Breaking the Menopause Myths with Ailsa Hichens

Music. And welcome to Change Your Relationship With Food, the podcast hosted by me, Kyla Holley.

With many years experience as an eating disorder and bariatric therapist, I know exactly what it takes to help you break free from your diet history and develop a more healthy relationship with food. Please follow this podcast to make sure you don't miss a thing. This week, I have a guest and her name is Elsa Hitchens. She is a menopause nutritionist based in the UK. So we've got something in common, which is great.

She's been in clinical practice for over 10 years and her superpower is putting the science of what to eat to feel great in menopause into people's actual lives. And she says there's less restriction and far less lettuce involved than you might think. So Elsa, what's the deal with lettuce? What have you got against lettuce?

Well, it's more that people, whenever I show up and people say she's a nutritionist their initial feeling is she's going to make me vegetables and so you know people think when they come to see me because no one's having a good day you know no one comes to just feel a little bit more healthy that they will often have in mind that I'm going to put them on a diet and that diet is going to be take away all the things that you were eating last week or you like to eat there's no

birthday cake you can't ever have a glass of wine and you have to exist on lettuce and kale and the whole thing is going to be a miserable experience yeah that's and it's it's not the case I mean obviously when people want to make a change if you do the same things you will have the same result but people are often surprised by what it takes to eat well and eat in a way that our body likes to exist and there is far less lettuce absolutely I work in a very similar way.

So I know where you're coming from about the lack of lettuce and the lack of kale. Now you've written a book and I have read quite a lot of it. I haven't managed to read it all because it's quite a substantial book. The book's called Everything They Told You About Menopause Weight Loss Is Wrong. And the first thing I want to say is thank you. Because I love the book. I thought it was fantastic. I had a lot of fun writing it. And do you know, it nearly wasn't called that.

It was merely called something slightly different, something in my subtitle. But when we went on to check out Amazon to put it on for pre-sale, somebody had a book that was very, very too similar, I felt. And I thought, oh, I can't have this possible confusion. So I switched things around that everything they told you, that was going to be the subheading. But actually, as it turns out, I like it a lot more. And it's completely true.

Yeah. Yeah. Now, one thing I, well, lots of things I loved about the book. I liked your sense of humor. There's humor throughout the book. And you bring that into a subject with that. I think for a lot of women, they view the menopause as something that's entirely miserable. And you don't seem to treat it that way. You bring humor into that. And you also bring knowledge and empowerment into it, which I think is fantastic. Oh, I'm pleased that you got that from the book because you're right.

People do think I'm in this situation. It's awful. And we're all online. We've got lots of opportunities available to us for finding out more information. And there's so much information about, you know, people are genuinely having an awful time of it in lots of different ways, for lots of different reasons, there is a huge missing piece that people don't know that that level of suffering is optional, that you don't have to.

Sometimes they have in mind that they have to, you know, if they can't take, replacement hormones, if they can't do HRT or menopause replacement hormones. They're then stuck and they're stuck in this sort of downhill spiral, like this lorry that's about to disappear off a cliff. And it doesn't have to be like that. So in everything that I do, I want to sort of shine a light on the fact that there is something different that's possible.

You know, we're not going to feel 100% all of the time because ultimately we are getting older and we have age-related things. But again, food and lifestyle can have a huge impact.

And I think people have got quite distanced from that so now in the middle ages we instinctively knew if we were you know if there's something wrong we would effectively eat our way better because what was available at that time apart from leeches were things like you know you go and you'd have some medicinal herbs you know you're feeling a bit there you maybe have some quince or some elderflower or something like that but in this you know modern day serves us very well but also serves us very

poorly because we've got really separated from the fact that the food we eat, and I didn't make this up, somebody else said it, so I'm stealing it from you. You know, we can literally dig our own grave with our knife and fork. It sounds a bit gloomy, but by making even some relatively small changes, we can make a huge difference.

But do you think our attitude comes from the fact that, you know, you've gone back a long time where people did have herbal remedies and things, But there's a great space in between, which is our mothers and our grandmothers and our great-grandmothers that did just put up with symptoms because there was no Google, no internet, no answers there. And the time for herbs had kind of passed. So I suppose we're drawing a lot of our attitudes and life experience from what we saw them go through.

