[Angela Foster] (0:14 - 0:19)
What is changing at that point of transitioning from peri into postmenopause?

[Dr. Sarah Berry] (0:20 - 0:56)
Premenopause, women are doing really well compared to men. We have lower blood pressure, lower cholesterol, lower levels of inflammation, a better distribution of our body fat. As soon as you hit peri and postmenopause, suddenly it all changes.

Blood pressure goes up, cholesterol level go up, inflammation goes up, and your fat distribution changes. Are seed oils causing inflammation? Most of the studies show that those who had a higher level of seed oil intake had significantly lower levels of all-cause mortality, cardiovascular disease, and other diseases.

The unfavourable effect of seed oils is actually not supported by evidence in humans.

[Angela Foster] (0:58 - 1:19)
Dr. Sarah Berry, welcome back. Thank you, Angela, for having me back. It's great to have you here.

You've done so much research, and you're so knowledgeable in this area. When we look at cardiometabolic health, specifically for women in midlife, what is changing at that point of transitioning from peri into postmenopause?

[Dr. Sarah Berry] (1:19 - 2:59)
So, Angela, we see lots of changes occurring peri and postmenopausally with women in terms of their cardiometabolic health, and by cardiometabolic health, I'm talking about factors such as blood pressure, cholesterol, levels of inflammation, levels of adiposity, but particularly visceral adiposity, so adiposity around your organs and around your belly as well, your abdominal adiposity. And what we've seen from our own research, and we know also from other published research, is that this is a huge time of change in terms of your cardiometabolic health for women. And interestingly, in our research, we see that premenopause, women are doing really well compared to men.

So generally, we have lower blood pressure, lower cholesterol, lower levels of inflammation, a better distribution of our body fat. So that kind of pear shaped where our fat is around our hips and not around our belly. As soon as you hit peri and postmenopause, suddenly it all changes and suddenly your blood pressure tends to go up.

Obviously, it's going to be slightly different for each individual, but if you look on average, blood pressure goes up, cholesterol level goes up, inflammation goes up and your fat distribution changes. So you go from the pear shape to the apple shape. And all of this is due to that loss of oestrogen, because we know that oestrogen acts on nearly every cell in our body and is very heavily involved in where we deposit fat, but also very heavily involved in how we metabolise food, how we also control levels of cholesterol, levels of inflammation and our blood pressure as well.

[Angela Foster] (3:00 - 3:38)
Super interesting. So when we're looking at that transition, when I sort of look at what happens with hormones, right, is progesterone tends to drop first and then we see oestrogen start to swing, right? It doesn't just go down in quite the same way as progesterone.

So women can be quite oestrogen dominant and then it comes down and then eventually, right, we see those hormones come to their lowest level and then you transition postmenopause. In terms of those changes that take place, so like that redistribution of body fat, noticing the belly fat going on, is that happening much closer to the menopausal transition or does that begin in the earlier stages of perimenopause as well? When do you typically see it?

[Dr. Sarah Berry] (3:39 - 5:12)
So what we see with our data is that this redistribution is occurring quite early on in menopause. And so, you know, you're right in saying that you have this perimenopausal phase or the menopausal transition phase where you don't have this beautiful, smooth reduction in oestrogen. You have what I always call the state of hormonal chaos, where you've got these peaks and these troughs and, you know, it's kind of a little bit all over the place, your oestrogen levels.

But during that time is when we start to see this redistribution, that you're getting more adipose tissue directed around your belly. And we know that this is problematic because we know that that is metabolically more active, but in a detrimental way. So we know that fat deposited around your belly has a higher likelihood of stimulating factors like inflammation, that it's metabolically more harmful than having it distributed around your hips.

We see that it gets progressively worse through the perimenopausal phase. And then we haven't actually looked postmenopausally at different stages to see if it continues to get worse. Anecdotally, we know from many people, they say my, you know, my middle just continues to expand.

I'm eating exactly what I was eating before. But it's quite clear that there's a lot of other published data showing that the risk of abdominal obesity, meaning fat deposited around the belly, can increase twofold in the perimenopausal phase.

[Angela Foster] (5:12 - 5:23)
That's quite a bit. When we look at women who are taking menopause hormone therapy, are they less likely to have the same gains in visceral fat?

[Dr. Sarah Berry] (5:24 - 6:38)
So we see that in our study, there's been other research looking at this and it's quite conflicted. So some studies show that HRT hormone replacement therapy or MHT menopause hormone therapy is protective. Some studies show that it's protective for multiple cardiometabolic factors, be it blood pressure, be it cholesterol, be it the abdominal obesity.

Other studies show less consistently that it is so. What our research shows, and this was published about three years ago, where we looked in, I think it was about 600 women, we looked at whether they were pre, peri or postmenopausal and we looked at all of these different cardiometabolic risk measures. And what we found was that if that you were taking some sort of hormone therapy, that there was protection for many of these different cardiometabolic health outcomes.

That's what our data shows. But I think it's really important to say that I don't think that there is the totality of the evidence isn't 100 percent consistent on this. But I do think that the majority of the evidence is supportive to this protective role.

[Angela Foster] (6:38 - 6:52)
And what about women who are eating foods that support oestrogen levels, for example, do we see that they also have less likelihood of having kind of inflammation and belly fat, visceral fat increase?

[Dr. Sarah Berry] (6:52 - 10:47)
So it's interesting, most of the research has been done in relation to symptoms around whether it's supplements or whether it's specific foods to support the menopause. Not so much has been done specifically in peri or postmenopausal women through the transition, looking at how it impacts these cardiometabolic risk factors. What we do know is from research in the border population, where it will be across all sorts of ages and across both sexes, that what is good for a male is typically good for a female and typically good at any age.

