C (5:43)

And so, Davinn, does that mean that you didn't even want to sort of think about it for yourself, never mind not telling other people? Like, you didn't want to consider this could be happening to you? Because it's like, this happens to, like, women when they get really old, and that by definition, it's taboo. I don't want to think about it.

B (5:58)

And I think another thing that I have really embraced, once I learned that it was perimenopause, was grieving, not having any more children. I didn't want any more children, but I hated the fact that my body was telling me that I couldn't. And there is a thing you've got to go through, and when you step through the door to the other side and you've learned all of the things that hopefully we will be able to help you with today. Some of them, a lot of them, that the other side is great, but it's a journey to get there. But the journey is what makes it worthwhile. Nothing brilliant is easy, you know, you gotta put the work in.

C (6:42)

I'd really like to talk about sort of diet and other lifestyle changes and whether these can impact symptoms, whether or not you're on hormone therapy. I have to say that five years ago, so we were already into Zoe, I would have thought that reducing menopause symptoms with diet and what we're doing at Zoe sounded like crazy. But, Sarah, this is an area that's been a really big focus and interest of you. So we've ended up doing all of this study, and you've Just released this big new study.

A (7:11)

Can you tell us what you found.

C (7:13)

And maybe explain what it is?

D (7:14)

Yeah, well, I would say start by saying I would have agreed with you based on what little evidence there is about diet and menopause that, oh, diet can't do anything, particularly because of all these crazy claims out there about supplements, about, you know, there's silver bullets, whatever, that it will cure all of this. But we looked at this, we put it to the test in our Zoe Predict cohort. And so we followed 5,000 women over a period of up to about 20 weeks. And these were perimenopausal women who had signed up to take part in the Zoe membership program. So these are women who we did various tests to look at their metabolic health, their microbiome, and then deliver personalized advice to them on some of these tests, but also based on, you know, their health history, where they are now with their diet, their lifestyle, et cetera. And we asked them loads of questions about their health at baseline and their symptoms. And then we followed them up over this period of, you know, it was between about 18 to and beyond 20 weeks. And then we asked them at the end about their symptoms, about how many symptoms they had, about the severity of the symptoms.

A (8:23)

So, Sarah, just to make sure this.

C (8:24)

Is really clear, because we talk a lot often about different sorts of studies on, on this podcast. Is this a randomized control trial that.

A (8:35)

You'Re talking about here?

D (8:36)

No. So this is what we call longitudinal data in the science world, and longitudinal data means that we collect data at various time points. So everyone was following the Zoe programs, everyone was changing their diet. And we collected data at the beginning and at the end. And so we looked at how it changed over time. The gold standard of scientific research is to do a randomized control trial where we'd have had another group of people who would not be changing their diet so that we can check that it really is the diet that's changing. I wasn't really expecting to see much in this, if I'm honest, but actually, even I was surprised, Davina, to the extent that I asked the researcher to go back and redo the stats.

B (9:16)

Seriously, that's so funny.

D (9:19)

And we've got fantastic researcher George that's been doing all of this research for us, and this is the research also. It's funded independently by the British Menopause Society, and I think it's always important to state that it is independent funding for this. And what we found was around a 34% reduction in overall menopause symptom. Burdens. This is taking into account the number of symptoms and also the severity of the symptoms by following a healthier diet. And actually when we looked into the details of the dietary changes, we weren't actually seeing huge, huge changes in people's diet quality. And I think that to me, Jonathan, is what's most important. We are actually seeing relatively small shifts, but very meaningful shifts. And even just when people were having small shifts, we still saw a huge impact and we saw it across so many different symptoms. There are other people doing research in this area. It's not only us. You know, I'm very proud of what we're doing because we have the resources to do it at a scale that allows us to look at an individual level what's going on. But there's many other studies that are also being run now. And you know, although it, you know, it's slower than it should have been. And collectively what this research is showing is that following an overall healthier dietary pattern, a Mediterranean style pattern as we often call it, can improve, reduce your symptoms as well as it will help improve some of these risk factors, you know, that we talked about associated disease, your blood lipid, your blood pressure, et cetera. So the kind of fundamental principles are here are reducing your heavily processed unhealthy foods, these ultra processed style of foods, so your very heavily processed red meats, for example, reducing refined carbohydrates, you know, your pasta, your rice, your white bread. But as though we were always about what can you add in rather than what you have to take away. And so the great news is that where we see the biggest benefit is actually by what you're adding in. So adding in unprocessed plant based foods, so fruits, vegetable pulses, whole grains, oily fish, if you're not vegetarian, having a decent amount of healthy oils, because we know that will help with many of these disease risk factors, but also could help with the symptoms as part of this overall healthier diet. I do think, Jonathan, it's important just to mention that there is a place for some people for a particular supplement. Now it's always important to say, look, I can only what I'm saying now is based on the evidence we have, who knows, you know, the evidence is evolving week on week, so it might be in years time that actually I'm wrong and I'm always happy to say when I'm wrong. One area where I think there is good evidence is around soy isoflavones. So soy isoflavones have a particular property which is what we call A phytoestrogen, so it behaves a little bit like estrogen and it actually can stick to the estrogen receptors and therefore mimic the effect of estrogen. Now, in countries that have a high level of soy isoflavones, so this is particularly in East Asia, so Japan, China, et cetera, they have about 70 times the amount of soy isoflavone intake compared to the uk. They have actually significantly lower menopausal symptoms, which is really interesting because we see a population that has lower symptoms who have a higher intake of this particular nutrient or chemical found in foods. And we also know there's this very plausible mechanism. So what we do know, if you look at all of the control trials that have been run on this, if you take a supplement that contains a particular amount and it's above about 15 milligrams of a particular soy isoflavone called genistein, that that has a significant impact on reducing symptoms, I'm really sticking my neck out here because I am quite skeptical often about supplements, but I have to lead with the evidence and the evidence is supportive of this particular supplement.

C (13:10)

Davina. It's incredibly rare for, say, I think, to ever say anything positive about a supplement. So I agree that is really interesting and I'm sure we will be doing some studies around this in the future, am I right?

D (13:19)

We are. Because even more interesting is your response to soy isoflow bones is determined by your microbiome. And this is fascinating and this is a really interesting area of research that we're also looking at. So we looked at people's microbiome pre peri and postmenopause. So we looked at the composition of all of these trillions of bugs that are in our gut that we know are linked with health. And what we found was that the composition of the microbiome, peri and postmenopause was actually quite different to premenopausal. And another researcher has also found this. But when we looked at how the composition was different, what was really interesting is we could build on previous research that we published and we found that there was a greater amount of bugs species that are associated with higher inflammation, higher fat around the belly and some other unfavorable health effects. And if you were perior postmenopausal, you had higher levels of these particular species associated with these unfavorable health effects. And this is really exciting because if we can target that, it might be that we can partially reduce some of those unfavourable side effects.

A (14:32)

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