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Fresh Leaf Forever
Mastering Menopause Through Lifestyle and Awareness
Join us for a candid conversation with the esteemed Dr. Nitu Bajekal, a leading OBGYN, as she shares her profound knowledge and personal experiences with perimenopause and menopause. With nearly four decades in women's health, Dr. Bajekal offers invaluable insights into how these life stages can vary widely across different ethnicities. She also opens up about her personal journey, revealing the challenges she faced and the inspiration behind her book, "Finding Me in Menopause." This episode is a must-listen for anyone looking to better understand these significant transitions from perimenopause to menopause and the need for support and understanding for women while they're in this phase.
Discover the truth about menopause symptoms and the solutions available, as we explore the critical role of hormonal changes. Dr. Bajekal addresses common skepticism around hormone therapy, emphasizing its significance in managing symptoms such as hot flashes and mood changes. We offer practical advice on lifestyle adjustments, from improving sleep quality to stress management, that can enhance well-being during menopause. The conversation also highlights the long-term impact of menopause on women's health and the need to embrace this life stage gracefully.
In the realm of exercise and nutrition, learn how strength training can combat osteoporosis and reduce cancer risks, while a plant-based diet can effectively manage menopause symptoms. Dr. Bajekal shares the powerful health benefits of soy and other plant-based foods, along with the importance of workplace support for menopausal women. This episode aims to foster a more inclusive and supportive environment for women experiencing menopause, both in the workplace and beyond. Tune in for guidance, encouragement, and a wealth of knowledge from one of the leading voices in women's health.Her social channels Instagram, TikTok to connect is @drnitubajekal. Be sure to follow @vaipkumar more of these wonderful offerings.
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Welcome to Freshleaf Forever, a podcast that gives you fascinating insights week after week. Here's your host, vaikumar. Hey folks, welcome to another episode on podcast Freshleaf Forever. Today we have a returning guest, dr. Nitu Bajekal. She is a senior OBGYN, multiple book author, a senior consultant, obstetrician and gynecologist practicing out of London, uk, with nearly 40 years of clinical experience in women's health. Her special interests include lifestyle medicine, menopause, pcos, endometriosis period problems, complex vulval problems and medical education. She's a keyhole surgeon with experience in laproscopic procedures. Holds surgeon with experience in laparoscopic procedures, including robotics. She's a fellow of the Royal College and recipient of the Indian President's Gold Medal. Dr Bajekal is one of the first board-certified lifestyle medicine physicians in the UK. She has written the Women's Health Module for the first UK plant-based nutrition course at Winchester University. It's with great joy that we welcome back Dr Nitu Bajekal here to podcast Freshleaf Forever. Hey, dr Nitu, how are you doing?
Dr.Nitu Bajekal:today I'm very well. Thank you, Vai, for inviting me. It's always lovely to come back and chat with you, so looking forward to our conversation.
Vai Kumar:Oh, thank you, Welcome back. And how about we start by giving listeners, in fact, first of all, congratulations on this fascinating book. Finding Me in Menopause, it's just beautifully written, and that's the purpose of our conversation here.
Dr.Nitu Bajekal:Yeah, thank you, it was the book I would have liked to have had.
Vai Kumar:Oh, yes, oh yes, it seems like a must read for anyone in the perimenopause and menopause phase. So why don't we get started by quickly telling listeners what perimenopause is and what is menopause?
Dr.Nitu Bajekal:Right. Perimenopause, as the word describes, is around menopause. So basically it's a time leading up to the time when you completely stop your periods. So usually that will be about four years around the age of 47. But we know that life is not necessarily always a certain data point, and so between two to eight years is when perimenopause can last. So menopause tends to occur around the age of 51. But again, that's all over the world. But again, it's not a fixed data point and the range is anywhere between 45 to 55.
Dr.Nitu Bajekal:So menopause is the time when you stopped your periods for 12 months completely, and that tends to be between 45 and 55. It's a retrospective diagnosis. You don't have periods for 12 months and there are no other obvious reasons, and you say this person is in menopause and perimenopause is a time before you completely stop your period. So if you are destined to stop your periods at, say, 45 or 46, perimenopause can be between two to eight years. It's a time leading up to menopause. And so you may be in your late 30s when you're actually going through perimenopause and you're at the peak of your career, or you may not even have started thinking of having a baby if that is your plan. So it's really important to understand what perimenopause is the time leading, or menopause in transition and menopause is the time when you stop your periods completely.