Yeah, and also, of course, things were different then, but they were at a stage where... You know, you probably were over the hill. Whereas the stage that when women are in their menopause era, it is the end of something, but it's not the end of everything. It's the start of something magical, that sort of second spring. And often we have a lot more freedom. We might have more financial freedom.

We might have more freedom over our time because our kids are older, maybe they're, you know, left home.

So it is actually the start of something. Whereas although I obviously didn't live 50 years ago I kind of get the the feeling that everything started a lot sooner this responsibility business started a lot sooner than it did but also there was a lot less expected of women at that time and of course advancement has its pros and cons and now we are doing we've got the jobs of our grandfathers and we've got the jobs of our grandmothers as women and we're juggling all of the

things and that's what makes it even harder. So there is a piece where, you know, I was really surprised. There were bits about going through menopause that I didn't know because it's not talked about in the textbooks. I had no training on some of the bits and so no surprise that some of the things women don't even know that it's part of this transition.

And some other things are a little bit awkward because no one's talking about vaginas and it's embarrassing and I'm happy to talk about all kinds of things but I do appreciate for many women it's. Excruciatingly embarrassing to go and talk about vaginas. About some of their personal problems with their doctors, so they never quite get a resolution.

And sometimes we don't even want to, you know, we're private people, we don't necessarily want to talk about some of the issues, even with our closest friends. Yeah. Do you think there's a bit of grief involved as well, you know, giving up our kind of, our childbearing years and that awareness that we're moving on to the next stage of life?

I think for some people there is. So I'm going to say what I think this is has no bearing on any science because I don't I don't know my feeling is that if you are if you've had the children that you want you've you've had children if you want children and you've had the number of children that you want that shutting that final shutting of the door because you know it's the ultimate end of you know you will definitely not be having any more babies naturally if you

are in that position you are approaching it in a completely different space and that's that's the position that I'm coming from so that that does color how I how I show up in the medical space but also I hear from other women who you know maybe they've had children but they haven't had the number there was there was an expectation they probably have a second child and it didn't happen or those people who didn't want they really didn't want children. It was an active choice.

But the fact that they now cannot have any at all, they cannot change their mind, that could be uncomfortable.

And of course, then there's the women who really wanted children and who were unable to have children. And it's the end of.

I feel from that position about, you know, when the door's shut, where are you in the world of wanting children or having children? Yeah, I think I'm in a very accepting position, just like you, in that I've had two children. That's all I wanted. I'm done. And when I came into it, I approached it actually fairly enthusiastically in that I thought the end of periods, yay, excitement. I don't have to worry about that anymore. Fantastic.

So, yes, I think I've had maybe an easier journey. I know some of my friends have really been through a tough time with it. Yeah, I think it also sometimes coincides with as our hormone levels are changing, one of the big things that happens is we lose our resilience. Not because we're weak or not because of anything like that, but the changing levels of estrogen and progesterone, which are some of the main female hormones, it means that our body has to cope with stress in a different way.

So it's not just the hormones don't just exist in a vacuum. So we lose this resilience, which is why the sort of mental anguish and sometimes low mood and heightened anxiety and just that feeling of overwhelm is a recognized symptom of that perimenopause era, transition to menopause.

So I think we've got that layered on top of any other feelings and it really just amplifies everything. It amplifies rage and frustration. It can amplify sadness and just that feeling of being very overwhelmed with what's going on. Yeah. Now, one thing I love about your book is that it's not only is it, I thought it was really witty. I really appreciated the sense of humor. And I appreciated the simplicity as well. The way that you explain things I thought was very easy to understand.

And you've broken the book down into kind of that science-y background knowledge that I think a lot of people don't have and perhaps need, and you've done it in a very simple way. Then you've talked about the food. Then you've talked about the bigger picture, because it's not just about fixing the food that we eat. And you've talked about sleep and stress. And then at the end, you've kind of put it all together rather nicely.

But I wanted to go back to those pesky hormones that we're dealing with. Can you do a little bit of a 101 for people that really don't understand the changes that occur in menopause just from a hormonal perspective? Yeah, absolutely. So this is an assumption that no one's taking birth control pills and sort of muddying the picture by taking different hormones.

