ZOE Science & Nutrition - Davina McCall: Make this choice every day to reduce menopause symptoms

Episode Date: September 5, 2024

Half of the world’s population will go through menopause. Yet research shows that a large proportion of women do not feel informed and equipped for menopause. In this episode, we reveal the results of a brand new study that highlight the impact of diet on menopause symptoms. Davina McCall is a British household name and much-loved TV presenter on a mission to change this. Her 2022 book Menopausing provided a roadmap for women to be fearless in tackling this stage of life. She has her own very personal menopause story and today, she shares it with us. Together with ZOE’s Chief Scientist, Prof. Sarah Berry, we’re having an honest and open conversation about perimenopause and menopause. 🤲 MenoScale Calculator - Track your menopause symptoms with our free tool 👉 zoe.com/menoscale 🥑 Make smarter food choices. Become a member at zoe.com for 10% off with code PODCAST Follow ZOE on Instagram here. Timecodes 00:00 Every woman goes through this 02:20 Quickfire questions 04:25 Davina’s menopause experience  14:16 What happens during menopause 15:20 The impact of estrogen decline 17:40 How long does perimenopause last? 18:30 Is there a blood test for menopause? 24:20 What menopause symptoms are most common? 32:35 Does everyone get symptoms? 35:54 Does menopause increase disease risk? 39:15 Should you consider HRT? 45:30 Davina’s life changing experience 47:40 ZOE’s new study on diet and menopause 52:33 Can ZOE membership improve menopause symptoms? 54:26 Can supplements improve menopause symptoms?  56:21 Gut microbiome health in perimenopause 58:26 Davina’s tips for exercise in menopause Free resources from ZOE: Live Healthier: Top 10 Tips From ZOE Science & Nutrition  Gut Guide - for a healthier microbiome in weeks MenoScale Calculator - learn about your symptoms Mentioned in this episode: Menopause is associated with postprandial metabolism, metabolic health and lifestyle: The ZOE PREDICT study (2022), published in eBioMedicine Sex and Menopausal Status Modulate the Impact of Meal Timing on Postprandial Glucose: Data From the ZOE PREDICT 1 Study (2024), published in Current Developments in Nutrition Management of menopause: a view towards prevention (2022), published in The Lancet: Diabetes and Endocrinology  Menopause: a cardiometabolic transition (2022), published in The Lancet: Diabetes and Endocrinology  Treating menopause — MHT and beyond (2022), published in Nature The Menopause Transition: Signs, Symptoms, and Management Options (2020), published in The Journal of Clinical Endocrinology & Metabolism Have feedback or a topic you'd like us to cover? Let us know here. Episode transcripts are available here.

Welcome to Zoe, Science and Nutrition, where world-leading scientists explain how their research can improve your health. Hi, I am clearly not your host, Jonathan Wolff, co-founder and CEO of Zoe. This is Davina McCall, and I'm in the the driving seat today and I'm going to tell you why. You see, there's a stage of life that every single woman goes through and it's not spoken about much. Your mum probably didn't tell you about it, your teacher never taught a class on it, that's for sure. But let me tell you something, if you've not been through this stage of your life already, it's coming for you. So I suggest you prepare yourself. For way too long, we've kept quiet about the menopause, the onset, the symptoms, the treatments, but those days are over. Today, we are shouting from the rooftops. So back in 2022 I published my book Menopausing.

What I really wanted to do was change the way that society perceived and saw us as midlife women and I wanted to share what I learned with you. I'm joined by my friend, Dr. Sarah Berry. She's a professor at King's College London and chief scientist at Zoe. And she's just led a new study about how diet affects menopause symptoms. And Jonathan's here as well. There's two really important reasons that Jonathan's here.

Obviously, he asks really good questions, but also because we need men on side. We really, really need all the allies we can get to hear us, help us, support us. So thank you. Davina and Sarah, thank you very much for joining us today. I'm so excited. Really excited. I can't believe it's you.

It's so funny. Your voice is so familiar to me. This is crazy. Well, I'm incredibly flattered. And I'm just hoping that my wife heard that because she is one of your biggest fans. So the fact that you just said that is going to win me more brownie points than anything I have ever done at Zoe. So Davina, Sarah knows this. And I know you do listen to the podcast.

We have this tradition here at Zoe where we always start with a quick fire round of questions. And you can say yes or no. See, I know. Are you ready to go for it? Yes. All right. Did you think you were going crazy when you were first in perimenopause? Yes.

When you first started having perimenopausal symptoms, did you realize what they were? No. Okay, we're going to come back to that. Sarah, can you suffer severe symptoms from menopause without hot flashes or disturbed sleep? Yes. Does menopause increase your risk of many chronic diseases? Yes. Can the right diet significantly reduce menopause symptoms?

Yes. And Davina, you get a whole sentence for this. You're lucky I don't get the sentence. What's the biggest myth that you hear about menopause? Women lose significance, importance, you become invisible, you are dried up, and life is over after menopause. And it's not. I've been really excited about this podcast because it's sort of a dream team to talk about this topic. And Davina, it's wonderful to have you here to sort of share your own menopause story.

And also these sort of quite amazing, I think often quite heart-wrenching stories that you've collected in your book, Menopause, which I think is really great. And to have you with Sarah Berry is fantastic because of the perfect timing because this is actually the first time that you're able to reveal a set of brand-new peer-reviewed scientific studies that you've been working on about menopause symptoms and about how changing food choices can affect them. So I think it's really great to have the two of you together. Davina, I'd like to start with something a bit different from what we normally do,

because normally it's very about the science. And I think this is a great opportunity to actually talk about a real lived experience. And so I would love to just start with you telling us about your experience when you first started having symptoms. Well, I think the first symptom that I had that really hit me was a night sweat. And I would have been about 43 years old. I was on a job in Prague and I stayed the night in a hotel and I woke up in the middle of the night and I was drenched. My hair was wet. It wasn't like just you're a little bit hot in bed and you think, well, I must throw the blankets off. It was bottom sheet soaked right through, had to go and get a towel, duvet soaked right through, had to turn duvet over. And I thought, my God, I'm ill. I'm really ill. And I woke up the next morning. I looked at myself and I thought, God, you really are ill. I felt pale. I felt like my

skin was kind of dry. And I thought, God, I'm so dehydrated after sweating that much all night. And I thought, well, hopefully it'll pass in a couple of days. It happened again the next night. And then it didn't happen for a while. And I thought, I'm better. So what I've now realized is actually I had little non-physical symptoms, so psychological symptoms a little bit before that. So things like, I'm a very gung-ho person. Anybody that knows me as a television host in the UK would know I've chucked myself out of a helicopter on a bungee rope on a TV show. I see myself as a brave and kind of gregarious, outgoing, robust woman. And my life felt a bit overwhelming.