Dr.Nitu Bajekal:Now important note for maybe some of your listeners who are from southeast asia indians, pakistanis, bangladeshi origin and from the black community menopause can occur early, so it can be at 45, 46, 47, depending on which part of India, for example, you're from. It's not, of course again not a fix. There'll be a lot of women who will say I'm still having my period and I'm 54. But there are a lot of women in that early age group, so they may be having these symptoms of menopause and perimenopause much earlier, when they are still in the workplace and nobody is even thinking about menopause at that time.
Vai Kumar:Okay, and just to get to your own journey and transition into that menopause stage, I know you had a lot of challenges and you have outlined it in the book beautifully again. So what prompted you to write the book and what do you think were some of the challenges that you kind of had to go through during that phase?
Dr.Nitu Bajekal:I think my first challenge was that I didn't have the confidence to share with my colleagues. So I was about 38 when I started noticing that my previously regular periods always clockwork didn't really bother me. Suddenly I started becoming very heavy. They were initially a little bit crowded, but then they started hopping and skipping and I thought I was because I was being bullied at work. I was also very busy. I was applying for a consultant job in London.
Dr.Nitu Bajekal:I had two young children, a dog, a husband who worked all God given hours like me, and no real family. We were immigrants from India. There was a lot of balls in the air and so I really my health. I was always a healthy person in that I mostly ate plant-based. I was never didn't have any excess weight. I was very physically active, but it didn't even cross my mind.
Dr.Nitu Bajekal:My mother and my sister were still. My mother had a period since she was 52. My sister, who's who's about eight years older than me, was still having her periods. So it didn't even occur to me that my periods that were stopping was anything to do with perimenopause and my low mood and libido issues, all these things.
Dr.Nitu Bajekal:I tried to brush under the carpet and then realized that actually my periods had completely stopped and I fell into that group where I was one of the specialists in those areas with premature ovarian insufficiency, where a woman, or those who are assigned female at birth, basically their period stopped under the age of 40. So one in 20 000 girls, young women, may never reach um, you know, may have the one period and never have a period again. So that's very rare but it still happens. And then one in hundred and in fact in india and all, there may be as high as four to five women in a hundred will stop their periods under the age of 40. That is a medical condition called POI, premature ovarian insufficiency, previously known as premature ovarian failure or premature menopause. We don't like the word failure, we're not very drastic term right.
Dr.Nitu Bajekal:Very drastic term. So basically anybody who has POI. And there are many reasons genetics, unknown, there may be some medical conditions as well, but most of the times we don't find a reason. And if anybody who's listening hasn't had a period for more than three months because women take three to four doctors before they can actually be diagnosed with POI and there may be other background conditions it may not be POI. It may be polycystic ovary syndrome, for example. It may be an eating disorder, it may be exercising too much. Whatever it is, if your periods are missing for more than three months, never to be ignored. It's important to see the right to see your doctor initially have the right tests.
Dr.Nitu Bajekal:So POI is what I diagnosed, knew I had it. I needed HRT, hormone replacement therapy or hormone therapy. But we are talking I'm almost 63 now, so we're talking 24-25 years ago, when the WHI study and the million women study from the US and UK had come out and basically the media got the information wrong and ran with it and said that HRT is dangerous, it causes cancer, when actually none of that is, you know, remotely true and unfortunately my family doctor refused to prescribe me HRT despite me going several times. So I had I been more confident because I had just become a consultant. I was a keyhole surgeon. I was, you know, an immigrant, a woman, a woman of color. I wanted to be at the top of my game. I did not want to appear weak. But actually, in retrospect, had I shared with my male colleagues because I was the only woman, I would have, I think you know, been able to get heard, think you know, been able to get heard. Instead, I managed on my own for quite a long time and luckily for me. In a way, my younger daughter was nine. Around that time she became vegan and many of my symptoms improved. But I didn't, of course, put it down to diet and lifestyle. I thought it was just life. But now I know what it did.
Dr.Nitu Bajekal:But any woman who's listening under the age of 40, I, who stops their periods, who's diagnosed with premature ovarian insufficiency there's a wonderful book by Dr Hannah Short called the early guy the guide to early menopause and POI. But also to seek medical advice. Please do not let a doctor tell you it's okay not to have periods. So that's my message and I wrote the book. I'd always wanted to read a book like what I had written and it felt right. We wrote the first book because Rohini, my older daughter, has polycystic ovary syndrome and she wanted me not to write a general book, and so she said you've got all these 35, 40 years of experience. You need to write about things that you know a lot about endometriosis or PCOS or menopause. So we started off with PCOS and then, of course, this book was bubbling inside me, and I hope there are many more books to come, but maybe I'm taking a few months off now.