But our estrogen levels are declining. And the reason, this is the main reason why we experience so many symptoms, because they're not declining in a sort of, you know, a nice, slopey-down fashion. It's like a spluttering car. And this is why sometimes we might skip a period, other times we might have a light period, and other times it's like you've been killed in your bed. Because this decline is, you know, it's like an old car. You know, we're getting this inconsistent supply of estrogen.

While estrogen is falling, one of the hormones that is incredibly important but often overlooked is progesterone. So progesterone, I think of it as being the calming one. So in your years where you're cycling, where you're having periods, it comes in towards the end and it's sort of the feathering the nest. But in terms of menopause, I think of it as being the calming hormone. So it makes sense. We've lost that sense of calm and we've got this inconsistent supply of etrogen,

which makes us feel like we're going crazy. We don't know what's going on with our body. Testosterone, which we think of as being very much a male hormone. And it's actually important for everybody's body. Some women cope with the lack of testosterone or the relative lack of testosterone very well. It's never particularly bothered me, for example. But some women lose motivation. Some of the things that we think of as male traits are confidence and foolishness and sometimes our sex drive.

And sometimes women, we're all different, of course we are, but some people are just more sensitive to the decline of specific hormones. And some women need all of their hormones replacing if they want to be feeling vital, if you like, and confident. So they're the three main ones. But the other two that really, really are worth a mention is what happens to our stress hormones. So cortisol is one of the main stress hormones.

That has a big impact, of course, in how calm we feel, in how energized we feel, whether we're going to sleep. which then has a knock-on effect on everything. When our ovaries are no longer making estrogen because, you know, it's on the way out, our stress glands can make estrogen. So they have to pick up the pace because everybody needs some estrogen. But then there's this clash because you're then giving the adrenal glands two jobs.

So the stress becomes a really big picture. And this is often completely overlooked. Now, we're often a little bit more overwhelmed. So we need to take better care of that bodily system. So this is where cortisol comes in.

The other really key hormone is insulin, which is, I mean, there are tons of hormones that are involved, but I'm just going to keep it to the sort of the fab five. So insulin is the fat storage hormone. So for most people, we don't want to be storing fat because that's something that goes a little bit wrong or can feel a bit more challenging in midlife. But also thinking about, you know, thinking about longevity and thinking about longer term health. We don't want to have high insulin levels.

And this combination of what's going on with lowered estrogen changes how our body responds to food, because also at the same time, our muscle mass is decreasing. So it's not just about our lady hormones and, you know, what's going on with, you know, we think about, oh, it's only the declining estrogen and the declining progesterone, But actually, in terms of how it feels to be us and how we want to be, which is energised, sleeping well, confident, vital, having our best life.

That is about all the other ones sort of hanging around the corner. But oxytocin, which is even more important. And that's, you know, your listeners might have heard of that as being the one that's, you know, when you're breastfeeding or you've had a new baby. And that's the one that just calms the stress. So all of these ones that we've never even thought about before start becoming really important.

So the bodies that we've had, and for some people, they may have maintained their weight quite comfortably throughout their 20s, 30s, and 40s. They get into their 50s and things change. So what do we have to do as far as our food intake? What are the key changes we have to make in order to try and keep on top of that and not let things run away from us? Well, there's a couple of different things that are important.

So I'll start with what I call the sort of strategic changes and the reason why I start there and why it is you know a strategy rather than the individual tactics have some cherries or have some have some lettuce, is because I often find that people want to know tell me the one thing I can eat so that I can and it doesn't work like that because you can't there is no we're sort of taking a. Medical approach like give me the pill for the ill but actually what we need

to be thinking about first and foremost before we're wondering about whether almonds are a good thing to eat is we need to make sure that we're having sufficient protein. We need to do that for several reasons. Firstly, we need to make sure we've got declining muscle mass and this is important. We need to make sure that we are feeding our muscles the right amount of the foods that it likes and our muscles like protein.

So we want to have about a palm size amount at every meal and make sure if we're having a snack, it also features protein. So protein also slows down how quickly anything that gets turned to sugar, whether it's a bag of sweeties or it's a piece of broccoli or some potato chips or something like that, how quickly that ends up in your blood. So we want to make sure we have protein.

