Part III: Navigating perimenopause and menopause: identifying and correcting nutritional deficiencies

Step 2:

  • After determining that you don’t have any medical complications and a doctor has ruled out other possible health conditions that can cause any of the symptoms you may be experiencing, try to fill any vitamin, mineral deficiencies by altering your diet or taking supplements if you can’t manage with diet alone.  Deficiencies can be found through blood tests and the help of an MD or a practitioner who interprets blood tests using what’s called functional blood analysis.


Your doctor may have ruled out medical conditions and declared your blood tests results to be “within normal range.” So does that mean that all your symptoms are due to perimenopause or menopause?  Not necessarily.  Your blood tests may indicate that you would benefit from some nutritional support. You may be able to eat your way out of your symptoms…or at least reduce their severity.  In other words, alluding back to the garden metaphor in my first post, you need to amend your “soil” for the best outcome for the “seeds” of the change (into menopause).


Specifically for menopause, you want to make sure you are supporting the endocrine system which is composed of the adrenals, the thyroid, and the sex hormones (estrogen, progesterone, and testosterone to name a few). Dr. Rhonda Nelson, likens the endocrine system to a three-legged stool.  While experiencing menopause, this three-legged stool gets wobbly.  The sex hormones are naturally in decline, throwing the balance.  The adrenals, due to stress perhaps, may be working too hard increasing the wobble. As a result, the thyroid starts to work harder in attempt to even things out. So, it’s important to  “feed” the adrenals, the thyroid, and the sex hormones–to provide them with the nutrients they need to do their job.


So how do you know which nutrients you are lacking in?  How do you know which part or parts of your endocrine system that need to be bolstered? Sometimes it’s as simple as taking an honest look at your diet and admitting it may be less nutrient dense than it should be.  If you want to know more definitively, you can have some blood tests.


Functional blood analysis:


Usually, when you go to your physician, you get a CBC or complete blood count and your doctor may add a TSH test to evaluate your thyroid.  Recently, physicians have started to add a test for Vitamin D levels.  A lab will analyze your blood and your physician will go over it with you if any value seems out of their normal range.  Most labs use what is called a “standard range” for each blood test. This range is derived from the average values for all the people coming to that particular lab—the values are dependent on the population of each lab.  A healthcare practitioner using functional blood analysis to evaluate blood test results uses what’s called a “functional range,” these values are not derived from each different lab’s average set of results, therefore their normal range does not change from lab to lab or region to region. The functional range is a tighter range than that of the standard range.  If you picture the standard range as a bell curve, the functional values are generally at the top of the standard range’s bell curve where the values are more appropriate for healthy individuals. If you don’t catch a value until it falls outside the standard range, it’s harder to correct the imbalance with diet or lifestyle changes, pharmaceutical measures may be necessary.


I like to compare my patient’s blood test results with the functional range values with the objective of nudging their values toward the optimal values BEFORE there is a need for pharmaceutical or medical intervention.  Ideally, the patient would make specific changes in their diet and lifestyle to achieve this, but sometimes supplements are the most realistic way to help a patient to get what they need.  Afterall diet, exercise and a hectic life may get in the way!


A word about the Thyroid:      

A thyroid that isn’t functioning properly can lead to a slew of issues including weight gain, fatigue, dry skin, irritability, and irregular menstrual bleeding. During midlife our adrenals tend to be working overtime, therefore, requiring more effort from the thyroid as I mentioned above.  Also, during menopause estrogen and progesterone hormone levels can affect thyroid function. It’s important to note that TSH levels–again, typically the only thyroid test requested by physicians–may test within the normal or optimal range if estrogen is elevated and progesterone levels are low.   So while you may be symptomatic your thyroid tests may be ”normal.”  An expanded thyroid panel, which includes TSH, total  T4, Total T3, Free T4, Free T3,   T3 Uptake and Reverse T3, may reveal if there is indeed a breakdown and where it is.  The reason why physicians don’t usually don’t request an expanded thyroid panel is that the results will not alter the pharmaceuticals they prescribe.  However, the expanded thyroid panel may indicate how best to nutritionally support their thyroid so as not to suffer symptoms or slide into thyroid dysfunction in the future.  Key nutrients to support thyroid function are selenium, zinc, vitamin D, and iodine.  Not surprisingly, stress is hard on the thyroid–so do your best to alleviate stress too!

photo Mayo Foundation for Education and Research

Please do NOT take supplemental iodine without the advice of a medical health care practitioner who has tested you for iodine deficiency.  If you haven’t first fed your thyroid with selenium, vitamin D, and zinc, or if you already have sufficient iodine, or if you take iodine incorrectly, you may increase any symptoms and it could be determinantal to your overall health.  


If you have been diagnosed with hypothyroidism, you may want to consider taking a more natural thyroid medication like Armour or Nature Throid.  Ask your physician if this is an option for you.  Your doctor may or may not be open to this alternative.


A word on phytoestrogens:

Estrogen is one of our sex hormones that starts to decline during perimenopause. Phytoestrogens are plant (phyto) derived estrogens. They are similar to human estrogens so much so that they can be taken up by our estrogen receptor sites if our own supplies are lacking.  Phytoestrogens are “weaker” than our own estrogen, so our own estrogens will attach to our estrogen receptor sites over any present phytoestrogens. However, by eating phytoestrogens you may be able to help ease perimenopausal symptoms and bone loss if your own estrogen supplies are not sufficient. They are most beneficial to those who have mild menopausal symptoms but can be helpful if trying to wean off of supplemental estrogen.