Dr.Nitu Bajekal:I'm sure I'm sure, this just has been a beautiful transition, I should say, and it's flourishing in perimenopause and menopause, and perimenopause because of all these symptoms that we are supposed to get, but most women may have some symptoms, some women will have no symptoms and it's not a time for doom and gloom for everyone so yeah, I just want people to realize you can flourish.
Dr.Nitu Bajekal:And yes, it's really hard when you get a diagnosis when you haven't even started building your family, for example. Those are different medical situations. But for the average person, I don't want you to look at this time and really that's why I wrote flourishing in perimenopause and menopause, because I do believe you can actually embrace it in different ways and seek the right help. But also, you know the attitude is so important, isn't it?
Vai Kumar:Exactly, and we all think it's inevitable and that you know we have to endure those symptoms and it's so much of still, even you know, like we are approaching 2025, and there's still so much of societal taboo in terms of discussing all these things Right.
Vai Kumar:And you mentioned about POI, that's premature ovarian insufficiency, and and coping with it I guess not just to you know remain silent but seek medical help in the form of, say, hrt, which is hormone replacement therapy. And you have highlighted beautifully how we all tend to, the number of ovaries we all tend to. You know it just reduces over time and that's like a common process, right yeah?
Dr.Nitu Bajekal:Let me explain why POI occurs or menopause occurs. So when we are conceived, around 20 weeks, there would be, say, like a couple of million eggs in each ovary. Ovaries are the egg baskets and they basically are the powerhouse of the hormones estrogen producing. Of course. Estrogen, progesterone, testosterone are producing the other parts of your body, but these are the main sites and they're regulated by the brain, by the hypothalamus and the pituitary, which release hormones which are chemical messengers which will work and stimulate the ovary, and there'll be a master switch in the hypothalamus that starts everything off and puberty starts. So what happens is you have these couple of million eggs by the time you're born. A million have got lost by what is known as natural attrition. It just gets, you know, degraded and so you may be born with a million eggs and then over time, by the time you reach puberty and then the time you reach your early 20s and 30s, the number of eggs keep dropping till you reach menopause, when a critical level of below 1000 is reached. So if your genetics are dictating, or your environment or whatever it is, if your ovarian egg supply has dropped to less than 1000 and you're only 25, then that's POI.
Dr.Nitu Bajekal:If you're 40, between 40 and 45, that's early menopause, unless you had it removed. The ovaries can be removed at surgery and chemotherapy and all as well. And then after 45 and between 45 and 55, when those number of eggs tend to drop below 1000, then the estrogen levels drop, which is responsible for many of the symptoms, and then the ovaries start telling the brain come on, produce more of the releasing hormones so we can release more estrogen. So it may work for a bit in perimenopause, your period stop and start and all that, but the hypothalamus ultimately will tell the pituitary we, we can't produce anymore. So the FSH, lh levels, fsh levels, the follicle stimulating hormones, tend to rise to a level that is menopausal and, as a result, there's just no more. There are not enough eggs to release these ovaries.
Dr.Nitu Bajekal:And the important thing to remember is that life expectancy now in most of the western world is in the 80s. So you are going to have anywhere between 45 to sorry 30 to 35 years in the menopause. So that's a long period of time. And so people often say, oh, I've just stopped my periods, I've had a few hot flushes, or I've had hot flushes terrible for two, three years and I'm done with menopause. No, menopause is from the day you completely stop your periods until the day we die, and there are long term impacts and there are some short term impacts, but we are always in menopause and that's why it's so important to embrace it, because it's not going anywhere. And we are not going anywhere, oh yeah exactly, oh yeah, exactly.
Vai Kumar:and you say in your book you call out like this, almost like 34 symptoms that can, yes, one, can you know, possibly all the overall women population can experience right and you started, you led us there, right there, into heart flushes and night sweats yeah all those they are supposed to be, some of the more common symptoms.
Vai Kumar:The vasomotor. Sorry, you were saying something else. Yeah, the hot flushes the night sweats, all the vasomotor symptoms, right Correct, with so much skepticism and say reluctance to take hormones? And with all these symptoms at play, why don't you just tell listeners how important it is to not ignore and what are the kind of the ramifications when it comes to, you know, tackling these symptoms?