We want to make sure that we have lots of veggies for fiber so sorry if everyone was hoping I wouldn't talk about vegetables but it is it's important we want the fiber from it it mops up any excess hormones it keeps us regular and it forms like a when we eat it it forms like a fibrous mesh. In the gut so that any of the starchy foods like, you know, French fries, jacket potatoes, rice, that ends up in our blood less quickly. So if anyone's thinking, well, why does that matter?

We want, our bodies aren't meant to deal with the amount of the starchy carbohydrates, sweets and sugars and pastries and things like that that we eat at the moment.

It's not that we can't have those things but the modern diet has just taught us that you know you go to a restaurant and be this giant mountain of rice and we've been accustomed to thinking that that's what our body wants because why would it be there but actually it's catering in its price so we want to make sure we've got protein we've got veggies and we're just mindful about the rest of it so that we can have a more stable blood sugar.

Now, the reason why this, so that's for everyone, but the reason why this becomes more critical is because as we are in that sort of menopause era, we've probably got less muscle mass unless you're a person who's been consistently lifting weights. And there aren't that many as a percentage people who've been consistently lifting weights. So some people consistently exercise, but it's not the same going to yoga or a spin class. It's not the same for preserving muscle.

Muscle is metabolic goal. So that means if you are one of the few enlightened people who got into strength training quite early and you've been doing that, your body will have high amounts of muscle and will be better at coping with cakes and cookies and french fries and things like that.

But for the majority of people, over time, when, you know, imperfect diets, because none of us is perfect, can also mean that we're losing that sensitivity to that fat storage insulin, which handles how much blood glucose we've got. And I think of it as being like, so we don't want lots of sugar. We want it to be taken out of the blood. We also don't want lots of insulin because that's a fat storage hormone. But what happens in midlife is we lose that sensitivity.

Our cells don't recognize the signals as well. So it's a bit like being, I was talking to a nutrition colleague of mine, or I think she maybe heard me on another podcast giving the bins analogy, which is that it's like when you get married. So there's a job to do. So I'm really, I'm talking about sugar being taken out of the blood by insulin, but. I talk about it, you know, the analogy is about the bins. So you've been married, you've just married, and you say, darling, it's bin day tomorrow.

I don't know, is this a thing in Australia? Do you have like people regularly? We have a bin day, yeah. Okay, I didn't know whether you did something magical with it. I don't know. Bin day, darling, could you go and put the bins out? In the early stages of the relationship, whoever's job that would be would be out of the door, message received. But then as you get older, you know, 10, 20 years down the line, you're going to have to give that message lots of time.

And it's not that the job isn't going to be done, but you are going to have to give many reminders.

Now, if that happens, and it does happen very often with insulin, so there'll be some sugar in the blood, because I don't know, you just had some birthday cake or a couple of apples, and your body will send in insulin, take that sugar out, that's not a good idea but then nothing will happen so it'll send in some more insulin and go don't forget take the sugar out nothing happens so that same signal is going on repeatedly so that can leave us with a bit of

a metabolic problem so it's not just that people aren't eating the right foods because there aren't any right or there's no food that's that powerful but how our body deals with what we put in changes. Right. Okay. There's a lot to digest, pun intended. You're obviously really passionate about nutrition. How did you get into this? Where did that passion come from? Well, my mother tells me that I've always been over-interested, this is her words, in what goes in and what comes out.

So I've always been fascinated. You know, So when food was presented to me, I always wanted a good old sniff of it. And, you know, table manners are better than that these days, thankfully. But I've always been fascinated by the power of food and herbs and supplements and, you know, some of the alternative things. And I went to university. I studied languages. And then I went on. I did a postgraduate in journalism. And I went on to do absolutely nothing to do with food at all.

I had a bit of an epiphany moment after that. you know, 15 odd years in journalism where I thought, I'm going to train as a nutritionist. So that's what I did. I just had, there was a personal moment in my life. One of my children died. And you know, when something bad happens, sometimes you just evaluate what you're doing. And I thought, yeah, why am I doing this? I'm going to do something I want to do. So it was a bit of a knee jerk reaction.

But it was going to a place that I'd always been interested in. Yeah. And you've certainly combined your talents then for nutrition and writing in what you've produced. And it's really evident.

