this catching up, if you will, in terms of the incidence of cardiovascular disease to our male counterparts, there's almost like aphasic. There's, you know, we, we see the onset of CVD for men, usually somewhere in their 40s and 50s, and then we sort of have this like 10 year delay where then, you know, that five to 10 years after menopause we will see now an increase in incidence in cardiovascular disease in women. So I think this ties in really well with some studies and some literature that you've looked at in terms of how we can manipulate the diet to improve some of the outcomes that we see in menopause, like the increased risk of cardiovascular disease and cerebral vascular disease and type 2, type 3 diabetes and type 2 diabetes. Really? So can you speak to a little bit around and maybe we can tie this in with what you've looked at in terms of how we can manipulate diet in menopause to improve some of the outcomes, some of the challenges that we see in our beautiful menopausal women?
- [45:22]
A
Yeah, absolutely. And I think when we think about the challenges of menopause, I think we need to think about it in two broad categories. One, the health challenges that you've just talked about and two, the symptoms. And we talk a lot, I think, now in social media and there's a lot of awareness around the symptoms, but I don't think there's enough awareness around the factors that you've just talked about, about the fact, and we see this in our own research, that in terms of many of the risk factors for cardiovascular disease or intermediary risk measures for cardiovascular disease, such as cholesterol, such as blood glucose levels, insulin sensitivity, blood pressure and so forth, we're doing really well as women up until the menopause and we see that in our own data. And as soon as you hit that peripostmenopausal phase, suddenly we catch up with men. And we've published some research showing this in our Zoe Predict cohort, that as soon as you reach the perimenopausal phase, your blood pressure shoots up and actually goes above that of men. Your cholesterol goes up, your insulin sensitivity gets worse, your triglyceride Levels, your inflammation, et cetera, et cetera. So that's why we see exactly what you said, this sudden increased risk of cardiovascular disease. And so part of it is, unfortunately, the consequence of loss of oestrogen, which is why HRT has been. You know, there's emerging evidence to show that HRT can be of benefit in terms of reducing that risk, although we're only just getting those clinical trials coming out now. But I think this is also a really important point in time that we can therefore think about dietary strategies to reduce some of these intermediary risk measures. So dietary strategies to reduce cholesterol, such as making sure we eat the right types of fat, not worrying about the total fat that we're eating, but reducing saturated fat from certain sources, not all saturated fat. So that's another myth. Increasing our intake of polyunsaturated and monounsaturated fats, reducing our intake of refined carbohydrates, refined grains, and so forth, that will help reduce some of these changes that you see. Unfortunately, it's the inevitable part of going through the menopause.
- [47:40]
B
And so the PUFAs and the MUFAs, so the polyunsaturated fatty acids, the monounsaturated, these are examples of those would be the olive oils, the avocados, the nuts, and the seeds that you've mentioned. Can you give a few, just for action items? So it's like, okay, I know I need to be increasing my MUFAs and my PUFAs or my monounsaturated. That's like how they are in my mind. That's how I learned. Then polyunsaturated, monounsaturated. So what do we want to increase? And then the saturated fat, are we. And again, saturated fat, large category. Right. So that in. That is also there's the butter, as you mentioned, there's coconut. So talk. Talk to us a little bit about what we want to increase, what we want to decrease.
- [48:16]
A
Yes. My first recommendation would be, don't worry about the amount of fat that you're having with it. Always. I always caveat, Stephanie. Within reason. But within reason, I think I wouldn't worry about the total amount of fat you're having. What we now know is it's the type of fat that you're having. So increasing your mono and polyunsaturated fatty acids through the kind of foods that you've said, the advocados, the nuts, the seeds, the olive oil, the seed oil. Dare you eat. Eat that?
- [48:41]
B
Dun, dun, dun. Yeah.
- [48:44]
A
And by the way, actually, Stephanie, I do just want to say that one of the things that I've come under huge attack about my perspective on seed oil is that I'm paid by the seed oil industry, that I'm a seed oil ship.
- [48:55]
B
Oh, you're a big seed, your big seed oil.