And I thought, how come I can't get my kids ready in the morning? How come I'm crying quite a lot, not just through PMT, which was kind of normal, you know, for a couple of days, but this felt I didn't know when it was coming or why it was coming. How come I didn't feel any joy anymore? How come I was kind of flatlining through life? I'd look at my daughters who would be having hysterics, crying with laughter about something. And I think, I can't remember the last time I did that. I'd lost the joy. And now I hear women saying, I just lost myself. I didn't know myself anymore. And that was such a brilliant way of lost myself. I didn't know myself anymore.

And that was such a brilliant way of describing it. I thought that was exactly how I felt. But also this low-level anxiety of, I didn't want to drive to the supermarket if it meant that when I came out of the supermarket, it was dusk. I didn't want to drive in the dusk. I went to the opticians. Is there something wrong with my eyes? Should I get long-sighted lenses? No, your eyesight's fine. It was such a weird fear for me, Mrs. Chuck Yourself Out of a Helicopter. I also started forgetting things, which lots and lots

of women can relate to at this age. And I went to my doctor. My dad had been recently diagnosed with Alzheimer's. And for me, I thought my dad was actually quite young. He was 68 when he was diagnosed. And I thought, my God, have I got early onset Alzheimer's? And I became very paranoid about that. I went to the doctor. She asked me a bit about my life. I had three young children.

I had a very, very busy career, but I was also a very hands-on mother because I felt guilty all the time. I was trying to be a wife to my husband, you know, running a home, put food on the table. You know, she said, you've got what we would call cognitive overload. And I thought, well, that's it. So then I went back and I told her about feeling like I've had a couple of bouts of illness. Does that mean I've got Alzheimer's? Is that another sign of it?

No, no, no, no. It's just this cognitive overload. Your body's struggling to cope. So I just thought I've got to start trying to relax. But the problem was all these symptoms and all of these things that were starting to happen. My joints started aching. I was tired. I didn't want to exercise so much. I was exercise lady. Why didn't I want to exercise? Why was I tired all the time? Then I thought, oh, is this just getting old? Is this just something? I had no one to talk to. So my mother, my real mother had had a full hysterectomy at 28 because she had ovarian cancer. So she was plunged straight into menopause. I had a very difficult relationship with my mother. She was an alcoholic and addict. And I have had such enormous sympathy towards her. She's dead, unfortunately. But I've worked with my mother in heaven on trying to forgive myself and her for our relationship.

Because if I'd have known all of this when she was alive, I would have been a lot more understanding. When she was 28, and Sarah, you know what that's like for a young woman to be plunged into menopause. Anyway, I didn't have her to talk to. My stepmother also had a full hysterectomy, but she'd been put on HRT, but nobody talked about it. It was embarrassing. And I thought, I'm too young. I don't really want to talk about it because I feel like it's going to age me and aging in my business wasn't good. Aging in terms of feeling like a sexy lady wasn't good. Just aging in general, you know, I don't want to get older. And so Davina, does that mean that you didn't even want to sort of think about it for yourself? Nevermind not telling other people that 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 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've got to put the work in. As Zoe's chief scientist, I wanted to talk about something that's not talked about, menopause symptoms. Over half of people on the planet experience perimenopause and menopause, yet symptoms are often misunderstood or dismissed. Zoe's new Menoscale calculator lets you score your menopause symptoms. Your Menoscale score may help you make sense of what you're experiencing. Personally, as a woman experiencing perimenopauseause it's a key talking point with my friends and now we have a score that we can share with each other to me this calculator is a game

changer at zoe we're moving menopause research forward we recently conducted the largest research analysis of menopause and nutrition in the world in research, participants reported an overwhelming number of symptoms. 66% of perimenopausal women reported experiencing over 12 symptoms like weight gain, memory problems and fatigue. The good news is our research shows that changing our food habits may reduce the chance of having a particular menopause symptom by up to 37% for some women. The Menoscale calculator puts our science in your hands. Go to zoe.com forward slash Menoscale to get your score. The calculator is free and only takes a couple of minutes. As we scientists say, if you can't measure it, you can't change it. All right, back to the show.

And I always feel a bit of a fraud sitting here talking about menopause. But I do think that, I think I speak for quite a lot of men actually, that it's one of the things that I knew nothing about. And it's been a massive eye-opener for me over the last few years to realize sort of what a big deal it is, but also that it's probably going on with friends of mine and I don't even realize and I had no idea really what was going on. Can I just say though how wonderful it is as

women, you know, when we hear a man like you talking like this about the menopause or doing this podcast or hosting it or saying, I didn't know anything and I want to know, it literally makes me cry. My boyfriend learnt about doing women's hair in the menopause or talking, he talks about it now, because he shared my journey with me when we weren't together then but we were friends. He was doing my hair back then and he thought I want to help women too and those allies, we need you. Yeah, I think as women, you know know when I was growing up it was never talked about so my mother's also passed away and I can't talk to her about my experiences now but when I

was younger I know my mum you know occasionally was changing the sheets more regularly and she said oh it's because I've been hot in the night but it just it was a taboo topic and so I think it's great that as females we're talking about it more you know certainly at our generation but I still think it's very taboo amongst most males what's interesting is I keep thinking you're talking about it more Sarah I'm talking about it and I look at all these doctors online and still it's not just women contacting me about the fact that they can't access information or help from their doctors, but it's even doctors still aren't educating themselves when they I think it's more important than ever that people like yourself, Sarah, and all the other brilliant doctors that I follow online, get out there and educate us all the time. And then me as a famous person with a platform, what I try and do with that is