Now, obviously, there's some small nuances to this, but what we know is that reducing saturated fat intake is a key driver, a key lever for us reducing our blood cholesterol. And given the blood cholesterol increases during the menopause, then that's something we can focus on increasing our polyunsaturated fat intake can also reduce our blood cholesterol. And so there's commonalities across all ages and sexes that are really important in terms of reducing these cardiometabolic risk factors.

And so what's good for one person in terms of cardiometabolic health generally is good for another person. Where we do seem to see a more individualised approach is when we look at symptoms. And there's some really interesting data where people have studied soy isoflavones.

So soy isoflavones are used often for peri and postmenopausal women in order to alleviate symptoms. And this is because soy isoflavones contain phytoestrogens. Phytoestrogens basically mimic the activity of oestrogen.

So they actually bind to the oestrogen receptors. Now, what we know, though, is how one person responds versus another is very different. And I think this is where it's really interesting.

And I think it's really important for women to be aware of this, because I think certainly for me as a perimenopausal woman, it's all anyone talks about when you're collecting your kids at the school gate. Oh, I started taking this supplement. I'm feeling great.

Or and then someone else will say, oh, well, I've just going to, you know, blown all this money on it and it's not working for me. And, you know, great if it works for you. But also understand that there are some supplements biologically, physiologically will work for some people better than others.

So if we take the soy isoflavones as an example, what we know is that some people have certain microbes in their gut. So we talk often about the microbiome, these trillions of species that are in our gut that we know are intricately involved in our health. And some people have microbes that are able to convert the phytoestrogens that are in soy into a really active kind of compound that really simply put binds even more strongly to the oestrogen receptors.

And we call these people equal producers because they're producing a chemical called equal. And it's this equal that binds really strongly. And so what we know from clinical trials is that if you have these species enable you to produce equal, you have a 75 percent greater reduction in menopause symptoms if you supplement yourself with soy isoflavones compared to someone who it doesn't have the same gut species that doesn't have the same microbiome composition and isn't able to produce equal.

And so that's a great example where I could start taking soy isoflavones. My friend could take exactly the same. We could do everything else the same, but it might be that she's one of the lucky ones that's able to produce equal from those soy isoflavones and is feeling great and dancing down the street.

Meanwhile, I'm still in bed crying over not sleeping last night with brain fog, struggling with all these symptoms.

[Angela Foster] (10:47 - 10:54)
How would someone know whether they produce equal? Like, is that an easy thing to find out with a consumer test? So great question.

[Dr. Sarah Berry] (10:55 - 12:25)
It's something I would love there to be a test on. It's, as always, a little bit more complicated than just saying, OK, you've got this particular species because as well as whether you have the species, it's also about the functionality of that bug. So whether that bug is kind of working, so to say.

So this is something that there is a lot of research going on internationally at the moment to try and identify those species, but also identify the activity of those species. So it's something that from a research perspective, we've got a pretty good idea from. But commercially, it's not something that I'm aware of that is available currently as a test out there.

So how would you know? Unfortunately, it's by trial and error, by trying, you know, taking the soy isoflavones, seeing if they help and seeing if you're one of those lucky ones whose symptoms do reduce when you take them. What we know is that in the UK, in many Western countries, that the prevalence of equal producers, so people that have these microbes is a lot lower than, for example, East Asia, where it's a lot higher prevalence of people being able to produce equal.

And we believe that might partly explain why there's a lower incidence or lower prevalence of menopause symptoms in many of these East Asian countries, where firstly, soy is a regular part of their diet. But secondly, they also seem to be able to produce equal greater efficiency than we can certainly in the UK, in the US.

[Angela Foster] (12:30 - 14:05)
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I mean, you've added a whole new layer here, right? By saying you might even have the gut bacteria, but these little worker bees might be quite lazy by the sounds of it. And they're not actually, even if you have them, you've got to motivate them to do their job.

I'm not sure how we would do that. But if someone wanted to eat in a way that improved the composition of their microbiome so they did have more equal producing bacteria, how would they go about that?

[Dr. Sarah Berry] (14:05 - 18:08)
And so you could have a lot of soy, but in the typical Western diet that we consume or typical UK diet, I don't know how international your audience is. OK, so most like North American, North American, South American, European, British diet. It's actually quite difficult to consume the kind of the threshold dose that I think that is shown to be effective.

So there's been lots of clinical trials and what they show is that you need to be getting about 15 milligrammes of the particular soy isoflavone genistein for you to actually have significant improvement in your menopause symptoms. Now, again, you'll still get that variability, but this is what the clinical trials show. So, yes, the starting point is you could go to your health food store, you could look for soy isoflavone supplements, make sure it's rich in genistein as a soy isoflavone.

Will that grow those species? I don't know. I don't have the answer to that.

Will just following a microbiome friendly diet grow those particular species? Again, I don't know. What we do know is that there is a greater prevalence of those species that are from people who have a higher soy isoflavone diet, which is indicative that maybe having more soy isoflavone then encourages greater growth of them.

So starting point could be trying a soy isoflavone supplement, making sure it has 15 milligrammes of genistein. Obviously, I'm a nutrition scientist and would always take a food first approach, but I think we have to be practical. And in some cases, I think there is a place for supplements.

The other features are all of those features that we know improve our gut microbiome composition. First and foremost, increasing our fibre intake. You know, I think we're seeing a surgence this year.

