Top 5 things to know about nutrition in perimenopause

Top 5 things to know about nutrition in perimenopause
Photo by Alyson McPhee / Unsplash

You're 40+ and what used to work isn't working anymore. You feel tired, bloated, your blood pressure, cholesterol and weight are creeping up. You're down a rabbit hole or lost in the weeds with conflicting information on what to eat. Let's cut to the chase – what do you need to know about nutrition to feel better and reduce your risks during perimenopause and beyond?

1.Lean protein matters.

The World Health Organization’s global recommendations for protein intake for a sedentary adult is 0.8 gm protein per kg body weight.  Women in midlife need markedly more (1.1-1.5+ gm protein/kg body weight) to off-set age-related changes in protein metabolism and muscle breakdown.  With aging there is a decline in protein absorption from the foods you eat, a decline in the hormones that build muscle (estrogen, progesterone, testosterone, melatonin, growth hormone) and an increase in the hormones that break down muscle (cortisol, excess insulin). Women in midlife can lose 3-8% of their muscle mass every decade from age 40, with a corresponding decline in metabolic rate and increase in body weight. Maintaining and building muscle in midlife requires intentional fuelling and fitness to compensate for the age-related decline in muscle mass, while simultaneously providing a generous pool of amino acids from dietary protein.  

2. There’s no magic macros.

The macro ratios that work will be the ones that keep you full and include foods you enjoy eating.  Assuming 1.1-1.5 gm/kg lean protein stays stable, a lower carb/higher fat intake can be beneficial for women with insulin resistance, assuming those are the foods they enjoy eating in the long run.  For women who aren’t insulin resistant and prefer a purely plant-based diet that’s naturally low in fat, again with protein maintained at 1.1-.15 gm/kg, this can be an effective approach.

The dietary pattern with the most research for health and prevention is the traditional Mediterranean style of eating which is moderate protein, moderate carbohydrate and moderate fat. It’s a flexible pattern of eating that focuses on whole foods, lean protein, high fibre foods, extra virgin olive oil, fresh fruits and vegetables. It fits with the palate and lifestyle of many cultures, which may explain part of its success.

What doesn’t work for macros is high fat, high sugar and erratic protein intake, which is the standard North American style of eating.

3. Calories matter.

Over-eating and under-exercising drive insulin resistance, high cholesterol, hypertension, type 2 diabetes. Poor metabolic health can compromise bone density, contribute to hot flashes, night sweats and depression during perimenopause.  A modest calorie deficit most days of the week – where your body, mind and spirit aren’t stressed by the decrease in calories – provides a metabolic milieu that discourages inflammation, heart disease, weight gain and diabetes.

4. Less is better with alcohol.

Alcohol is a risk factor for many of the conditions you’re working to prevent in midlife-insulin resistance, weight gain, hot flashes, night sweats, disrupted sleep, fractures, breast cancer. There’s a 7-10% increased risk of breast cancer for each 10 gm (<1 drink) consumed per day. For breast cancer, there is no “safe limit” of alcohol consumption. Even drinking small amounts of alcohol can increase your risk.  

5. Build a Nutrition System.

You’re playing the long game in midlife nutrition. More than ever, the focus moves away from short-term, “crash” dieting,  and more on developing sustainable nutrition systems that set you up for nutritional success most days of the week.  A nutrition system includes a routine around meal planning, grocery shopping, food prep, cooking and clean-up. Some examples of nutrition systems:

– outsource and hire a personal chef. Hand over a shopping list and let them work their magic.

-use a meal kit or meal delivery service. Let the service take care of the groceries, meal planning. You just cook and clean up.

-prepare a weekly meal plan with a repertoire of 7 recipes to rotate through the week. Food is prepped fresh every night. There’s no surprises and ingredients are always there.

-meal prep system. Prepare 4-5 batches of food at once, and enjoy throughout the week

-meal assembly system. Prep or cook a selection of individual whole foods, store them in individual containers and simply assemble them throughout the week at mealtime

You want to develop a system around foods that help you feel your best.

Have some fun experimenting with different recipes and foods. If it’s available to you, consult with a Naturopathic Doctor, Functional Medicine Dr, Nutritionist or Dietician who can provide clinical guidance and make personalized recommendations.

Then, when you discover how to eat to feel your best, the bigger job is to build a system so you can eat like that every day. A system takes time to implement initially but in the long run sets you up for efficiency and consistency.  Getting different results in midlife often demands different habits and strategies.

Bio: Julia Fountain ND NCMP is a Naturopathic Doctor, NAMS-Certified Menopause Practitioner and founder of HealthSpan Wellness in Georgetown ON.  She provides education and evidence-based clinical support by offering the best of all worlds - nutrition, lifestyle medicine, herbal therapies,  laboratory testing and menopause hormone therapy for women 40+. For more on her group programs and private practice for women looking to build their health and put life on play, not pause in midlife, visit