amplify science. You know, that's what I try and do with any good, great bit of science. I think I'm going to share that, That needs to get out there. And essentially, I've just come back from New York recently. And one of the things I'm struck by is that the conversation in the States is actually behind the conversation in the UK. And it's often in many of these things, it's the other way around. And things like start in California, right? And they go to the rest of the States and the rest of the world. And I think it's part of why we're having this conversation with you that in some way, this taboo has been breaking in the UK earlier than

certainly anywhere else in the English speaking world. This is why, I mean, we'll talk about it later, but I'm so excited about this piece of research that you're going to talk about later, because there just hasn't been any at all and we deserve it really let's be honest absolutely and this goes beyond menopause as well that women's health has been incredibly underfunded terrible and you know i often tell jonathan i've run more than 30 randomized control clinical trials until i started working on the zoe project only one of those had been in women all of them had been in men for a whole host of reasons. But mainly because it's cheaper to do it in men because you don't have to consider factors like the menopause,

which become an inconvenience in research, but it shouldn't be. No. Can you help to explain a bit like what's going on that can sort of explain this story that Davina was describing? Yeah, and I think what I liked, Davina, about the story you explained was, okay, it might have started with those night sweats, but actually, you straightaway moved beyond that to all of these other symptoms. What's really important is to remember there's more than about 50 symptoms, and it varies from one individual to the other. It varies the time course of the symptoms,

the duration of the symptoms, the intensity of the symptoms. And that's because oestrogen receptors are all over our body. And it's oestrogen that declines mainly in the menopause. So that's the primary reason we start to have all of these experiences. We have oestrogen receptors throughout the body. It affects things like our hunger, our energy, our mood, as well as our heart health, our muscles, our bones etc so once you have this decline in oestrogen which is what happens in the menopause that's why you can have so many varied types of symptoms and i think what's interesting is what you described avina

is this fluctuation of symptoms and this is really interesting as well because i think a lot of people think okay you hit 51 which is the average age of menopause. Suddenly you've gone from premenopause or your postmenopause, that's it. But there's this whole phase before, which we know, which we call the perimenopause, which is where your oestrogen levels, as well as some other hormones, start to change. But you don't just have this beautiful, gradual decline in oestrogen so that your body slowly just learns to handle it it's like this crazy roller coaster and you know i always visualize things i'm afraid using a graph but you have these like peaks and troughs and you know it's going i visualize it at um a funfair park on an actual roller coaster yeah that's what it's like it is but but the graphs support that i mean

imagine your i hate roller coasters so i can't even go on one of those caterpillar ones that's what it's like it is but the graphs support that i mean imagine your i hate roller coasters so i can't even go on one of those caterpillar ones that's bad enough for me but i'm sure you're more adventurous uh divina but this is what's happening with your hormones they're going ups and downs and they vary throughout the day they vary from day to day and that's why you could be functioning perfectly normally and literally literally within minutes, you're hit by something. And I think that's what's so distressing. And it's because you're not getting the oestrogen to those receptors that previously were functioning in a normal way with oestrogen. I also think what's interesting is for our whole lives as women, we are taught to kind of understand our monthly cycle.

So I used to know that on these two days of the week, I didn't need an app. I was regular as clockwork, 28 days. And on these two days, I was going to be horrible. So I'd almost like brief everyone, okay, two days coming up, guys, right? Like, you know, brace yourselves, I'm going in. And I would know that that would happen. But the thing that's so unsettling, I think, like you said, is that the night sweats would happen. And it's not like a month later, they would happen again it's not like a month later they would happen again. You just would never know. You could never prepare for anything. And Sarah, just to make sure I've understood that right, because I think I was definitely

brought up with this idea that basically you hit menopause, everything is completely normal until then, and then you stop having periods and it's all over. But you're describing this long sort of perimenopause period where you're saying almost from day to day, the level of this estrogen is all over the place and that that is therefore what explains the description that Davina is talking about, about suddenly having the night sweats and then just switching off three days later. Yeah, absolutely. So menopause is the point at which it is a year after your last menstruation, so your last period. But leading up to that, you have these fluctuations, these peaks and troughs in oestrogen. It can last from two

years to five years on average, but for some people it can last up to 10 years. And it's that phase that's particularly troublesome in terms of all of these symptoms. What we do know though, is that actually you still continue these symptoms post-menopause or post-reaching that kind of stage where your estrogen is a little bit more stable, but you still have these symptoms. And we've actually conducted some research where we've looked at how many symptoms people have, depending on how far away they are from their last period from the menopause. And we see that it gradually reduces year on year, but it's still really high. Even five years later, it's still very high. And so this is another myth that I think is like, oh, it's just perimenopause and then you're done. No, it does continue after.

Can I ask you something? So lots of women talk about taking blood tests to see if they're perimenopausal or not, but doesn't work does it because if you're if your estrogen is going up and down and up and down in a day like you're not going to know absolutely and i think this is a huge waste of money a huge waste of resources and again it's one of those myths it's like so frustrating when people say oh i've had my hormones checked and they're fine it's like okay they were fine at that point of time but what about tonight or what about tomorrow unless someone can develop a monitor that's continually measuring them waste of money and actually there's some data to show that six

million pounds is wasted in the uk each year by women going and getting these tests now they're not done on the nhs because we know it's a waste of time but it's also giving people wrong information because it's saying oh this is where your hormones are where yeah it's you giving people wrong information because it's saying, oh, this is where your hormones are. And then you think you're doubly mad. You think, oh, I'm feeling like this and it's not my hormones. Is your story like a particularly bad story here? And as you were interviewing people for the book, is this like you had this awful experience and it's absolutely real but like you were very unlucky i really wanted this book to be obviously science from dr naomi potter who is a menopause expert who's been a menopause expert for many many years i was going to bring the personal side but i thought who wants to just

hear my story you want to hear loads of women's stories because as you say jonathan everybody has a different experience but my experience i would say in terms of what I'd read for people, they submitted all their stories online. And it was funny. It was sad. It was hopeful. And it was heartbreaking. It was all of these different things. Each story was different. Some women were left so desperate having been told again and again that it wasn't perimenopause because sometimes people are frightened if they don't understand enough about it to prescribe HR work because it's hormonal low mood not actually clinical depression and then they go on stronger antidepressants and stronger and they're still

feeling bad and then it turns into something else and um this a friend of mine said that his girlfriend he found his girlfriend with a knife uh to her wrist one night and she was just please help me i please like i i am going mad and this is this is the only i feel like this is the only option left i interviewed two women in scotland who had both had moments but what was frightening about a menopausal sort of suicidal thought was that it happened out of nowhere often it would be like i, I'm driving in my car. I just want to drive into that wall now. So it can affect women extremely seriously. And my friend went and took his girlfriend to the doctors and sat down and played bad cop and was like,