Thankfully, one of the only food fads that I think I'm fully supportive of over the last 10 years, a fibre maxing. And so we're really going to see a transition away from this focus on protein that everyone's been preoccupied with over the last few years to fibre. And that's because 95 percent of us in the UK, in the US and many countries in Europe don't get enough fibre.

Only about five percent of us get even the recommended amount. And we think we should be getting even more than that potentially. So increasing our fibre intake is one of the best things we could do for our gut microbiome.

Having a diversity of different fibres we know is really important. So it's not just about the total amount, but it's about the quality and the diversity. We know that different gut bugs feed on different types of fibres.

And so having fibres from a whole diverse range of minimally processed plants, so whole grains, nuts, seeds, lentils, pulses, fruits, vegetables, trying to get as many of those plant based sources of fibre in your diet. Polyphenols, we know polyphenols, again, are really fantastic at improving the composition of our microbiome. And polyphenols are these bioactive chemicals that are found in many plant based foods.

They tend to be found in high amounts in pigmented, so very colourful fruits and vegetables. They tend to be what gives the fruits and vegetables their bitterness, but also the colour of their food. So raspberries, blackberries, blueberries are really high in polyphenols.

Polyphenols are also found in other foods and drinks that we wouldn't necessarily expect. Tea, coffee, cocoa, so chocolate, but make sure it's dark chocolate with lots of cocoa solids. Again, these are all great sources of polyphenols, all improve the composition of the microbiome.

And then as well as what you're adding in, thinking about trying to minimise those heavily processed, unhealthy foods, your processed red meats, for example, your processed grains. So, you know, your white rice, white pasta, those kind of foods, trying to keep those to a limit so that you're allowing enough space for all of these microbiome friendly foods.

[Angela Foster] (18:09 - 18:19)
I think I heard Tim Spector talking the other day about the bacteria that just wait for you to have a coffee. Yeah, my coffee felt so much more special in the morning after that.

[Dr. Sarah Berry] (18:19 - 19:13)
We published a paper last year where we looked at data in our ZOE predict cohort. We have data now on 350,000 people where we have very deeply phenotyped data around lots of health measures, but also really detailed diet data and very in-depth microbiome data. And what we found was that we could predict if someone was a coffee drinker by the presence or absence of a particular gut bug.

Now, don't ask me to name this gut bug because it's got such a long name and I cannot remember it for the life of me. But if you have that gut bug, we can say with 100% certainty that you are a coffee drinker and it's phenomenal. And it just shows, again, that power of if you're not drinking that coffee, you're not feeding that bug and then the bug will just die away.

So interesting.

[Angela Foster] (19:14 - 20:27)
When you look at just where we started with the visceral fat, you mentioned quite a few things, right? So we have poorer blood glucose control, we see inflammation going up, cortisol is playing a part that's rising. And we've got these changes in oestrogen.

When you look at visceral fat developing, if you have visceral fat, it seems that you're now more prone to insulin resistance. But if you have insulin resistance, it seems to drive visceral fat. So do we know like what is driving it?

Because I guess if I look at myself, I've been, just as an example, I've been monitoring my data using DEXA scans. And so across the kind of perimenopause transition, and I've seen a very minuscule rise, I didn't, and it's still below the radar, the level of visceral fat, but it's hard to isolate these things because I exercise daily. And so that I think makes a difference.

And then I try and eat as many of the types of foods that you're eating and all of those things, right, are also lowering inflammation, improving blood glucose control. So do we know like, is there a thing that's kind of the starting point of causing this and then the others are coming off the back of it? Or is it just this whole kind of metabolic issue that's all going on at the same time?

[Dr. Sarah Berry] (20:27 - 25:58)
So that's a good question. And it's a hard question. It's a bit like the chicken and egg.

We don't know which comes first. We do know that there is a bi-directionality. We do know that if you increase your visceral adiposity, then you increase your, um, you know, chances of insulin resistance due to particular hormones and chemicals that are released from your adipose tissue.

We know that if you are insulin resistance, then in turn, that also therefore means that we're not metabolising food in the same way. We're not, um, processing our blood lipids, our cholesterol in the same way, because insulin has a role on lots of, uh, with lots of other hormones as well. And so all of that can then contribute as well to weight gain.

So it's kind of this circular process. And I think what I often say to people during the menopause transition is, you know, to remember that it's a really challenging time in terms of you've got all of these symptoms going on, you know, we see in our own data, and we've got collected this data in hundreds of thousands of women, that although we typically talk about heart flushes, actually the most prevalent symptoms are anxiety, mood swings, depression, brain fog, poor sleep. And if you're feeling pretty damn fed up and you're not sleeping, how motivated are you to eat well? How motivated are you to do physical activity?

So you've got all of that going on. Plus the fact that this loss of oestrogen is directly causing a swell, this increase in, or this change in where your fat is deposited. We know that we know that oestrogen in simple terms, directs the fat to your hips.

We know as you lose oestrogen in simple terms, it then is more predisposed to going around your belly. So you've got the direct action of insulin increasing your adiposity around your belly. You've got the indirect effects of the fact that, you know, 85% of people report poor sleep, 80% say they feel anxious, depressed, fed up, low mood.

And so therefore less likely to want to partake in physical activity or even eat well. And then we also know that during the menopause transition, it can impact factors like your hunger signals. We hear so many people saying, I'm eating the same that I always had, but I'm so much more hungry.