I love it. yeah oh thank you I always knew I had a book in me and I always really wanted it to be a crime thriller it turns out that it's not well it kind of is because the crime is the menopause I'm not sure what the thrill is yeah so why is it realizing that you have much more power over the situation than you think you do because I see so many women struggling and I just thinking I really wish they knew to stop waiting on HRT or their medication for an underactive thyroid or anything

that's going on in that space stop you can't just have the pill you know yes have it I'm not anti HRT or anything like that by any means but it's not going to fix all of the things and I that makes me the saddest of all where people are waiting for their doctor to fix them but they could be doing things that aren't super hard. And actually, some of the stuff, some of the lifestyle stuff is actually really nice. I think it's an area though, and I don't know what it's like in the UK.

And my main audience for this podcast is in the US actually. So that's another market altogether. But I know in Australia. There's a lack of funding. There's a lack of enthusiasm about women that are out of their childbearing years and moving into the next stage of life. There's just very little as far as support there, I think. Is that the same in the UK? It is. It's very patchy. So we have the National Health Service, which is great, but it's mostly great when you're in an emergency situation.

For women, it's very patchy. And you can have a great menopause doctor. So usually there is a menopausal champion at the local practice. GPs or general practitioners, which is what we call the doctors who work at these practices, they are, by virtue of the job they do, they have to know about all the things. And sometimes, you know, they don't care so much or they don't know so much about menopause. So we have a big bunch of people who feel they are being poorly served.

We have, you know, because the information isn't there or they're not being, they're being treated as though they're being hysterical. So they're being sort of gaslit and patronized at what is a really, really fundamentally difficult time for some of them because anxiety and low mood is a well-known feature of this stage of life. So sometimes it's really not very helpful.

And because we do have a private sector, you know, there are some very well-known menopause doctors in that space who are clued up and very helpful but that then comes with a price tag that many people can't afford yeah so you could be lucky or you could be unlucky what do you think is the big take-home from your book you know if you had to kind of sum it up in in a sentence i would say enter the longest sentence known to humanity yeah we've got time we've got time okay

you have much more control over your menopause and how you feel than you think.

And you owe it to yourself to take responsibility for your own health and drive this thing forward until you feel better. That was quite a concise sentence. I thought you did well. It was a bit long, wasn't it? I thought you did okay. There's some very much like boo-hoo news. It doesn't go – one of the things I'm pretty sure that most women either don't know or probably don't want to hear is –. It's not just menopause. We are now creating the health for the next few decades.

And with the changes that I've explained about how it affects the food, you know, how we cope differently with the food that goes in our body and the changes to our bones and all of this kind of thing, it sets us up, unless we make some reasonable changes, it sets us up to be at far greater risk of cardiovascular disease and dementia and alzheimer's and all of those things that we definitely don't want so it's not just we're trying to survive through menopause but really we want to tee ourselves

up so we can thrive through as much of it as we can and create a brilliant next life not next life not for the not the afterlife next stage and and i think we've you know older people now are very different than older people were even when we were children I mean if you look back even on tv you would get on tv a woman in their 50s depicted when we were children in the sort of 70s I suppose they really did seem like old ladies whereas now we're at that

age one thing that really shocked me I'm going off on a bit of a tangent but for anybody of our age who remembers the good life in the UK. Yeah. And I remember watching that as a child. I was quite a fan. I really enjoyed it. But the character of Margot that Penelope Keith played, I always pictured her when I was younger. She was a middle-aged woman. She was, I wouldn't have guessed her age, but I, you know, I would have said she's easily in her fifties.

She was 38 when she filmed that oh my god I know you were just a question then. It just plays with your head, that concept of how old the actors were when they played a role and how old I think we thought they were back then. And I think aging, the whole concept of aging has really changed. And we don't want to just live a long time.

We want quality of life. we want to be traveling and and being active and being vibrant well beyond I suppose what our expectations would have been if if we had been born 50 years earlier yeah I mean one of my motivations to I mean I have quite a desk ironically have quite a desk-bound job but one of my motivations to get up go for a walk in the morning before I start work to do exercise to lift weight is because once my children have left home,

I don't want to be housebound because I'm physically incapable of doing things. I want to be able to have that independent life, which isn't just. Oh good, she can get out of a chair to go and make herself a cup of tea. But I can go out and I can climb a mountain. I can go on the holidays that I want to.