- [48:57]
A
But I would like to ask. I'm talking about this now, set the record straight that I have never received a penny of funding from the seed oil industry. Not to say that I won't in the future because I've got loads of studies that I want to do on seed oils and if they're willing to fund them, great, because I can still work in a very independent way even if they had funded them. But I have never received any funding from the seed oil industry. So when I recommend seed oils as a source of poofa, it's based on my scientific knowledge and the evidence, not because I'm being paid by the seed oil industry. Okay? So avocados, nuts, seeds, olive oil, seed oils, any of these kind of plant based sources of fats we know are going to be really beneficial. We know that they'll reduce your bad cholesterol, your LDL cholesterol, and can in some instances have favorable effects on your HDL cholesterol.
- [49:48]
B
And the egg yolks, those are great sources of fat as well.
- [49:52]
A
So the egg yolks only have a small amount of fat. They are high in cholesterol. But what we do know is that unless you're having excessive amount of dietary cholesterol, dietary cholesterol does not have much of an impact on circulating cholesterol. So circulating cholesterol, so the cholesterol in your blood, when you go to the doctor and they do a blood measure of your cholesterol is predominantly coming from cholesterol that's produced by the liver in the form of either good or bad cholesterol. In very simple terms, where bad cholesterol is your LDL cholesterol, if you're eating a normal amount of dietary cholesterol, with eggs being quite a big source of that, the evidence shows that it doesn't impact your circulating cholesterol. It's once you get to quite high intakes. So that's why having one or two eggs a day is perfectly healthy in terms of cholesterol.
- [50:46]
B
Yeah. I also, this is the other thing that makes me, I'll say not angry, but I, I get, I get agitated by it is all cholesterol is good, right? There's no such thing as bad. I know that. That's how we talk about it, it's like good and bad cholesterol. Because the layperson, like, it's, it's, you know, we're gonna be like, okay, it's the carrier protein. It's like the carrier protein that's more oxidizable. Like, I understand that. But my. I do wanna say that, like, cholesterol is an energy. It's a wound healing energy substrate. Like, we need cholesterol. And as you mentioned, you know, I think it's around 80% of the cholesterol that's in our bodies is endogenously produced. Like, we are producing most of it. So if you go to your doctor and your doctor says you need to reduce your cholesterol, like if you stop eating all the egg yolks and all the shrimp and all the things that you think have, like maximally, you're going to decrease that by, I don't know, 20%. So you have to really understand that this is really gen. This is like there's some sort of genetic component to the amount of cholesterol that you're producing. And you don't have a lot of control over the total amount. But to your point, you do have control. And I kind of want to. This is sort of where I'm going with. This is like with our fat intake, we can kind of change the ratio of the carrier proteins. So like basically the boat or the taxi that takes the cholesterol to where it's supposed to go because we want carrier proteins that are less susceptible to oxygen. Right. They're less, Less oxidizable.
- [52:07]
A
Yeah. So I think that the evidence now is quite clear that within, you know, typical intakes of dietary cholesterol found in things like shellfish or eggs, like you say, it has minimal impact on circulating cholesterol in the blood. The easiest way to modify your circulating cholesterol is to change the type of dietary fat. So to reduce certain sources of saturated fat fat, to increase the poly and monounsaturated fat, like we've said, and that will reduce your bad cholesterol, the LDL cholesterol that we know is bad because of where it goes in your body and also how it can become, like you say, oxidized, how it can become taken up by the blood vessel lining and over time cause buildup of plaques, et cetera.
- [52:53]
B
Well, it's interesting too, because I think it's a little bit backwards for people to learn that. Yeah. That if you have more of the monounsaturated and polyunsaturated fatty acids, you're Going to actually improve your lipid profile. Whereas I think the maybe conventional thinking used to be like, remove all fats from the diet, have more high, have more carbohydrates, which we know. And I would love for you to speak on this in terms of, like, the difference in outcomes versus when you're having a carb, like more carbohydrates or more of these processed, simple, refined carbs versus more of these monounsaturated and polyunsaturated fatty acids and the impact that it has on cholesterol.
