What is lifestyle medicine and can it make a difference during menopause?
Dr. Shashi Prasad is a GP, Advanced Menopause Specialist and Lifestyle Medicine Physician, who works with women to empower them as they enter menopause transition. She helps women to make the choices that they are most comfortable with in terms of managing their symptoms and approaching midlife in the best health possible. Here, she talks to us about lifestyle medicine, what it is and how it can make a difference during menopause.
Explain for me what you do - what is lifestyle medicine?
My interest in Lifestyle medicine developed from my passion for women's health. As a GP I felt I was doing a lot for my patients but also felt that the preventive medicine aspect was missing.
Lifestyle medicine is a very powerful tool to manage your health and wellbeing. It has 6 pillars - Nutrition, Movements, Sleep, Stress Reduction, Relationships and reducing Addictive substances like smoking & alcohol. It empowers people to take control of their own health in a preventative manner, and moves away from doctor led to patient led medicine. It enables people to take steps to improve their health and feel better - whether it's nutritional interventions, exercise, stress reduction or quitting smoking.
Intensive Lifestyle Interventions are also very effective in treating and even reversing certain chronic diseases like diabetes, obesity, high blood pressure. And it can be used very effectively along with conventional medicine.
With menopause, some women can't take HRT due to underlying conditions or don't want to, and they need alternatives. I found that lifestyle medicine is very powerful in this group of women as it can help reduce menopausal symptoms or help women cope with them better.
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Is nutrition an important starting point in lifestyle medicine?
Yes, nutrition is a core pillar of lifestyle medicine. Your health starts in your gut.
Nutritionally well balanced diet is very important- whole foods, nutritionally dense with protein, vitamins and micro nutrients rather than processed foods which are high in calories and low in nutritional content. This can have a huge impact on a person’s general wellness, energy levels, weight and risk of chronic diseases.
The second aspect of nutrition is the gut microbiome. If we have food that supports the microbiome, it has a beneficial effect on all aspects of health. Our gut bacteria like food rich in fibre, fermented food, cruciferous vegetables etc.
Does that mean fermented foods are good for menopause?
Yes, fermented foods can be helpful during menopause. Gut microbiome has a role in oestrogen metabolism.
How did you get into this area of medicine?
It's been a journey for me. I was working as a GP and I found many areas of unmet need. As a GP, I could give medicines for many illnesses, but I felt sometimes I was not successful in treating the root cause of the problem. So I tried to explore other options and found lifestyle medicine which can have a great impact on the health and wellness of people. There is also a huge unmet need in menopausal care in primary care. I saw so many women with menopausal symptoms who needed proper care which was not available in primary care. Hence, I undertook training to become a menopause specialist. I sincerely believe in combining lifestyle medicine with conventional care to give the patients the best personalised treatments.
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Do you feel there is a general gap in the support for women in menopause?
Absolutely, there's a big gap really. There's so much awareness about menopausal symptoms and increased acceptance of HRT among women recently, but the service provision is not there to meet the need. There are not enough trained clinicians or services available, to provide the support and care needed by menopausal women.
Is menopause different from one woman to the next?
Absolutely. No two women are the same and it’s not one size fits all. Their symptoms can be very different and response to treatment also varies a lot. Their personal choices and beliefs may be different. It requires a lot of patience and a deeper understanding of the circumstances of women to give bespoke care. Hence we need to have a wide choice of treatment options to personalise treatment and that’s why I feel menopause care is an art not just science..
Do you find confidence for women in advocating for themselves and asking for what they need is an issue?
Definitely, I would agree with that. There's so much information out there but not everything is correct & reliable, hence it causes lots of confusion and uncertainty. Some are still not sure if HRT is good for them, while some feel they absolutely need to have it for good health. Not everyone needs HRT, and lifestyle interventions are equally important. When they go to their doctors, women might not get all the information, or be denied HRT and often women may not feel confident enough to emphasise their needs and opinion.
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Do you find there's an equal split between women who want to take HRT or go down a holistic route?
I think the needle has swung at the moment. At the moment there is a significant increase in the number of women wanting HRT due to increased awareness and increased discussions around menopause on social media. A decade ago, not many women wanted it. I think having an overall holistic approach is very important to support their decision making.
Do you have any particular tips for how women can start on their menopause journey?
I think the first thing is to get a very thorough assessment to decide where you are in your menopause journey and to understand your individual health circumstances. Further plans will depend on that.
Will it be lifestyle first - nutrition, exercise, supplements, or is it more appropriate to start HRT straightaway? Often we will talk about all the options and what they feel will suit them best.
The main thing is that women need to start thinking more about their health and really start taking care of it from their late thirties/early forties. If you don't, the health consequences start quickly piling up. It might be weight, anxiety, metabolic issues - if you start addressing them from a lifestyle point of view earlier, then you can help prevent health problems rather than trying to fix them down the line.
Nourishing food is really important. Women need to go for a healthy well balanced diet, unprocessed whole foods, lots of fruits and vegetables, and plenty of protein. They can consider adding Vitamins and Minerals to their diet - Vitamin D, Vitamin C, Omega 3, Magnesium can be very helpful.
Exercise again is very important. With menopause transition women start losing bone and muscle mass much quicker. Hence regular exercise, weight bearing exercises and strength training is very important.
Stress reduction and relaxation is again very important for midlife health.
There's very clear evidence that women who approach menopause with positivity and fitness - they cope with menopause symptoms better.
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