I am not leaving until someone listens. And she got some psychiatric help and she also um tried hrt and thank goodness that did help her what you're referring to as hrt is hormone replacement therapy which is often called hormone therapy for example in the u.s you know i i am very keen to say that um all i try and do with um hormone replacement therapy is to just say the facts I don't want to wax lyrical about it. I don't want to say it solves everything. I know that there are many women that can't take it. But I do want the truth to be out there for people because in order to empower yourself, when you feel literally so powerless and lost and invisible, the truth is going to empower you. But when you feel like you're being gaslit

or not listened to, and I always think gaslighting is really overused as a word, really. But being told you're mad for having these symptoms and no, don't be ridiculous. It's not that again and again and again, makes you feel more mad, which actually can be very dangerous. So the truth is really important to me. Get the truth out there, make women feel better about themselves, but most importantly, empower women. So my story, I think, is kind of middle of the road. And vaginal estrogen, I would say, is like a godsend to women, to relationships, to the way you feel about yourself sexually which again we're all a bit embarrassed about talking about sexual health and happiness and it's a game changer I use vaginal

estrogen it's in my book all about it so if you want to know more you can go and have a look that written by a doctor thank you Davina what I know Sarah is an expert on is symptoms associated with menopause I'd love to actually take this transition because I think Davina's painting these different pictures of like individual real experiences, which I have to say, every time I hear this, I think they're pretty horrifying. Like these are like really shocking stories, but and they're very complex stories so can you tell us about this latest research and like what you've discovered and how that's different from i guess the the understanding that we had before around menopause and symptoms yeah so at zoe we've been really interested broadly in women's health and we've been focusing in on peri and post-menopausal women in relation to two core areas one is symptoms symptoms, and I think we're

talking a lot about that, which is great. The other is your increased risk of disease, and we can come on to that in a bit. When it comes to symptoms, what we've been doing is looking in our cohort of participants, so our group of participants that we're studying, and looking at how many symptoms people have, but also how severe the symptoms are. Because we often talk about the type of symptoms, but we don't actually ask people in questionnaires often how severe this is. So we've got a group of 70,000 women who are peri- and post-menopausal. So we've got about 30,000 people who are peri-menopausal, 40,000 who are post-menopausal, that we're asking standardized questions to everyone and collecting also lots of biomarker data

about their risk with disease as well as symptoms. So are they not on anything? So they are literally just purely going through it? Because if they were on something, their symptoms might be any kind of medication. So some of them are. So we collect loads and loads of information about them. And what we first looked at is, how many symptoms do these women have, regardless of whether they're on HRT, so hormone therapy or not.

And what really shocked me actually, Jonathan, is that 99.8% of our peri- and postmenopausal women reported having one symptom or more. That's not what I thought that you were going to say. I thought you'd have going to say. I thought you'd have more people not having any symptoms. No. Obviously, what symptoms they have are hugely variable. So we asked them questions about 20 different symptoms. And we asked them about, for each of these symptoms, how severe were they on a scale of one to five? What we found was that 66% of this group had 12 or more symptoms. And again, that really, really surprised me. And what I found interesting is,

because this is the first time we also looked at the severity of the symptoms, the symptoms that were most common, which was sleep, irritability, weren't actually the symptoms that people reported as being most severe. So we often think about the irritability or the sleep as being the ones that have the biggest burden. But actually, it was the other factors that caused actually the most burden to their life or, you know, really impacted them. And this was weight gain. This was change in their metabolism, loss of libido, going back to your point, was something that-

It's really important. You know, although it was less prevalent, so less people had that as a symptom, it was what they said was the most impactful. then fatigue people were saying that's just like one of the biggest problems having the kind of fatigue symptoms and they have the impact that every day and there's been some other research by another uh a group uh where they looked at overall how does it just impact day to day and they that 10% of women have actually left their jobs because of their symptoms. And that 45% of people say that they actually cause really distressing symptoms, you know, and impact their day to day life. But I was really surprised by this data from our own cohort, Jonathan.

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Thank you, and on with the show. And is this, like, new news, or does everybody already know about this range of symptoms and this is the way that it's generally studied and followed? So there is a growing number of studies showing the different variety of symptoms. So I think every few months there might be something coming out saying, oh, this is also a symptom or that's a symptom. We don't have really good data though about the number and the severity of symptoms at such a large scale.

So the fact that we've got 70,000 women here, really good data there about the number and the severity of symptoms at such a large scale. So in these, you know, the fact that we've got 70,000 women here, it also allows us to tease apart the variability in the symptoms. And what we've also done is we've performed some kind of statistical analysis that allows us to look at how some symptoms cluster together. And that's really interesting. And this is new as well, that we see that there's certain symptoms that cluster together um you know so there's like these three kind of core groups of symptoms that we see grouped together so symptoms that are often related to neurological effects and and sarah when you say help me to understand neurological so um so we're talking about irritability anxiety

uh would forgetfulness be a part of that yep and sarah so you said one group is around these things So we're talking about irritability, anxiety. Would forgetfulness be a part of that? And Sarah, so you said one group is around these things to sort of, this is like the brain, irritability, anxiety, forgetfulness. What were the other two groups that you discovered? So we've got ones that group together as what we call vasomotors. So these are the ones related to hot flushes, night sweats, chills, those kind of things. Then we see a group that's very much centered around um sexual reproductive kind of urogenital health so this is like low libido vaginal dryness and then we see the factors that are psychological but particularly around the nervous systems this is irritability low mood depression anxiety mood, sleep disturbances, headache, brain fog, memory loss.