We know that it impacts also how you metabolise food. So again, we've published some research from our Zoe predict studies where we looked at about 600 women and we looked at those who were pre or post menopausal. We gave these women exactly the same breakfast with exactly the same amount of carbohydrate.

It was a very high carbohydrate meal. Those who were post-menopausal had a significantly higher post glucose response, meaning that they had a significantly greater short term change in their circulating blood sugar levels compared to the pre-menopausal women. We then took this a step further because we know menopause is an age related disease, so how can you, or age related events, sorry, that was an error.

Um, we know that menopause is an age related event. So what we did was we then with our cohort took an age matched group of pre and post-menopausal women. So we had an equal amount of people of the same age who were pre and those who were post-menopausal.

And we still found that dependent on not your age, but your menopause status, there was this poorer metabolic response to consuming carbohydrates and post-menopausal women compared to pre-menopausal women. We know that this can go on to cause bigger glucose dips. So bigger dips in that circulating blood sugar two to four hours after consuming a high carbohydrate meal.

And again, we know from our own research that those dips in circulating blood glucose or blood sugar cause people to consume more, sets them off on this kind of rollercoaster. And so if people have this dip, our research shows they consume about 320 calories more over the day compared to if they don't have that dip. So you've kind of got all of these facts working against you.

And then it's at a time where so many women are saying, being so hard on themselves. Now I'm not saying, okay, sit back, eat what you want. Don't be physically active.

Yes, absolutely. It's one of the most important times to be physically active. But I do think as well that we need to be really aware of how unfortunately nature is working against us.

And I don't mean to paint a doom and gloom picture, but I think it's important to be aware of this because as a 49 year old woman, when I see these pictures of Jennifer Lopez, Halle Berry, you know, with their most perfect washboard belly and perfect figures, you know, it can be hard to think, wow, how can I live up to that? Now I can't because I have kids, I have jobs and, you know, also I want to enjoy my life. I want to enjoy my food.

I don't want to be on a treadmill all day long and only eating carrot sticks. Um, and so I just think it's really important that we recognise that our bodies are changing and that is a natural part of what happens as we age. As we go through the menopause transition.

Plus we have all of these other factors that are kind of working against us. But yeah, absolutely. Let's still try and be physically active.

And it is a point in time as well to be even more mindful than before about what food we're eating.

[Angela Foster] (25:59 - 27:59)
And to make the changes that we can, as you say, right, because women are under a formidable amount of, of stress. It's interesting because we have, um, a quiz that we started, um, uh, about a couple of months ago, I would say coming up to, and so far we've had around 1500 women take it. And over 40% of them report this increase in abdominal fat.

Um, but they also, as you say, report things like brain fog and also, you know, increased anxiety and just almost like the inability to be able to sort foresee what they want in their future with the same clarity. Right. I think there's so much going on that we actually just need to show a bit more kindness to ourselves and support each other.

And that's where I think kind of communities come in friendships, right. The moms at the school gate that you're talking about, right. We can support each other through this transition because we're all going to go through it.

Isn't, there's not a single woman that doesn't end up right. If she gets to that age, um, going through it. So I think that making the changes that we can, um, when we're looking at diet.

Um, one of the things that I think people often get confused about is, um, cholesterol and what raises cholesterol and what raises inflammation you mentioned there that saturated fats increase. Uh, I think there's, um, plenty of studies, right. Showing that saturated fats increase LDL cholesterol.

Then we end up in the whole debate of people will say, does it really matter? Is it oxidised? Is there inflammation going on?

Uh, are seed oils causing inflammation? I think, did you earn your label as the most hated woman in America for talking about seed oils? I did the pinnacle of my career, Angela, the high point when, uh, and in fact, I will link back to our previous episode, actually, where we talked about seed oils in quite a bit of depth.

Um, but can you clarify for, for everyone listening today, what causes, what foods are really causing inflammation and which ones are linked to increased cholesterol and increased cardiovascular risk?

[Dr. Sarah Berry] (27:59 - 33:35)
Yeah. So I think it's important to start with saturated fat. So saturated fat generally.

Um, is well known and the evidence is very strong to show that it increases LDL cholesterol, which is our bad cholesterol and therefore is associated with an increased risk of cardiovascular disease. So studies show saturated fat increases. Cholesterol can also impact inflammatory pathways negatively.

So increase inflammation and importantly increases risk of cardiovascular disease. I think though, it's really important to point out some of the neurones and as with everything in nutrition, it's a little bit more complicated than it looks on the label. And so I'm afraid I kind of have to go a little bit deeper because I think it's important to go deeper so that listeners can understand why there is so much confusion and potential miscommunication out there and misinformation out there.

What we know is that what food source, the saturated fat comes from also matters. And this is quite new emerging evidence. And so we know that the food matrix, which refers to the food structure, um, and also the nutrient interactions within that food also can modulate how a given nutrient impacts our health.

And so to put this into practise, that's something meaningful for anyone listening. We know that if we take dairy, saturated fat that's in it, unfermented dairy, and by this we mean butter, for example, very clearly is associated with an increase in LDL cholesterol and an increased risk of cardiovascular disease. However, fermented dairy, which is yoghurt and cheese actually is not associated with an increase in cholesterol and increased risk of cardiovascular disease.

And that is because of something that goes on during the fermentation process. We don't fully understand exactly what it is. There's multiple different mechanisms that have been proposed, but what we do know is consuming the same amount of saturated fat from butter versus cheese or yoghurt raises cholesterol.

But if you have that saturated fat in cheese or yoghurt, actually it doesn't raise cholesterol. And so this is why you can sometimes have these med influencers going online saying, Oh, this saturated fat story is all a myth. You've been told, you've been lied to all this time.