- [53:30]
A
Yeah, absolutely. And I think, Stephanie, you make an important point that we need to think always about the. Instead of what? And so the low fat shift that we saw maybe 20, 30 years ago is a great example of this, that there was evidence that fat might increase cholesterol and therefore increase the risk of cardiovascular disease, without looking at the nuances, that actually is the saturated fat that does this and not the other fats. So there was huge consumer demand for low fat foods, partly because of that, but also partly because fat is more calorific. So it contains 9 calories per gram versus carbohydrates, which is 4 calories per gram. So there was this huge shift in thinking as well, that if you remove fat from foods, you produce a low calorie food, so people will eat less and therefore they will lose weight. But with the removal of one nutrient becomes the problem of what do you replace it with? Because at the end of the day, that food still needs to be eaten. It still needs to taste nice. And so this is a huge challenge, I think, in food science, when you therefore create a food that's low fat, what are you putting in instead? And often other chemicals are added, whether it be sweeteners or refined carbohydrates, et cetera, et cetera, whatever will give give the same kind of functionality to the food. And often by stripping out the fat, you're actually creating a food that is less healthy. So many low fat yogurts, for example, will have lots of other nutrients added into them and lots of other sweeteners, not necessarily the natural yogurt. So low fat, simple Greek yogurt, low fat, simple kefir, or natural yogurt can still have all of the healthful components of the yogurt and very little added to it. But I think we always have to be quite careful when we see low fat alternatives. Well, what else is in there instead of the fat?
- [55:19]
B
Okay, so we have for menopausal women who are thinking about improving any type of DYSLIPIDEMIA whether it's high cholesterol or triglycerides or ldl, your recommendation is to increase the consumption of polyunsaturated and monounsaturated fats. We've given some examples of that to reduce the consumption of carbohydrates. What else would you think about, for, or maybe speak a little bit more about what were some of the food changes, if there were any additional food changes that you made with this menopausal cohort, the study that you looked at.
- [55:50]
A
So in our menopausal cohort, when we looked at one point in time in terms of risk factors for disease that we've talked about, but we also looked at symptoms and that's where we saw huge shifts, shifts and symptoms that changed when people change their diet. So I didn't really want to shift gears into thinking about symptoms.
- [56:12]
B
Yes, absolutely.
- [56:13]
A
So we have a huge cohort, ZOE, of over 250,000 individuals. And we looked at a subgroup of these of 70,000 women who were peri or post menopausal women. And we looked at their symptom prevalence and symptoms severity. And we looked at them at one point of time. And then in a subgroup of 4,000 people, we followed them over a period of time after they had changed their diet to look at how diet might be associated with changes of symptoms. And the first thing that we found was just how prevalent symptoms were. So we found that 99% of women were experiencing at least one symptom. We found that 66% of peri and postmenopausal women were experiencing 12 or more symptoms. And what I found most surprising is the symptoms that I typically thought about in relation to menopause, and this is me as a 48 year old woman, was hot flashes. That menopause is all about the night sweats, the hot flashes. Actually, we found they were the least common symptoms. They were still common in about 50% of women. But the most common symptoms were the symptoms that are related to our brain function. So they were things like brain fog, memory loss, anxiety, depression, mood swings, sleep disturbances. So about 85% of women were having these kind of symptoms, the brain fog, the memory loss, the sleep disturbances. That's a huge amount of peri and postmenopausal women having these symptoms. And we know from other research conducted in the UK, about 10% of women actually leave the workforce because of these symptoms.
- [57:49]
B
10%? Did you say 10%?
- [57:50]
A
There is survey work that's done here in the UK showing that 10% of women say that they've left their job because of their menopause symptoms. And when you look at our data, you can see why that such a huge proportion are having these really burdensome symptoms. And I think it highlights to us that as women going through the menopause, we need to be aware that it's not just hot flushes, it's not just night sweats that, you know, a few years ago I was thinking, you know, what's wrong with me? Why, why am I forgetting my words? Why do I forget why I go downstairs, which I still do every day, you know, why am I less coherent sometimes, et cetera. And that's so common for perimenopausal women. But what was really interesting as well is we measured people's symptoms about 12 to 18 weeks after going on the Zoe program, which is a personalized nutrition program. But underpinned is the basic eating health, the basic health eating principles. You know, increase your fibre, increase your diversity of plant based foods, reduce your intake of heavily processed foods and so forth. And what we found was that there was about a 35% reduction in the prevalence of these symptoms. So in the severity of the symptoms and the number of symptoms reported by women after they had gone on the Zoe programs, after they had modified their diet. Now, it is really important to highlight, Stephanie, there was no control arm. It wasn't a randomized control trial. It was an observational study where we were following women over a period of time. We do know that when you're reporting any kind of symptoms, whether it's menopause, pain, et cetera, that by repeat reporting you do often get a small reduction anyway just from that subjective nature. But I think to see a 35%.
- [59:35]
B
Reduction, that must be statistically significant. 35, yes.