That was me. And fatigue. And they seem to cluster together. Obviously, you know, it doesn't mean that if you have those kind of symptoms, you're not going to have the hot flushes. But it's interesting how we're seeing how they group together. And this is interesting because it means now that we're seeing these clusters, we can now look at how these different groupings might relate to other kind of factors

that we might be able to help with and david does that match up to your experience speaking to different women i mean i i what i thought was really interesting because i i think what's happened in the past that women were expected to suck it up i mean women have always been expected to suck up everything and um you know you've got very very painful periods just suck it up um it's been interesting around endometriosis and adenomyosis my daughter has adenomyosis she won't mind me talking about it she's she's given me permission because to spread the message you know but she's 22 it normally gets diagnosed at 30 that's how long it takes for a woman to keep going back going my periods are really painful. They're lasting for ages.

I've got cramps in between, you know, and they just go, just suck it up. That's just what you're told to do. So I think when it came to perimenopause in the past for our parents, our mums were expected to just suck it up. So if you had painful joints and you were tired and you were a bit antsy and angry, it really, unless you were dying, that you'd go, oh, they weren't, I just sailed through it. So it's funny that you say this because I'm thinking of my own mother right now. And I've said this on previous shows. She definitely never said anything about the menopause when that was happening. And I'd probably left home at that point.

But I did ask her about this a couple of years ago as we started to have the research that was coming through Zoe and people were telling stories like this that I. But I did ask her about this a couple of years ago, as we started to have the research that was coming through Zoe and people were telling stories like this, that I, as I said, I had no idea. And I was like, I said to my mom, so, you know, did you have all of this terrible experience? She said, oh no, I like, it was totally fine. I didn't notice anything, but I'm listening to you just now and saying that you think that's true. Or is this just like some of your examples where you're not supposed to complain. And so you just now and saying that you think that's true or is this just like some of your examples where you're not supposed to complain and so you just almost deny it to yourself and i think also in that generation we were led to believe that this was midlife and this is what happens naturally

and it is a natural part of aging that you'll start feeling more tired and your joints will ache a bit and when you lean over to put your socks on, you'll go, I definitely started doing that. I do that. Stop it. I'm going to tie my laces. We're all going to live till we're 100 with your help. Thank you. And we want to be as vibrant and as fit and as healthy as we possibly can

for as long as we can. And that means staring down these things that can lead us to believe that we are getting older. And I don't mind getting older. I love being the age that I am. I don't want to change. I have people telling me sometimes, oh, your face is so thin. But I can't help that. I've lost collagen. I've lost the fat in my face. I can't do anything about that. If you want me. I've lost the fat in my face. I can't do anything about that. If you want me to put a load of stuff in my face, you know, and then you'll all judge me for that. So it's like, I'm just staying like I am. So I don't mind aging in this way. I've got

gray hair. I choose to color it. That's fine. That doesn't bother me. I've got slightly crepey skin here. It doesn't stop me from wearing short sleevesleeved shirts. I like getting older, and I'm definitely mentally a more evolved human the older I get. I was very, very cripplingly insecure in my early 20s. And as I've grown up, I have lost the vestiges of youth, but I've gained a happier kind of view of life. I'm much more satisfied and happy so I don't mind getting old at all but I don't want to give in physically and so that's why I think for me you know exercise is paramount I want to stay fit I want to stay mentally agile I want to be able to move these are the kind of symptoms that I think back in our mother's days they were like well this

is where we start wearing the cardigans and we knit a bit more and we take life a bit more easy. But their life expectancy was a lot shorter than ours. And ours is, we must have added like 10 years or 20 years to our lives. I still want to be playing. No, let's up the ante. I want to be dancing in a nightclub when I'm 70. Like, come on. Jonathan wants to be dancing in a nightclub when I'm 70 like come on Jonathan wants to be dancing with you as well yeah he often uses dancing at his daughter's wedding as the his reason for what we do at Zoe no it's a future you've got to dance at her wedding and I think this idea that somehow you couldn't do this that's that to me is a great example it

feels like somehow you've really given up something that's a great joy and very depressing so yes we talk about that often i talk about like for me zoe is about being able to be able to do all of those things you know at my my daughter's wedding which is probably 30 years from now i'm gonna be about 80 so i want to be able to i want to be jumping up and down on the dance floor i don't want to be like wheeled in like for this, you know, one special dance. And I think you and you and I need to do this to help educate our younger generations and show them that aging is not a bad thing. I've always been sort of slightly led to believe that aging is a terrible thing. And actually, it's brilliant. I think it's such a brilliant segue, because I know that people are going to be looking to get to the actionable advice. But before that,

there's, I think, one thing that you mentioned, Sarah, in the quickfire questions I really want to pick up on, because we talked a lot about symptoms and people say, well, you know, you're just feeling bad, but don't worry about it. But Sarah, you talked about the fact that going through menopause actually increases women's risk of serious disease. Could you help us understand what that means? Yeah. So as well as feeling rubbish with all of the symptoms, also it actually impacts your health. It impacts your risk of many chronic diseases, such as your chances of getting type 2 diabetes, cardiovascular disease risk, etc. And that again goes back to the function of oestrogen.

Like I said earlier, the oestrogen impacts nearly every cell in our body. And so it impacts all of the different kind of mechanisms and processes involved in the development of different diseases. We know that when you are premenopausalal your risk of chronic diseases is much lower at any given age than a male and we see this in our own research so we publish some zoe predict research where we look at each point in time at the risk of different um you know disease risk factors blood pressure cholesterol glucose control etc and we see that it's actually we're doing better than men so we're kind of you know happily laughing away soon as you hit the kind of perimenopausal postmenopausal

phase suddenly the trajectory changes and not only do you catch up with men in some of these areas you overtake them so depressing and it's because of the role of oestrogen now i know you say it's depressing to be in it but we can do something about it, which is what's good. And we see in our own data that once you get past the menopause, but even at the perimenopausal phase, suddenly your blood pressure increases. Suddenly your cholesterol, particularly your bad cholesterol, the LDL increases, your levels of inflammation increase. And this is because we know oestrogen has quite an important role in maintaining certain anti-inflammatory responses, to put it kind of quite simply. We know that your blood glucose controls, your blood sugar control also is impaired. And we've even done some research in

our ZOE Predict study where we've actually taken an age-matched group of individuals. And Davina, the problem with anyone studying menopause is it is an age-related event so how do you know it's okay menopause and not age but because we had so many people we were able to say okay let's take a group of people who are exactly the same age and let's look at people who are pre-menopausal because obviously the age of menopause is very variable and those who are post-menopausal and we see differences for example in many of these factors purely because of the menopause and not because of age you know and in and we see differences for example in many of these factors purely because of the menopause and not because of age you know and in particular we see these differences in how we

respond to sugar and how we respond to carbohydrates as well so you've talked about sort of how serious the symptoms are i think so you've talked about like there are actually 50 symptoms as part of this complete um lack of understanding right even people, women who are going through this about how they might see it, that it isn't just about symptoms, that it's really having this big shift in how your body's working and the risk. I'd really love to talk about like getting the help you need and what you can do with it. And, you know, I think Davina, in your book, you talk a lot around hormone therapy, you know, HRT as we talk about it, and sort of medical intervention. Maybe we could start with sort of those medical interventions.