Saturated fat doesn't cause heart disease, doesn't raise cholesterol. Well, actually, if they're taking the data from yoghurt, they're absolutely right. But if you again, look at the totality of the evidence, populations consuming more saturated fat have higher LDL cholesterol, have higher risk of cardiovascular disease.

Saturated fat from tropical oils, coconut oil, palm oil, et cetera, raises LDL cholesterol. Saturated fat from the unfermented dairy such as butter raises cholesterol. So generally saturated fat, yes, absolutely reducing that can reduce our levels of cholesterol.

We know it's highly variable. There was a study only published about six months ago by a group in Reading in the UK that looked at the variability in response to reducing your saturated fat and increasing your polyunsaturated fat intake. And they found some people were really responsive that they had huge reductions in their LDL cholesterol, but some people almost had no effect.

So again, there is that into individual variability. Some people are more responsive than others. Great starting point of reduce your saturated fat to reduce your cholesterol.

What you can also do is increase your polyunsaturated fat intake. So your omega-6, which I know many people are scared of because of unfortunately, again, the misinformation out there is one of the strongest ways that you can reduce your LDL cholesterol. And contrary to all the misinformation out there, it does not negatively impact inflammatory levels.

So there's all these arguments. And I know we talked about this in more detail on one of our previous podcasts. So listeners can go back and hear me dive into that there.

But I think it's really important to reiterate that the evidence out there about the unfavourable effect of seed oils, because of their high polyunsaturated fat, particularly their omega-6 fat is actually not supported by evidence in humans. There's more than 40 randomised control trials. He's the gold standard of our research showing that seed oils or omega-6 polyunsaturated fatty acids do not increase levels of circulating inflammatory measures across a whole host of different inflammatory measures.

In fact, most of the studies show that they may reduce these levels of inflammation. They reduce our levels of cholesterol. It reduces risk of cardiovascular disease.

There was again, a great study published last year in JAMA in hundreds of thousands of people. They've been following them in the US over many years and looking at their levels of butter versus seed oil intake and found that those who had a higher level of seed oil intake had significantly lower levels of all-cause mortality, cardiovascular disease and other diseases. And so the evidence is consistent all in one direction.

Now, if you cherry pick out studies that are done in a Petri dish or in mice at super physiological doses under really unrealistic conditions, yes, you could find the odd study that shows that seed oils have a detrimental effect in that Petri dish or in that test tube, but not in humans based on current evidence.

[Angela Foster] (33:35 - 33:57)
And there was a study that you mentioned when you and I were talking a little bit offline, the Sydney Heart Study, is it that's often cited, but that was done, I think you were saying in the, in the seventies when there was partial hydrogenation involved, which is very different because that, I think that's been banned, has it not now in the UK? We don't have, we used to have, we used to eat biscuits and things, right? That would have partially hydrogenated fats, even peanut butter at one point.

[Dr. Sarah Berry] (33:58 - 36:58)
Yeah. And I think, Angela, this is a really great example of how and why there is so much miscommunication and misinformation because the pace at which are the foods that we're consuming, the processes that are being used by the food industry, the rate at which that's changing is incredible. And so studies that maybe were relevant 50, 60 years ago, aren't necessarily relevant now.

And all of these studies looking at partial hydrogenation is a great example. So the study that you refer to as the Sydney Heart Study, this was a study that was conducted in 1966. And this was in men that had previously had some sort of cardiovascular event.

And what they were asked was to increase significantly their polyunsaturated fat intake from primarily sources of omega-6 seed oil. So it was primarily using safflower, safflower seed oil, but other seed oil sources. And what happened was, is in the group of men who were asked to increase their polyunsaturated fat intake, they had significantly higher rates of death compared to those who had, or stayed on a high saturated fat intake.

Now that is evidence to say, oh my gosh, we shouldn't be consuming seed oils, look at increased death. But again, as I always say, it's a lot more complicated and nuanced than that. Back in the 1960s and seventies, most of the seed oils that were consumed were consumed in the form of margarine spreads.

So margarine spreads were produced following a process that was used by the food industry called partial hydrogenation. And what partial hydrogenation did would take a liquid oil, like a seed oil, it would undergo this process of partial hydrogenation to produce a hard fat that could be used like a margarine spread or used in confectionery or used in biscuits. But the problem was, so as a by-product, it would produce trans fats.

It was the trans fats that would actually give the solid attribute to the spread. And so it would produce a large amount of trans fats that we know are really bad for us. They increase inflammation, they increase cardiovascular disease risk, they increase our levels of LDL cholesterol enormously.

And in this Sydney Heart Study, actually the majority of the people were consuming the additional polyunsaturated fatty acids from seed oils in the form of partially hydrogenated seed oils that no longer resemble any of the seed oils that we consume today because the process of partial hydrogenation is no longer used. So the fats that we consume today in the margarine spreads that are formed from seed oils or from, you know, seed oils that are modified to go into different food products, they do not contain trans fatty acids anymore. And so, you know, I think it's a great example of, yes, there is truth to that story from the food that we were consuming 60 years ago, but absolutely not now.

[Angela Foster] (36:58 - 37:10)
But things have moved on, as you say. I guess the question that we covered it in the last one, but we should just answer it very quickly because I know it's going to be in listeners mind immediately. It's often asked is, well, what about the hexanes?

[Dr. Sarah Berry] (37:11 - 39:33)
Oh, my gosh, these scary processes that food industry put these fats through, you know, you see all these scary words such as hexane, ethanol, bleaching, deodorisation. You know, they don't go and put peroxide in to bleach the fat. I think that, yes, seed oils undergo a refinement process.