- [59:40]
A
I mean, without a control arm, I'm being that cautious scientist that's not going to get that clickbait, because I'm not saying that extreme headline. But I think where we gain confidence, Stephanie, with this is that there are some clinical trials. For example, there's a clinical trial that compared the typical Western diet with the Mediterranean diet and they saw a reduction to a nearly similar magnitude in some menopause symptoms following a Mediterranean diet versus a Western diet.
- [60:08]
B
Was it the same like brain cognition, like the brain fog, the inflammation, the forgetfulness, the word constant confusion, all the things that happen.
- [60:16]
A
So for that study, if I recall correctly, I think it was mainly vasomotor symptoms. So by vasomotor we mean the night sweats, the hot flashes. That's because typically a Lot of research has just focused on those because typically, unfortunately, that's what people thought menopause symptoms were. The hot flashes, the night flush. So that's why many of the studies that are published look specifically, specifically at those symptoms. But the fact that some studies are seeing a similar magnitude of reduction gives me confidence that what we're seeing is likely to be a true effect. But I think we would need to do a crossover trial to really see how it compares to a control.
- [60:58]
B
You also said something just in passing, I don't even know if you realized it, that when some of these symptoms were happening to you, being immersed in this nutrition sign, even you were saying, what's wrong with me? Why is my brain not functioning? Why can't I remember why I walked into this room? I just think it's important to highlight because I think so many women jump there. We jump to blaming ourselves. What is wrong with me? Why am I broken? When we just have failed these beautiful women in predicting for them what is going to happen so that when they do experience these symptoms, they cannot identify. Maybe this is perimenopause, maybe this is some of the changes that are happening with my hormones and my metabolic hormones, et cetera. Like, we all, we always do this as women where we blame ourselves. Like, something must be wrong with me. So I just wanted to highlight that, not to embarrass you, but just to like, even, you know, a very well researched scientist who's in the menopausal nutrition science space can experience some of these symptoms and say, oh my gosh, what's wrong with me?
- [62:04]
A
I must be broken totally. And I still doubt myself. I'm still like, well, is this menopause? Am I getting dementia? Am I getting Alzheimer's? You hear so many women saying this. You know, what's wrong with me? You hear so many people say that. And I say, despite what I know, how do I really know it's the menopause versus something else we don't know, you know? And what gives me some confidence is I did decide to take hrt, so hormone replacement therapy, and I think that's helped with some of the symptoms. It doesn't entirely help, but yeah, I still get memory loss, I still get brain fog, I still get confused. And you know what I find really worrying, or rather I feel really sad about, is the amount of women that don't realize it's the menopause and think that, that there's something really wrong with them. And I don't mean medically, I mean psychologically, that they lose all their confidence. They lose their confidence to the extent that they don't want to go to work. They lose their confidence to the extent that things that were easy before, like driving to the supermarket, becomes a challenge. And you hear this, so many women saying this, and I think particularly the generation above me, you know, I am 48 and I think many of my generation are now realizing actually how impactful the symptoms are on our general well being. But I think if I talk to women who are maybe 10 or 15 years older, certainly here in the UK, there's this assumption that, oh, you just need to suck it up, it's just part of what happens, get on with it, don't be so melodramatic, et cetera. And I think that's awful. And even if you look at some of the traditional questionnaires that are used in menopause research, so there's the green climacteric scale that's typically used to look at menopause symptoms. One of the questions is about your level of excitability. I mean, Stephanie, I don't know about you, but if a male GP was to ask me, how excitable are you? I'd probably want to punch them because it's such a patronizing term. It makes me think of how the.
- [64:15]
B
Word hysterical, it's like that word.
- [64:17]
A
Exactly.
- [64:17]
B
I hate that word.
- [64:18]
A
Yeah. And it's like, oh my gosh, is that how women were perceived when they were going through the menopause? Thank God we are of a generation and thank God my daughter will be of a generation where that is not the case. And we've actually developed a new questionnaire related to menopause symptoms called the MENA Scale. It's an open access, free resource for anyone to use and it's making sure we use modern terminology. It's making sure we include the symptoms that we now know are the most prevalent. And you can get it on the Zoe website. So it's zoe.com menoscale anyone can go on. It asks about the top 20 symptoms and then it asks how severe they are for you. You can complete it daily, weekly, monthly, but it's the first online open access, free tracker that we've also recently just validated as well to be associated with quality of life. So women, if they are deciding to make a change to their diet can, before they start making the change or they are starting on hrt, they can go and fill out this MENA scale, have a look at what their score burden is at the moment and then maybe do it on a weekly basis and see if it starts to come down to see what works for them.