And then, because we've been teasing the audience a lot, I want to switch to talking about this amazing new study, Sarah, looking at sort of diet and lifestyle? I was so terrified of it. I was like, there is no way I'm ever touching that stuff before I became perimenopausal. After three years of being perimenopausal and having no help or support or not knowing what it was and feeling totally disempowered. So when somebody suggested HRT, I just said yes. And then after I'd said yes, I was like, is it going to hurt me? And then the facts that I got about the new types of hormone replacement therapy, it sounded so different that I made a decision for myself, but I thought I didn't have the correct information. Why is it

so hard for me to find that? So that's why it was important for me to talk about that. I am also very prone, this is what I'm excited to hear about, also trying to support women who don't want to take it or who really importantly, because I think this is the hardest place to be of all, who really do want to take it but have had some kind of estrogen-sensitive breast cancer which makes it difficult for them to do that or another health issue that means that they're unable to and they were but now they can't. So actually we really do need to talk more about alternatives and what other ways can we help support women that can't take hormone replacement therapy.

I think as well it's really important to make listeners aware of what the current evidence is around hormone therapy as well so like Davina I think there's so many people out there are still scared about it and might recall news that came out I think it was about 22 years ago now over this big study called the Women's Health Initiative where the headlines were you, HRT or hormone therapy increases risk of cancer, of stroke, of cardiovascular disease. And it was painted a really scary. I remember hearing that. Yeah, it was all over the news.

I'm thinking, I'm not going on that. I don't want to go into detail of the study, but the analysis that was performed has since been re-performed. And a lot of the findings that were in those initial headlines we now know are inaccurate the population that they used to take the HRT were also way way past the normal prescribing age like way into the 60s where people already had complications but most importantly the type of HRT that they were giving is not the kind of hormone therapy that we now use, certainly in the UK. And so in that research, they were using oral, so tablets for hormone therapy. Now that is still used in the US a little bit, but in the UK, it's simply not used. What we use instead is

transdermal. So it's either a gel or a patch that people put on and the current evidence and this is even you know summarized by our menopause societies in the UK is that there's no evidence for the majority of the people obviously there will be some cases like you've said Davina of any harm of taking hormone therapy and actually the evidence emerging now shows that it can reduce your risk of cardiovascular disease. And given that postmenopausally, you have at least double the risk and up to five times the risk of cardiovascular disease compared to premenopausally, then that's great news. We also know from our own ZOE predict research that all of those risk factors that I talked about earlier, when we looked at people who were taking HRT versus those that weren't, we saw that actually it prevented

for most of those that increase in blood pressure, that increase in blood lipids, that reduction in kind of insulin sensitivity and glucose control. So that there is for the majority of people a benefit. And I think it would be really good to try and educate people not to be scared from some very old news. Thank you, Sarah. And I think for anyone listening who maybe hasn't listened to many of the Zoe podcasts before, there's a couple of podcasts that you've done on menopause, you know, with other doctors and scientists where you've sort of gone into hormone therapy in quite a lot of detail. So I think I would definitely point anyone who's interested to understand more to do that because it's also there's a lot of complexity I've

definitely learned a lot. Yeah I think what's interesting in our results as well Davina and these are some of our new results Jonathan of when we look at you know the symptom prevalence that I talked about that 99.8 that's 66% of people having more than 12 symptoms. We also broke it apart according to whether people were on HRT or not on HRT. And I was actually quite surprised that people on HRT were still actually getting quite a lot of symptoms. Yes, it significantly reduces them. But naively, I had thought, oh, it's like the wonder thing, and it will still, you know, totally stop all. And that's why we need to take the holistic approach. So Davina, what was your experience of hormone therapy? So after four days, I felt a weight lift and I was playing around a bit with my progesterone

because my bleeding was quite irregular and I was, I didn't like what was happening with that. And, um, I was suggested I could go back on my, my Renner coil, which meant that, um, I wouldn't have periods again. And I was like, yes, please. And even though that's not body identical, it's, um, it's such a small localized bit. I was told by my gynecologist that this is a good alternative. And suddenly that was it. I was in my sweet spot and I did have a couple of symptoms that were still going. And that is why I went back to see my doctor at a checkup and the doctor said, okay, I think it might help if we increase your oestrogen. And I think those types of symptoms, I was still having the odd night's sweat.

They said, I think if we upped your oestrogen a bit, that would disappear. And in fact, for me, by that point, my mood and everything was coming back. I was a little bit less anxious. I was beginning to smile again and laugh, but these night sweats were hugely debilitating in terms of work. So I did up the dose of estrogen, but with the permission of a doctor, I cannot stress enough, do not mess around with your hormones on your own. Please make sure that you speak to an expert. For you as an individual, how big of an impact did this make?

Almost going to start crying. It's life changing. And I'm 10 years on and it completely changed everything. I was going to leave my job. I love my job. I've been doing it for 32 years. I just got really, really good at job. I love my job. I've been doing it for 32 years. I just got really,

really good at it. Safe pair of hands. And suddenly I just thought I can't do it anymore. And now I'm like safe pair of hands again. This is a miracle. I am a better mom. I am a better partner. I am a better friend. I'm funnier. I've got my sense of humor back. I'm dancing, you'll be pleased to hear. My joints don't ache anymore. I feel great. And in terms of cholesterol, my cholesterol has always been high. So that was interesting you said that about it goes up. Be interesting to see.