Again, food is the first medicine! In the table below you’ll note food categories that are important for everyone to partake in.  The table is not exhaustive, I have only included nutrients, symptoms, and overall effects to health that I felt were particularly important for women in midlife.


Food category foods Contains vit/mineral Menopausal symptoms Overall health
fiber Legumes, soy, prunes, vegetables, fruit, whole grains Almost everything BUT doesn’t provide B vitamins, some essential amino acids Hormonal balance Gastrointestinal and heart health, stabilizes blood sugar, cancer prevention, bowel regularity, weight control (you feel more satiated, therefore eat less)
Plant protein > processed meat, meat with hormones/antibiotics Legumes, nuts, beans, seeds (don’t forget quinoa), soy Calcium, protein, if vegan ensure you take a B12 supplement Bone health, hormonal balance Be mindful of how meat is raised, processed, and prepared…this may be more responsible for any ill health effects than the meat itself
Good fats Olive oil, avocado, fish, walnut oil, flaxseed Omega 3, 6, essential for absorbing fat-soluble vitamins and minerals such as calcium, A, D, E, and K Hormone balance, skin and hair issues, memory issues Benefits nervous system, heart health, brain, eyes, cholesterol, inflammation
Fermented foods tempe, vegetables and if you eat dairy: kefir, yogurt Probiotics.  Additional nutrients available dependent on which food is fermented therefore may include antioxidants, anti-inflammatory, fiber Keeping the vaginal flora happy! Feed that gut microbiome–we’re only just discovering the importance of the gut biome on overall health! Suffice it to say scientists expect it affects mood and brain function.
Dark leafy greens Kale, chard, collard spinach, mustard, dark lettuces, broccoli Calcium (except for spinach, chard), vitamins a, c, k, many have iron, folate, potassium, fiber Bone health Cancer prevention, help heart, gut, immunity, anti-inflammatory
phytoestrogens whole grains, veggies, seaweed, fruits,

soy (160 mg daily)

Lignan found in:  ground flaxseed (not oil) 1-2 tablespoons daily, and seeds such as pumpkin, sunflower, sesame, and poppy, whole grains (rye, oat, barley), bran (rye, oat, wheat), berries

Hormonal balance, estrogen dominance or imbalance of progesterone,reduced hot flashes, decreases vaginal dryness, help with vaginal tissue atrophy, decrease heart disease by lowering  cholesterol, LDL cholesterol, and triglycerides, may inhibit bone loss, lower breast Antitumor, antioxidant
Bioflavonoids (mild estrogenic) Pith of citrus peel, try tea from rose hips, nettle (Lamium album), citrus fruits, plums, apples, berries, peaches antioxidants Vaginal lubrication, pelvic tone, strengthen the bladder, joint health, water retention, hot flashes, heart health, muscle cramping Anticancer

Please look at my Pinterest board for a graphic on food sources for given nutrients.

A word on supplements:

If you have followed me all on facebook, you’ll know I’m a big fan of Gastropod.  It covers the science and history of food–it’s got my geeky heart!  Anyway, a great listen is their “V is for Vitamin” episode:   They interview Catherine Price, author of the great book “Vitamania:  How Vitamins Revolutionized the Way We Think About Food.”  The long and the short of it:  eat your vitamins.  Eat your nutrients in their intended form: as whole foods rather than eating the different nutrients as a bunch of separate components in the form of pills. When we eat a carrot, we get more than the beta-carotene and vitamin C, we get all the chemicals that make up this orange root vegetable–our knowledge of nutrition is really new and we just don’t know how the rest of the carrot synergistically acts to make it healthful and nutritious.  

photo Kathleen Hiatt Cutter


I am not a big fan of supplements.  I agree that a healthy individual who eats the rainbow daily with organic whole foods probably doesn’t need a multivitamin. If your diet is poor or your system is out of whack and you test for deficiency–you may want to supplement.  But whole foods, foods that are not processed are a superior way to acquire your nutrition.  


If you eat the SAD or Standard American Diet–one that lacks fresh fruit and vegetables, whole foods and is ladened with highly processed foods, fast foods–in other words high in calories and not nutrient dense.  For general health, you may want to consider taking calcium magnesium supplement along with a B complex and a multi-vitamin.  If you do take supplements, I’d advise taking a high-quality whole food supplement if possible, not a synthetically derived supplement. Again, I like to ingest recognizable foods whenever possible for best absorption and benefit.  I prefer Standard Process as they grow the vegetables on their organic farm whenever possible and they strive to source what they can’t grow from sustainable and organic farms.  Unfortunately, you have to buy Standard Process supplements from a healthcare practitioner. Local health food stores have other options.  


photo by Ijy

Worthy to consider:  

You may have also heard that our kale of today is not the same as our grandmothers’.  This is because the soil is less rich in minerals as it has been exhausted.  It hasn’t been rested between growing seasons and is not properly amended.  So, arguably the food we eat is less nutritious now as the soil is nutrient-poor, the resulting crops are less nutrient dense. Here, you’ll note, is the literal soil and seed!   Interestingly, a few years back there was a study that concluded that organic produce is NOT more nutritious than conventional produce. In short, just because a food is labeled as organic, it doesn’t mean the soil is mineral and nutrient dense. Either way,  organic is advisable as it fewer pesticides and it’s arguably better for the planet. Also, organically produced foods may, with their better farming practices and standards,  have better soils in the long term.


Next time:  Step #3

Outside help to support the menopausal journey.

Disclaimer: This is to serve as information only, please seek the care of a medical doctor for symptoms and concerns you may be experiencing.  This is in no way to serve as treatment of any disease or illness.  The following is for information only.