Yes, there are chemicals used. What then remains in the seed oil is either trace or non measurable. You know, it's so, so low.

We know that the majority of the studies, these randomised control trials that show that there's no increase in inflammation, that there's beneficial effects on cardiovascular disease risk and other intermediary risk factors are using refined seed oils, they're not from cold pressed seed oils, they are using refined seed oils, so I believe that the proof is in the pudding and actually if you don't put the seed oil through some sort of refinement process, firstly, you have a very ineffective way of producing the oil because if you're not refining it and using solvents like hexane to extract the oil from the seed, the amount of oil that you're extracting is very low.

So environmentally, I think it's very negative for our environment that you'll actually have so much waste. Now, some of that waste can be used for animal food, but you do have a large amount of waste, but also, you know, if you look at the research, if you speak to people in the industry and have an understanding of what the refinement process actually does and, you know, I'm not a food chemist, so I have just the kind of superficial knowledge, but what we do know is the refinement process is to remove impurities, it's to make that oil more stable, more shelf, give it longer shelf life, make it more stable for human consumption so you don't get so much oxidation, so you don't have any of these minor compounds that we know degrade the oil and ultimately can increase the oxidative capacity or rather, sorry, the amount of pro-oxidants in the oil. And so by, you know, this argument that, oh, well, it's bad for you because it's refined, it doesn't hold out in human clinical trials and it doesn't hold out if you actually look at the attributes of the oil post-refinement.

[Angela Foster] (39:33 - 39:57)
Thank you for clarifying that. One thing, just when you were talking about cholesterol there, you mentioned LDL cholesterol, what about the nuances around ApoB within that, that being more kind of pro, I can never pronounce this word, atherogenic, yeah, I was going to say atherosclerosis, yeah, atherogenic. Yeah.

Can you just explain that? Cause that's a question that commonly comes up for people.

[Dr. Sarah Berry] (39:57 - 43:58)
Yeah. So ApoB basically refers to a particular particle in which our blood lipids circulate, so lipids, whether it's cholesterol or triglycerides, triglyceride is the form of fat which we consume. So when we're consuming anything that's got fat in it, dietary fat, 99% of it is in the form of triglycerides.

They are not soluble in water. I mean, if you think you look at when you put some fat, you know, some melted butter in, uh, in water, you see it forms these big globules. So you cannot, um, blood fat cannot circulate in our blood because it's not water soluble.

So what happens is, is that when you consume fat, um, and fat produced by the liver, which also includes cholesterol, such as LDL cholesterol, our bad cholesterol, HDL cholesterol, our good cholesterol, they're packaged into these specialised lipoproteins, these specialised particles. Um, and these particles have almost like a delivery stamp put on them that directs them to where they need to go. And what happens is, is when you consume fat and also fat produced by the liver is put into a lipoprotein particle that has a apolipoprotein B put on it.

So like a stamp or, or an address label late labelled B. And so any dietary fat, any fat produced by the liver, any cholesterol is coming out of the liver is therefore packaged into this particle containing and what we call an apo B and what we know therefore is that, and the apo B directs in, this is quite simplistic terms, but directs the fat to our kind of peripheral tissues where it can be more prone to be taken up by our blood vessel lining under correct, um, environmental conditions, particularly if, um, you know, it's very inflammatory or pro-oxidant for example, and so what we know is that if you have higher levels of circulating apo B that tells us that you'll have more likely to have higher levels of LDL because LDL is always packaged in these apo B particles. And you're also more likely to have higher levels of triglycerides.

So fat either coming from the liver or coming from the food that you're eating. And we know that those triglycerides and those LDL cholesterol that's packaged within apo B is what we call atherogenic. So it can promote the formation of atherosclerosis, which in simple terms is that the furring of the lining of the arteries that build up a fat that you can get in the lining of the arteries.

And so what apo B does is give us a more global measure of harmful blood lipids. I think that's kind of looking at a deeper layer of the LDL. Yeah, absolutely.

And you know, there's loads more nuances. So people who are specialists in this area, and this is what I look at in a lot of my studies, you can go even deeper, you know, you can look at the LDL particle sizes, you can look at their density. You can do the same for HDL.

There's all of these other inter intermediary lipids as well and lipoproteins. But actually from a kind of population point of view, really from us as an individual, is your LDL cholesterol high? Is your apo B high?

If it is, yes, let's do something about it. Let's increase our polyunsaturated fat intake. Let's reduce our saturated fat intake.

Let's increase our fibre intake, particularly soluble fibre. So fibre from oats, for example, beta-glucan, that has a really potent role also in reducing our cholesterol levels, you know, and reduce all of those sources of foods that we know increase our cholesterol levels. So again, it's those heavily processed, highly saturated, you know, heavily processed red meat, pastries, et cetera.

[Angela Foster] (43:59 - 44:24)
Thank you for clarifying that. The final question is in relation to the estrobolone and how that gets impacted and how during that perimenopause transition and how it's impacting oestrogen levels within the body. I know that's changing and that we can then end up with our gut bacteria kind of opening up the envelope, if you like, and then oestrogen recirculating.

What's the best way to support the estrobolone?

[Dr. Sarah Berry] (44:24 - 44:57)
Gosh, that's a good question. That's a tough question. Something I don't think I know enough to be able to answer and something that I don't think generally we know enough about.