And I think that is important but there is it can be very overwhelming this stage of perimenopause where you're in the thick of it you're feeling rubbish and also around you everyone else is feeling rubbish so everyone's having a good old complaint about how awful it is that does lull you into a sense of I just have there's nothing I can do everyone's in it it's just we all have to feel absolutely shocking We have to just buckle up and just somehow get through it. And that isn't the case at all.

It's very common, but it's not normal to feel like this. And it's not that you won't have any degree of discomfort in your menopause era, but...

Doesn't have to be as dreadful as it is for many women. Yeah. Well, I actually found, I asked you to summarise the book and I've written a little bit of a summary. It's probably a bit shorter than yours. I've put, the book empowers women with knowledge so they can take action. And that's the message that I got from it because it's very much not, woe is me, I'm in this terrible situation, let's all gather together and share our stories of impending doom.

It's very much empowerment and, okay, we're in this situation. We don't have a choice. How can we make the very best of it that we can? And that's how I saw it. I thought it was a real positive read. Yeah. Oh, thank you. I mean, that was the intention that it's, as you said, it's like, here's some science about how it all goes a little bit wrong.

Because I do find it's helpful that people understand in you know they don't need all of the information but understand from a high level perspective what's happening and then okay well what are we going to wait so that we can do all of that better what are we going to do from a lifestyle perspective and then the very last part the last few chapters are about how to actually do the work because having more knowledge is good but it doesn't mean

that you're going to make any changes yeah so and that's the important thing I didn't people I didn't want people just be nodding along going yeah okay that's fine that's me I know that now I want people to be able to identify. Where is the best place for them to start so that they can then.

Start doing something start having the life that they want and it like one small thing is obviously the place to start because as most people probably know creating new habits is about doing one thing and focusing on that and then you know feeling really quite smug because you've smashed having you know six glasses of water it's not where you ultimately want to be but you're giving yourself like a street parade and then you're more inclined to want to add something else rather than do.

14 things you do it for two weeks and then I don't know something happens and then you don't do any of the things yeah yeah I have covered that in a podcast so if you're interested in that listen back now from for you how how do people get hold of you and how do they get hold of the book well the book is available on Amazon as a paperback and in some other places like Barnes and noble as a paperback it's available in all territories as so

wherever anyone is listening to whatever your local amazon is you can get either the paperback or you can get the kindle version and i'm being asked to record an audio which isn't ready because i've not started it so maybe at some point my website is foodfabulous.co.uk and in the best book i've got some resources that direct the, to my website where there's a free download of something or other and there's information on some of the things that I've spoken about.

Beautiful. Well, look, we will put all those links in the episode notes so that people can get hold of you. I genuinely recommend this book. I'm not just, not because just Elsa's looking at me and I have to, but genuinely she sent me a copy. I've read a great deal of it, not cover to cover because it's, as I say, it's quite a substantial book. There's lots of information in it, but there was so much in it that I really enjoyed.

And I genuinely recommend this for anybody who is in menopause, coming up to menopause, or just wants to know what the future holds. I don't think there's, you know, don't wait until you're there until you discover how your body works essentially, because this is a lot of the education and knowledge you share with us at the beginning of the book. Yeah, and even post-menopause. I mean, it's for all women who are over 40, let's say.

Okay, and a few under as well. Oh, if they want to get started and prepare themselves, then they're going to have the world's easiest transition. Absolutely. Well, I think it's just knowledge about how our body works. I mean, why would you not want to know more about the thing that you inhabit every day? I think it's really valuable. So, look, thank you so much. as I say, we'll put Elsa's contact details in the episode notes.

I will be back next week for a solo podcast. Don't know yet what the subject is because things come to me during the week. Also look out for our Weird Wednesdays, which we started a couple of weeks ago. Have a look out for them on social media. And thank you so much for listening. And thank you, Elsa, for joining me today. Thanks for inviting me to be with you.

Don't forget to check the links in the episode notes to our six-week Change Your Relationship with Food course and to the Change Your Relationship with Food workbook and journal, which is available on Amazon. Music.