- [65:33]
B
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- [67:09]
A
But you know what, Stephanie? I know, you know, even for myself, you know, so many of these things are your own lived experience. So I was very lucky. When I was an adolescent, I had heavy periods, but I had no pmt. I had no cramps. I sailed through having my periods and my best friend used to take off about three or four days a month from school because of her cramping, because of the pain, because of her pmt. And I'm going to be really honest that I used to think, oh for goodness sake, you know, she should just get on with it. You know, everyone probably gets a bit of whatever, but it's only now that I'm learning that for some women, the cramps that they get in menstruation are on the same pain level as giving birth. We need to let people know that because I was one of Those people that unfairly judged my friends. Now I'm still friends with her. So I've apologized for that as an adult.
- [68:05]
B
Luckily, you're still friends. Yes.
- [68:07]
A
You know, but that's the problem. It's the same with menopause. And I think that we need to educate everyone around us as to what the reality is like, and I don't mean in a doom and gloom way, but I mean, just say that we can be more empathetic towards people.
- [68:22]
B
Yeah, yeah. And I think that that also speaks to the bio individuality of everything, including diet, which is what we're talking about today. Right. Your individual experience as a menstruating woman and then your experience as a perimenopausal and then eventually menopausal woman is going to differ from your girlfriend, from your sister, from your mother. Right. So it's important that we have these conversations so that we know when those things happen and to have a diverse amount of conversations that when these things happen, we don't misinterpret our experience as something is wrong with us. Right. And of course, there's, you know, this podcast, if you're listening to this show, you're going to know that there's lots of strategies that can help ameliorate some of these symptoms. I talk a lot about lifting weights and protein and stress management and all the wonderful things. And this adds some really great color as well.
- [69:06]
A
And I think, Stephanie, on that, there's another point I'd love to add is that in that bio individuality that you talk about, we also need to be mindful that what works for one person doesn't necessarily work for another person. And I think menopause is a really pertinent time for this because many women are dead. We know that 50% of women turn to alternative therapies like supplements, for example, in order to alleviate their symptoms. But what we know is that firstly, many of these supplements have very weak evidence to support them. And we use a term in science called menno washing. You stick menno in front of it and then you can charge ten times as much. But what we also know is that what works for one person isn't always what's going to work for you. So your friend might say, oh, my gosh, I've just started taking this supplement. I'm sleeping better, I'm more alert. I don't feel so anxious. I don't have my hot flashes. That's great. And that might work for them. That doesn't mean it's always going to work. For you. And we're starting to understand scientifically why. So if we take soy isoflavones as an example, Soy isoflavones are what we call a phytoestrogen. So these are chemicals that are found in soy products and they have the same structure as oestrogen. So they bind, or a similar structure, what should I say, to estrogen? So they bind to our estrogen receptors, they activate our estrogen receptors in a similar way to how oestrogen does. But what we know is that some women are able to convert these soy isoflavones into a really active form depending on the composition of their microbiome. And some people aren't able to convert them into such an active form. So we know if people have the right gut microbiome species to be able to produce what we call equal, which is the really, really bioactive form that binds really tightly in simple terms, that they will have a bigger reduction in symptoms when they take soy isoflavone supplements versus people that don't produce this equal chemical. And so that's a great example of where your friend might have started on a soy isoplane supplement and be like, wow, this is phenomenal. You might try it and it's like, it's made a small impact, but again, it's nothing wrong with you. It's because we're different. And what works for one doesn't necessarily work for the other.
- [71:23]
B
I've never heard of the term menno washing before. That's really crazy. Yeah. Is that. Is that just like anyone can say, hey, this is for menopause, and then just they're just jacking up the price because women are just so desperate to find some.
- [71:35]
A
Absolutely.
- [71:36]
B
Is that what it is? Yeah.
- [71:37]
A
I could take this cup of tea and I could say, this is a menopause tea. I don't need any evidence to prove that because I can call it a menopause tea. I would need some evidence to start making certain health claims. But I can call this a menopause tea. And rather than charging, I don't know how much it is a tea bag that I get, probably it works out 5p a tea bag maximum. I could probably charge £1 50. I could charge 20 times as much, I'm sure, because I put menno in front of it, because I wash it it with the word menno. You know, there's menopause hair conditioner, menopause hair shampoo, menopause face creams. Yes, our hair changes, yes, our skin changes during the menopause. But unless I'M totally stupid. How is a different shampoo that just says it's perfect for the menopause going to be different to maybe a shampoo that is just, you know, is for curly hair or maybe has a bit more oil in it, etc. I didn't know. But stick menopause menno in front of it and you can charge what you want.