I've always had low blood pressure. It'll be interesting to see. But it hasn't changed since I've stopped bleeding, which I must've done because I'm 56, but I feel sane. And that is a gift that I've been given. Thank you for sharing. I think it's an amazing story. I would like to transition now because we've been teasing the audience for a long time. 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 um study and you've just released this big new study can you tell us what you found and maybe explain what it is 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 um 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 based on some of these tests, but also based on their health history, where they are now with their diet, their lifestyle, et cetera. And we asked them loads of questions about their health, the 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. So Sarah, just to make sure this is really clear, because we talk a lot often about different sorts of studies on this podcast. Is this a randomized control trial that you're talking about here? 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 program,

so 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

steps. No, seriously, that's so funny. And we've got a fantastic researcher, George, that's been doing all of this research for us. And this is the research also that'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 are having small shifts we still saw a huge impact and we saw across so many different symptoms i mean talk about falling in love with you guys like with all of my heart because nobody oh us. Honestly. And it's like when somebody does go, no, we see you and we've got your back and we're going to do some work on it. It was so upsetting. You think we're all going through this thing and no one's helping. And this is something, it's not just medicine. This is something that literally every single woman could do. And a 34% reduction, it's ridiculous. That's over a third. Yeah. Sorry.

And we see that, you know, I'm not a hugger, but I'm going to have to give you a hug now. But you know what I mean. Totally. Please help. Well, you know, I was surprised by this. And interestingly, we see this as well with those taking HRT, because we also looked at people who were taking HRT. So for those taking hormone therapy, we also saw that on top of the benefit of the hormone therapy, having a healthy diet had a huge impact. But I think it's important, Davina, to your point to say that when we did look at the

diet, we used an overall dietary score to quantify how much there was a change in the diet. And so, a lot of the principles that were changing were the kind of fundamentals of healthy eating. So, increasing your plant-based un unprocessed foods reducing your processed meat etc and you know we can dive into that a bit more but these are things that are accessible to everyone and so you know our zoe predict program was a fantastic springboard for us to study this and to be able to look in depth but it doesn't mean that everyone needs to be you know going out and having these personalized recommendations. What we learn from this is that overall changing the quality of your diet can have an impact.

Do you know someone who feels anxious about menopause or could do with being better informed? Why not share this episode with them right now and empower them to feel better with the latest scientific advice? I'm sure they'll thank you. So Sarah, these people were Zoe members, which means that they were doing this test, getting these personalized results about their body, and then they were following the advice on their app, this sort of daily coaching advice to help them to understand what they needed to do to change their diet? Yeah. So I think as scientists, what we always want to do is look at our own results,

but we want to look at them together with the bigger picture because, you know, 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, social disease, your blood lipids, your blood pressure, etc.

So the kind of fundamental principles that 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 Zoe, we're always about what can you add in rather than what you have to take away. And so the great news is, 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, you know, 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, what I'm saying now is based on the evidence we have. Who knows? 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 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 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 this is particularly in east asia so japan china etc 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 controlled 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 sceptical often about supplements, but I have to lead with the evidence and the evidence is supportive of this particular supplement. Davina, it's incredibly rare 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? We are because even more interesting is your response to soy isoflavones 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 post-menopause was actually quite different to pre-menopausal. 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've 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 peri or 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 unfavorable side effects. I'll tell you what, I mean, I can't tell you how exciting it is actually sitting in the studio listening to this because I'm usually in a car or running or something going, oh, thinking I must write this down, must get this. And I'm actually sat here listening to it. I keep forgetting that I'm in it. I keep kind of thinking, oh God, I'm just listening. It's so good. I mean, that is fascinating, isn't it? The question I get asked most of all is how do you

stay the way you are? And if I'm honest, I don't know. I just just am but I don't eat a lot and I eat well I mean thanks basically to you guys and your podcast I eat really well I've changed a lot I've changed my diet to much more of a Mediterranean diet I used to eat a lot of processed meat a lot I didn't realize that sausages were processed no honestly I didn't's quite funny. I'm half French. Salami was a daily thing. You know, I don't do any of that anymore. I literally don't even go down that aisle. So I've changed my diet a lot. You know, I do exercise, but I also think that an active life, which again, if you're tired, you're not sleeping, you don't want to be active in between exercising. Do you feel that exercise has been an important part of your feeling better through menopause?

And does that come through also through some of these individual stories that you were collecting through this book? I mean, exercise to me, I think when I've read all the stories that came through, the people often were saying that exercise saved their life. I mean, in terms of mental health and where it helped them mentally, often talking about exercising outside, that's a huge thing in terms of menopause and mental health that nature is a great healer that um even doing things like i don't know yoga on grass grounding um bird song you know even just walking in london outside but when you walk put a

little bit of a pep in your step if you can, pump with your arms, you know, don't sort of saunter around. When you walk, walk with purpose. I always think that's a terribly aging thing when you stop walking with purpose because I want to dance at my kids' weddings. I want to play football with my grandkids. I want to be active in my 60s and 70s. I want to feel as good as I feel now. But I also try and do a bit of cardio, either a spin class, which is like clubbing on a bicycle. So that's really good fun. I try and do a little bit of running. I struggle with running. I'm not a natural runner. My Achilles don't like it. But when I'm in a good shape, running can give me a

high, like a feeling of euphoria, but the maximum I run is 5K. 4K is probably preferable. And then I might do some weights. For a couple of years, I was just doing two, three kgs. I've gone up to five, six kgs, fewer reps, but more. I am losing muscle tone like you wouldn't believe all over the place. And I know that strength is the key to my safety moving forward. My bones need to be protected by my muscles, so I do a bit of that. And I like being part of a community and working out. So it's either classes or online classes or something like that where I can feel like I'm not alone or isolated. But I also really feel for people that don't like going to gyms. I mean, a gym for a menopausal woman is like a nightmare because you feel invisible. You

probably are invisible in a gym. You go, you think you don't know anybody. Everybody knows everybody. Everybody's muscly. You've got the wrong clothes on. So that kind of thing, working out at home and finding an online community or something is a really nice thing to do, I think. I think as well, we see in our own data what Davina is saying as well. So we know the muscle loss is a big problem post and perimenopausally. So that's why the strength training is important. But interesting, this new data as well, Jonathan, and this is actually only a couple of days ago that I got to see this. So I haven't told you this bit.