We do know that the gut microbiome plays a role in metabolising oestrogen. We know that oestrogen likewise plays a role in our gut microbiome. How we can utilise that to our advantage, I don't feel I have suitable expertise to give a clear enough answer, I'm afraid on that.

[Angela Foster] (44:57 - 45:40)
I'm always happy to say when I don't know something, Angela, and it sounds like, well, I'm grateful that you do, because it sounds like there might be more research, right, the microbiome is just our knowledge of it is evolving all the time, is there anything that we haven't covered? For me to sum up for listeners, I would say that we need to be, from what you're saying, we need to really diversify our diet and eat more foods containing polyphenols, all those bright colours, increase fibre, increase the sources, right, and the differences of types of foods that we're eating alongside all the other things like reducing stress, good sleep, exercise, et cetera, and go a little bit easier on ourselves, I think, as women going through this transition, but is there anything that I haven't asked you that you'd like to share?

[Dr. Sarah Berry] (45:41 - 51:57)
I think there's a couple of things. I think you're absolutely right. Let's be compassionate to ourselves during the menopause transition.

I also would say, have a look at all the different tools in your toolbox, and it's very easy for us to over-focus on what we're eating, but I think a really exciting area of research that I'm particularly interested in is how we eat. And by this, I mean things such as how fast you eat your food, the time of day that you eat your food, how many snacks you have, your snacking habits, your fasting periods. We know all of these matter, and sometimes it's easier for us to make those kinds of changes than it is to do a vast overhaul of our diet, because, you know, our diet is so ingrained in our culture, our social interactions, in what's affordable, accessible to us.

You know, for me, it's about what my kids will eat, and unfortunately they won't eat those pulses, beans, et cetera. So, you know, there's other ways that we can also improve our health, and that is through how we eat. And so we know that eating speed, for example, is one really simple thing that we can do.

We know that on average, many of us eat very fast. We don't need to do a fancy test. Most people know if they're a fast eater or not a fast eater.

We know from research, if you can just slow down the rate at which you eat your food by 20%, you can subconsciously, without even realising it, reduce your calorie intake by 15%. So if you know you're a fast eater, and you will know this from when you're sitting at the table, when you realise, oh my gosh, I've finished all my food, but everyone else is still eating, just slow down the rate at which you eat your food. Try not to eat after nine o'clock at night.

Again, really consistent evidence showing eating later at night negatively impacts your metabolic health, particularly important during the menopause transition and postmenopausally. We also know if you eat later in the evening, the more calories you eat later in the day, actually the more hungry you wake up the next day. And so that's something to be quite mindful of.

And then we're also really starting to understand how giving yourself a 12 to 14 hour window overnight where you're not eating, so a fast period of 12 to four hours is actually really important in improving your gut microbiome and your metabolic health. So even if there's no difference in terms of body weight, and a study came out, I think it was last week, showing old people practising intermittent fasting or time-restricted eating didn't lose weight, well, actually it's not just about weight. What we know is that for those people who are eating in a 10 or 12 hour window, so giving themselves a rest overnight, giving all of their cells a rest, that they tend to have better metabolic health.

And we see this in our own studies. So there's a few little tweaks that you can make that I think can also go a long way. And then one last thing to think about is consistency.

And we know now that consistency of sleep is so important. So we publish research looking at social jet lag, social jet lag basically means the difference in the timing of your sleep from weekend to weekdays or work days to non-work days. And we know that people who experience social jet lag, so have these kind of erratic sleeping patterns, actually have poorer metabolic health, have more unfavourable microbiome composition.

And we've done research on this. What we're also starting to understand is consistency in eating patterns also seem to matter. And there's some research that was published recently showing that if you have an inconsistent or erratic eating pattern, that that could be associated with poorer metabolic health compared to having a consistent eating pattern.

And so what I mean by this is, you know, some people will say, Oh, I'd be really good today. I've just had two main meals. And then the next day they're like, Oh, well, I was so good yesterday.

You know, I'm going to have five, six snacks. I'm going to have, you know, my three main meals, but then the next day I'm going to be good. The evidence shows our body likes consistency.

And so if you are a snacker, fine, carry on snacking. And again, we've shown that as long as it's good quality snacks, it's fine to snack. But if you're not typically a snacker, don't start snacking.

It's about having that consistency day to day. So I think these are things that we can all do that shouldn't have too much of an impact on us. And then I think Angela, the last thing I'd like to mention is snacks.

We've done so much research on snacking. 25% of our energy in the UK, in the US and many Western countries comes from snacks. That's a huge amount.

That's quarter of our calories comes from snacks. What we know is that actually, if you can snack on healthy snacks, that can actually significantly improve your health. And the most important thing I think to remember about snacks as well is generally they're under our own individual control.

What I have for breakfast is under my control. What I have for snacks is generally under my control. My lunch and dinner is generally dictated either by my kids or by where I am having lunch that day, whether it's a work setting, et cetera.

But most of us can control our snacks. And we conducted a clinical trial at King's where we randomly allocated people to either consume typical UK snacks and US snacks or consume almond nuts. And what we found was that after a six week period, the improvement in LDL cholesterol and blood vessel function, when people were having healthy snacks, so nuts instead of the typical UK, US snacks was so high, it equated to a predicted 30% reduction in cardiovascular disease risk.

They didn't change anything else. They were told just carry on doing everything else that you're doing. And so I think sometimes we need to think outside the box and that's why I wanted to mention how we mentioned snacking.

If there's one thing that your listeners do today, it could be slow down how fast you eat your meal tonight and tomorrow, think a little bit more carefully if you are a snacker about what kind of snacks that you have, because you can significantly improve your health by doing both of those two things.