- [72:40]
B
Wow.
- [72:40]
A
And it's a shameless. Because what worries me about this is great where there's evidence, but where you've got women who are desperate because they're experiencing these awful, debilitating symptoms.
- [72:49]
B
Yeah.
- [72:50]
A
And women who.
- [72:51]
B
It's predatory.
- [72:53]
A
Yeah, it's predatory for. And especially for women who can't afford it. But what I would say is if it does work for you and you can afford it and it has men in front of it, great, do it. But if it doesn't, move on and try something else.
- [73:08]
B
I can't waste this opportunity to just coming back to Nutribolics to ask you about oats.
- [73:13]
A
Oh, yes. Oh, sorry.
- [73:15]
B
It is one of my favorite foods to consume. I call it my protein. I do my protein powder with my oatmeal. It's either my pre or my post workout. I have gotten into, we'll say again, firm disagreements with people online. And there are people online who talk about this idea that the phytic acid gets that's from the oats come and just like steals all your minerals, like Pac man going around and you know, takes all your minerals from you. And I know that you've done a podcast on this which is going to be far more in depth than what we're going to talk about here. So I'll make sure that we link to it. There was a Zoe podcast that I was actually watching you talk about and you and your co host actually had two different oats. You know, I think you had paired it with some other things and he just had it naked. But I want you to talk. And then you measured your blood glucose. It was very entertaining. So why don't you, why don't you talk to us about oats, your opinion on them, how we might think about consuming them and then maybe debunking. Is it Nutribolics? Is it that the phytic acid is going to seal our minerals and leave us with scurvy and you know, all the other things that have been claimed online.
- [74:19]
A
Well, I think that there's loads of Nutribolics around oats as well as so many other foods like seed oils, like saturated fat, like dairy and oats. Is a great example where I think it does harm, because lots of people that were enjoying their oats and enjoying their oats in a healthy way are now avoiding oats. I think oats are a fantastic food, especially if paired with other foods in the right way. You know, oats we know contain this wonderful fiber called beta glucan, and we know that beta glucan can significantly reduce our cholesterol as well. So thinking back to what we talked about earlier, how would we reduce the increase that we see in peri and postmenopausal women in cholesterol that occurs? This is another great way to do it. And we know that if you can have up to 3 grams a day of beta glucans, it can significantly reduce your bad cholesterol. So that's about, you know, a large bowl of porridge oats will significantly reduce your bad cholesterol, and that's because of. Of the beta glucans. So I think that's one of the reasons why they're really beneficial. They've also got plenty of other minerals, plenty of other vitamins. I haven't even heard that myth around the phytic acid. So that's new to me. I mean, honestly, every day that I do a podcast, I hear the person interviewing me talk about another myth that they've heard of. That's like, wow, okay, so I didn't even know about that myth. I think what we hear in terms of oats a lot on social media is the scaremongering about the impact that they have on our circulating blood glucose or the blood sugar effect that. Oh, my gosh, they spiked my blood sugar.
- [76:01]
B
Spiked my blood sugar. Surprise.
- [76:04]
A
Yeah.
- [76:05]
B
Yeah.
- [76:06]
A
And I think if you're eating the old fashioned, you know, the rolled oats, the steel cut oats, the ones that you cook for more than like your 30 seconds, that they're going to. Yes. Cause a small increase in circulating blood glucose or blood sugar, because that's a normal physiological response to eating. It's a normal physiological response to having carbohydrates. But they're not going to cause this massive spike. The traditional oats. So the stale cut oats, the large rolled oats that take longer to cook, actually cause a quite small increase in circulating blood. The problem is where you get these really heavily processed oats that have been finely ground so the food matrix is destroyed. But also often they have sugar added in or other refined ingredients added in. That's where they can cause this big blood sugar spike that then causes this big blood sugar dip. But I Think what we can also do is make sure that we pair our oats with healthy proteins, healthy fats. So, for example, a great oat bread breakfast is oats with nut butter, for example, or seeds or other nuts added. And I think, Stephanie, you said you. What. What term did you use?
- [77:19]
B
Yes, I call them protes. So protein and oats. Yeah.