I love always surprising him with bits of data but we started looking at physical activity and the different types of physical activity so we started looking at how does the amount of physical activity so the cardiovascular the resistant training for example and also the number of hours that people say they sit down in a day how does that relate to symptoms which I wouldn't have thought apart from you know your bone health or your achy joints, I wouldn't have thought it would actually relate much. But what we found is that the more you sat down, the worse your symptoms are.

And these weren't just muscle symptoms. These were all of the symptoms. The other thing we saw is both cardiovascular and strength training, they were inversely. So the more cardiovascular training you did and this wasn't like loads this was just like you know i don't know 20 minutes maybe a day or a few times a week and strength training so the resistance training that that actually resulted in an overall reduction in many many different symptoms which I think is great. He's going to tell us we need to wrap up now.

I know that face. I know him too well. It's good though, isn't it? You've learned a lot. I have learned an enormous amount. I've learned a lot. This has been a win, win, win. I knew this was going to be a fantastic episode.

It's been an amazing episode. I'm going to try and do a quick summing up, and I know both of you will keep me honest. So we started Davina with your own story, which is really powerful. And you talked about, I think rather this rather remarkable set of very different symptoms, right? From something like a night switch, which you described as, you know, thinking like you might've had like some virus or something through to things that seem like loss of joy and confidence and tight. They all just seem like completely separate symptoms that I would never

have imagined being linked up to one thing. And Sarah, you were then explaining that this is related to sort of what you just described as a roller coaster of estrogen. So it's not like it's just declining over time. It's like really high and then really low and then really high. And you experienced this through this period of perimenopause which you said is on average sort of two to five years before menopause but could be up to a decade and then you said it also continues post-menopause it's not like it just stops and you were saying you could have symptoms for you know another five years we see symptoms up to 10 years so up to 10 so describing like a period between like 10 to 20 years, depending upon the person.

So very, very big period of time for, as you described, you know, every woman. So more than 50 symptoms associated with perimenopause and amazingly 99.8% of women had at least one symptom which I feel you could round up to like pretty much 100% which is extraordinary. Jonathan I do need to correct you as I or just for accuracy it was 20 symptoms that we've measured but we know that people can have up to 50. Got it okay so 20 measured in this in this study and, but we know that people can have up to 50. Got it. Okay. So 20 measured in this study and then up to 50 that people can have.

You said 66% of women in this group had 12 or more symptoms. Correct. So like that's an enormous number of symptoms. So again, very different from this idea that it's, you know, it's just hot flashes and, you know, maybe one other thing. And interestingly, you said you could sort of cluster those into sort of three groups that came together. One, which was sort of about irritability and anxiety and forgetfulness. One, which was this sort of classic hot flashes and night sweats and chills. And then a third one, which is sort of about low libido and vaginal dryness. And then I guess a number of symptoms that probably were sort of in it didn't nicely fit in here, but you didn't talk so much about.

Then you gave us sort of the bad news that it's not only symptoms, but actually this is also the period when you're seeing this big increase in risk of disease for women. So this going through this period really matters for more than just the symptoms that's going on. And then we came, I think, to the good news, which is great. And you talked about hormone therapy, HRT, as it's called in the UK, that the current evidence is just much better than many people will have heard, you know, probably, you know, 20 years ago. Davina, you shared your own story, which is pretty amazing, sort of describing this thing so terrible, and then almost like a light bulb, it sounds like transforming. Obviously, you need to

discuss this with your doctor. There are a set of people for whom this is not appropriate. As always with medication, there's risks as well as benefits, but I think clearly very different picture. And I think that comes through with all the scientists and doctors that have been on this podcast. Very different from the story, I think, that I had understood even five years ago. And then we got into this amazing new study, Sarah, that you shared, which was a study actually of perimenopausal women going through Zoe, being members of Zoe. It's just come out. So very exciting. 34% reduction in the overall symptom burden. I love Davina's face of excitement. I just can't believe that.

So that is amazing. It blew my mind that definitely i need to get the data triple check interestingly also true you said even for women who are on hormone therapy so it wasn't just that this is like you know if you don't take any hormones you're saying that you were still seeing a significant shift even for people on hormone therapy yes and in the region of around 30 as well so even that big so like that's amazing so they may be they may be in a better place but then even more there's still an additive which i think comes back to this thing we talk about all the time but it is amazing here which is just how important the food is that you eat and that if you can eat the right food for

yourself for your body how impactful it is but also sarah i think you also said you were really shocked and if we'd said this five years ago, you'd have said that that was nonsense. We'll have more detail as more analysis always comes after the first paper. But overall, this is in line with what you would expect with shifting towards a diet that's very in line with what we talk about on this podcast all the time. So you're saying reducing ultra- ultra processed foods, reducing refined carbohydrate, like your pasture and your white bread and things like this, adding in all these things with fiber that support your microbiome, like your fruit and your vegetable and your beans, whole grains, oily fish, you mentioned healthy oils. And then you

said, wasn't in this study, but there is one supplement that you're really interested in, which I can't pronounce, soy isoflavones. Soy isoflavones. And the chemical that is particularly potent, we believe, is genistein. So we will be doing more research and reporting back on that. And then right at the end, we touched on exercise and Davina gave this great story about sort of this personal impact and the stories from elsewhere. And Sarah shared this new research that I also had not heard about until 10 minutes ago, which is an interesting you see in this data, like this clear impact on symptoms, where if people are basically sitting down more during the day, their symptoms are worse. But on the other hand, they're sitting down less, they're doing more exercise, actually the symptom burden is lower. So this isn't just some sort of made up feeling like this is real and that you're seeing the impact, which is amazing.

It's been amazing. I don't really want to go. I just want to stay here and learn things all day. Well, Sarah's not going anywhere. I love boring people with my research. Davina and Sarah, thank you so much for coming in. And I know we'll hopefully get you both back and we can talk about more of this as more of this research comes in. Thank you so much for having me.

Thanks for bringing it all alive. Now, if you listen to the show regularly, you probably already believe that you can transform your health by changing what you eat. But now there's only so much you can learn your health by changing what you eat. But now, there's only so much you can learn from a weekly podcast. If you want to feel much better and hopefully live many more healthy years, you need something more. And that's why each day, more than 100,000 members

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