[Angela Foster] (51:57 - 52:41)
That's extraordinary. That's so powerful. Just like have a handful of almonds instead.

What would you say to the parent listening to this who maybe has to run their kids around? I have to do this a few nights a week where we're doing club runs, right? And it's impossible to eat as early as I would like.

Is there a way of composing that meal that would be better for me? So for example, I know we talk about having plants and whole food source of carbs and things like that, but would like lowering the fat intake in that food give me better recovery overnight or reducing the protein or the amount of carbs to control for blood sugar spikes? Like, is there something that we could do if there are some nights or, you know, we're eating out with friends, it's kind of eight, nine o'clock or even half nine, what could we do to improve outcomes?

[Dr. Sarah Berry] (52:41 - 54:28)
So I think firstly, if you're eating out with friends, enjoy it. Don't worry about it. Food is there to bring us joy.

It is part of those social interactions and embrace that. And so I would say to anyone, if you're having a lovely time out with friends and you're still eating at 10 o'clock, don't sweat it. It's not going to make a big difference.

I think though, as a busy working mum as well, it is really problematic. I mean, I just pick so much on those kinds of evenings because you're dashing here, dashing there. I think often the best thing is, is planning ahead.

But again, how can we do that as busy working mums? Having leftovers, cooking extra the night before so that you can have whatever you cook the night before the next day or freezing it, batch cooking, those kinds of things, batch cooking stuff that can just be chucked in the microwave and very quickly cooked. I tend to actually eat with my children, even if it's five o'clock, but that's because I, I quite like eating early and then I'll have a snack a bit later.

But unfortunately, you know, there's no magic answer to that. And I think this is part of the problem that we have. Everyone blames, you know, the terrible food landscape that we have with all of these heavily processed unhealthy foods.

But the reality is, is most households have two working parents who have full-time jobs. They have kids who nowadays, you know, have all of these, like you say, clubs to go to their own social life, their own sports that we're trying to get them to. And it's challenging.

There isn't time and we are not giving time that we used to 50 or even just 20 years ago to preparing these wholesome home cooked meals. And I don't know what the answer is beyond the obvious stuff like the batch cooking, that sort of thing. Um, yeah, I mean, I suffer the same and unfortunately Uber Eats is on fast style often on my phone, which is not ideal.

[Angela Foster] (54:28 - 54:41)
But it happens, right? It happens sometimes. I think it sounds like what you're saying then is to the, to the best extent that you can and plan is eat something healthy, but there's no, um, particular foods that it's like, oh, if you're eating late, skip this and have this.

[Dr. Sarah Berry] (54:41 - 55:42)
No, I mean, look, there's evidence to show if you're having high fat foods late at night, it can impact your sleep. But then at the same time, if you're having high carbs late at night, then, you know, there's evidence to show that that's not beneficial in terms of metabolising as well, your, your glucose. I think it really goes back to the very basic healthy eating principles of having a balanced meal that's got balanced amount of healthy proteins, healthy fat, healthy carbs coming from minimally processed foods.

Um, I don't know, but there might be studies out there that have looked specifically about, you know, the, the perfect way to, uh, sorry, I'm really sorry, something popped up cause I meant to be in my other meeting. Um, you know, there might be studies out there looking specifically that I'm not aware and, you know, I think to any listeners out there, I've said now a few times, I don't know, I don't have the answer, but I hope that that's a sign of a good nutrition scientist because we can't be experts in everything. Don't trust the person that says they know everything.

[Angela Foster] (55:43 - 55:54)
100%. 100%. Thank you so much, Dr. Sarah Berry. It's been amazing to have you back. And, uh, yeah, there's just so much, so much gold in there for people to listen to and take away and super practical. Thanks for coming back on the show.

[Dr. Sarah Berry] (55:55 - 55:57)
Pleasure. Lovely to see you again, Angela. Take care.

[Angela Foster] (55:58 - 57:21)
I hope today's episode inspired you on your journey to vibrant health and high performance. Make sure you check out the show notes for a summary of all the important links to everything we talked about. And if you enjoyed this episode, hit the follow button and share it with a friend on social media, or leave a review over on Apple podcasts.

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If you’re entering perimenopause and suddenly noticing more abdominal fat, higher cholesterol, poorer sleep or increased anxiety, you’re not imagining it.

In this episode, I’m joined by Professor Sarah Berry to unpack what actually changes in women’s cardiometabolic health during the menopause transition. 

We explore why premenopausal women are often metabolically protected compared to men, what shifts during perimenopause, and how declining estrogen impacts fat distribution, blood glucose control, inflammation and cholesterol.

WHAT YOU WILL LEARN
• Why cardiometabolic health often worsens during perimenopause
• When visceral fat redistribution typically begins
• The role of estrogen in fat storage, cholesterol and inflammation
• Whether hormone therapy protects against abdominal fat gain
• How glucose dips can drive an extra 300+ calories per day
• What ApoB really means and why it matters beyond LDL
• The truth about seed oils, saturated fat and cardiovascular risk
• Why soy isoflavones work for some women but not others
• How replacing typical snacks with almonds predicted a 30% drop in cardiovascular risk

Disclaimer: The High Performance Health Podcast is for general information purposes only and do not constitute the practice of professional or coaching advice and no client relationship is formed. The use of information on this podcast, or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for medical or other professional advice, diagnosis, or treatment. Users should seek the assistance of their medical doctor or other health care professional for before taking any steps to implement any of the items discussed in this podcast.