- [77:23]
A
And so I think, yes, they're a high carbohydrate rich breakfast, but they've got this amazing amount of fiber, this amazing type of fiber. And as long as you pair them with protein, whether it's in the way that you do or through other foods and with some healthy fats, they're a really, really healthy breakfast to have. And I think it's a shame that there is a scaremongering out there that, I mean, people are really moving away from that as a breakfast.
- [77:49]
B
Yeah. And it aligns with what you're saying. Aligns with the idea of the chrono nutrition. Right. So what when you eat certain foods, you know, during the day, like, we're more insulin sensitive, right?
- [78:01]
A
Yep.
- [78:01]
B
In. In the morning. So it would make sense that we would have more carbohydrates in the morning. And I've actually noticed a huge difference in my performance in the gym. So I typically work out in the morning if I don't have just, like, even just a little bit of carbs and protein. Like, it doesn't have to be a full protea with the nut butter and the chia seeds and the berry. Like, even if I just have a little bit of something, makes a huge difference in my ability to push myself at the gym. And so I just. I just really love what you're saying. And I think part of my, like, secret mission of this podcast is to really. Some of the. I don't know the exact right term, but we'll just call it, like, food dysmorphia. Like, people are so petrified of carbohydrates. They're so petrified of fats. They're so petrified of all these foods that are actually seed oils, like we've been talking about that are so great for us, that have such good literature demonstrably showing positive outcomes in humans. I just. It. You know, eating well shouldn't be as complicated as it is. You know, you have, like, the bros, like I said in the grocery store, screaming about whatever oil or whatever kale or whatever thing, and the phytic acid or the blood Gl. That's another one, like, blood glucose. Oh, my God, my blood glucose spikes when I Work out. It's like, yeah, you should expect that.
- [79:18]
A
Yeah, because firstly, you should expect it. Secondly, actually the beta glucans, because of how viscous they are, so kind of like sticky, they actually delay gastric emptying, they actually delay the rate they absorb it. And do you know what's really interesting in that, that people talk about it in such a negative way about oats causing this spike. Actually what the evidence shows is that eating oats improves your insulin sensitivity, that it reduces the risk of type 2 diabetes. So as well as the effect that oats has in terms of blood cholesterol and cardiovascular disease risk, in terms of we know it significantly lowers blood cholesterol, it also improves insulin sensitivity. If it was so bad for us, therefore in terms of our blood sugar, why would it reduce the risk of type 2 diabetes?
- [80:02]
B
Right, right, yeah. Common sense, unfortunately is not common.
- [80:07]
A
So one thing I love that what you said is that we need to just simplify things down and it worries me that. But I think with this explosion of social media and people talking about nutrition, we're over complicating things. And I think ultimately it just boils down to quite simple messages of have a balance, have a variety, avoid heavily processed food, have plenty of fiber, have plenty of plant based foods, ideally in their original structure. We don't need to complicate it more than that.
- [80:42]
B
Yeah, I couldn't agree more. That's beautifully said and a perfect way to end, a perfect way to wrap it up. So if we wanted to, if people wanted to find out more about you. I know you are one of the chief scientists at Zoe, tell us where we can find out about you. I know you mentioned the menoscale which we'll make sure that we add in the show notes as well. But tell us a little bit about where we can find more about you.
- [81:01]
A
So you can find out about the work I'm doing from my university website. So I'm a professor at, at King's College London. So you can go to the King's College London web pages to see about the studies that I'm running, the grants that I've got, the publications that we've got coming out. I'm also active on Instagram under Dr. Sarah Berry. So any new research that I'm either recruiting for, publishing or talking about will always be on my Instagram pages. And then our Zoe website is also a fantastic resource for people who want to find out more about what we're doing at Zoe, the science that we're doing, but also all of our Kind of opinion and view on the latest science that's coming out. And then we also have our Zoe Science and nutrition podcast that I regularly speak on. But we also have other experts in the field.
- [81:53]
B
And I don't know if it was an intentional, but I know this just from knowing a little bit of Greek. But Zoe in Greek means life. I don't know if that was intentional in terms of the naming of the company, but I do. I love the name Zoe.
- [82:02]
A
Whether it's intentional.
- [82:04]
B
It is intentional. I thought. I thought it might be.
- [82:06]
A
So one of our founders of Zoe is Greek, and so that's why we chose that name. Because for Zoe, everything we do is about life, about the pleasure of life, the pleasure of food, the pleasure that food brings in terms of our culture, our social setting, our emotions. And we want food to be about pleasure and not about restriction.
- [82:27]
B
Love it. Thank you so much, Doc. This has been just a delight.
- [82:30]
A
Oh, thank you.
- [82:34]
B
All right, so here is the after party, the after show comments where I tell you what I really think about this episode. So this was with Dr. Sarah Berry, and I gotta say some of the things that I really loved, like the highlights for me, and I'm interested to know if these are the same for you. There's a bunch of them. I've been making notes as she's been talking. So the first thing is this idea of chrono nutrition. Like how we eat when we eat is super important on our outcome. So she had mentioned, you know, snacking is okay, like, you can. The frequency of snacking doesn't matter as long as it's not really after 9pm and then as we're adding in things like more fats, more protein to our snacks, that can also lead to better outcomes in terms of body composition. So I really love that, especially as someone who I am a big snacker and I'm always. I have my main meals and then I'll sort of be looking for things in between meals. And I love the point that she made about snacking insofar as it's something that we choose, right? So meals are typically communal, where we might be having it with our children or our family or with coworkers or with clients or whatever. But the snacking is something that we actually have control over. So I thought that was like a really cool point. I was like, oh, yeah. When I snack, it's just me, myself and I al desco or whatever I'm doing. Right? So, so loved that. I also really liked the. The Nutribullox. There's my British for you talking about the seed oils. And at the end, if you made it through the end, and hopefully you're still listening if you made it to the end, where we talked about oats and how these are really demonized in social media, but actually have been shown in the literature to have positive health outcomes on our cholesterol levels, on our body composition, on our risk for cardiovascular disease, cerebrovascular disease, type 2 diabetes, et cetera. And then the other thing I loved was the menopausal chat. So talking about, first of all, have you ever heard the term mena washing? I feel like I'm gonna use this term now all the time, where it's like, you basically call anything in menopause whatever, and you'd like, you know, you charge, you know, 10 times, 20 times, 100 times the price. So that was a cool word that I learned. But then also that you can actually manipulate your food to improve not only the physiological outcomes. We were talking about cardiovascular disease, et cetera, but also your experience, right? Your physical symptoms, the vasomotor things like the hot flashes, the night sweats, but also some of the cognitive deficits that we see as well. The brain fog, the memory loss, the anxiety, the depression, the mood, the affect, all of that. I loved that. In general, I would say Sarah is a very measured and conservative scientist, and I really appreciate that. I think I said it in the show where I would prefer to listen to her than some bro shirtless in a grocery store, kind of like, yelling about, like, whatever, canola oil or how it's going to kill you or what have you. I often will. That's actually my clue. Whether someone is scientifically literate or not is how measured they are in their word choice. When you hear someone saying always and never, usually, that's a big red flag for me. Or categorizing something like, all seed oils are bad. Like, that's also. That throws a red flag up for me as well. So I hope that the overall message here for you is that we don't have to be as scared as food as maybe we've been led to believe on social media and that life and food can actually be quite pleasurable. Like, you can actually enjoy your food. It's not about restriction. It's not about depriving yourself of food that, you know, maybe is culturally significant for you or just food that you love. You can enjoy all of it within reason. Like, I'm not telling you to just go and have, like, wads and wads of peanut butter, right? But you know you can peanut butter and seed oils and oats and all these things are a part of a very healthy, nutrient dense diet. So I hope you love this as much as I did. I'd love to hear how what you thought of the episode. So if you want to leave us a note on Apple, you want to leave us a comment on Spotify or wherever you listen to the show, would love to hear it and we'll look forward to seeing you soon. All right. All right. I hope you enjoyed today's episode and I must give you the obligatory legal and medical disclaimer here. Year this podcast Better with Dr. Stephanie is for general information only and the advice recommendations we discuss do not replace medicine, chiropractic or any other primary health care provider's advice, treatment or care in the consumption of this podcast. There is no doctor patient relationship that has been formed and the use and implementation of the information discussed are at the sole discretion of the listener. The information and opinions shared on this podcast are not intended to be a substitute for primary care diagnosis or treatment. In other words, guys, be smart about this. Take it with a grain of salt. Take this information to your primary healthcare provider and have a discussion with him or her to make the best choice. That is for you. Remember, I am a doctor, but I am not your doctor and these conversations are meant for educational purposes only.