Dr.Nitu Bajekal:Yeah, If they go unaddressed, there are, you know. We say there are 34 symptoms, there are probably 60 symptoms. Okay, and you know, because menopause is a whole body situation at the end of the day. So you can imagine that estrogen receptors in every tissue, every cell of the body and so you can imagine whether it's from the brain. You can imagine brain fog, memory issues can be an issue for some people. But, as I said, remember all these symptoms may never occur for you and some of the symptoms may occur Rarely will I see. Remember all these symptoms may never occur for you and some of the symptoms may occur Rarely will I see patients with having all the symptoms. But if you go from head to toe, you can imagine there can be thinning of hair, loss of hair. You know, depending upon your genetics, your family history, as the estrogen levels drop then the hair follicles tend to not be as healthy. If you're anemic, that makes it even worse. So you need to make sure that you have good iron stores.
Dr.Nitu Bajekal:Again, as I said, going into the brain memory loss, brain fog, feeling, you know, having issues with processing and organizing those things can be issues for some people. Others may notice joint pains. Others may notice that they may have palpitations, night sweats, hot flashes, and that's because the temper temperature regulatory zone is set and it's become very sensitive. So as soon as it falls slightly outside, women will notice that they either have hot flashes or cold sweats or night sweats, because they're basically finding that they have this sensation of heat which can last anywhere from like a few seconds to up to a minute. Usually can be just once a day, can be 100 times a day and you know that's why layering of clothes can really help in these situations. So hot flashes and night sweats are the most commonly known, but not everybody will have them. Low mood, lowered libido, those from brain if you go down to those are real issues can cause relationship issues as well for women, because you may be having different desires at that time and hard to explain. You also may be at a situation where you have you may have children who are trying to go to university or college, others may have elderly parents or you might be just trying to negotiate. Do I want a family or not? So many things can be there.
Dr.Nitu Bajekal:So perimenopause will have very similar symptoms to menopause. There can be other things ringing in your ears. You can have sensations under your skin called formication, like as your hands are crawling. You can have joint pains, tiredness, fatigue. You can have erratic bleeding in perimenopause because symptoms such as heavy periods, frequent periods, may become even more prevalent if you have a background of fibroids or endometriosis or adenomyosis. So those things have to be kept in mind and that women may have pushed them to the back of the because they've been so busy and now they're finding that these symptoms are getting worse. But all the symptoms that you see in menopause can occur in perimenopause, but in perimenopause, as women are still having periods, however infrequently, they may have period issues as well, and then of course there are genitourinary symptoms.
Dr.Nitu Bajekal:So, for example, women may notice increased cystitis. So every time they go to their doctor, the the doctor will say, oh, you have an infection and they give them antibiotics. But actually you don't have an infection. Your estrogen levels have dropped, and so, while it's important to check your urine, usually it's because of estrogen receptors and estrogen levels have dropped and so that makes the bladder very sensitive. The vagina becomes very sensitive, dry, you can have a sensation of paper cuts, especially after penetrative intercourse or and so on.
Dr.Nitu Bajekal:It is important usually tends to occur in the second half. So menopausal symptoms tend to be the early first five, six years where you'll have the basomotor symptoms that you were describing hot flashes, night sweats, some joint pains, libido issues and sleep issues While after five, six years women tend to find more of the more arthritis. They may have heart health issues, cholesterol issues, which can all start in perimenopause as well, but they may notice cystitis and vaginal dryness, as the estrogen levels now have really dropped to a low and local vaginal estrogen is safe. It is not even HRT. You can women almost everybody, including women with cancer with the okay of the specialist, can use vaginal local topical estrogen after checking in with your doctor and you can use it for the rest of your life, usually twice a week and it really makes a difference to quality of life.
Dr.Nitu Bajekal:So there are so many symptoms that can. If you take any bowel symptoms, you know, know gut upsets, constipation, you know change in gut microbiome that can be a problem. Bladder increased frequency, you know leaking of urine urgency. So literally there's a range of symptoms from every organ and that's why easily they add up to 34.
Dr.Nitu Bajekal:But as I said again please don't panic, because there's help for almost everything and also most women won't have all the symptoms, and this is where diet and lifestyle. So not every woman can take HRT, not every woman wants to take HRT, not every woman can take HRT. But even if you're on hormone replacement therapy, which is safe, you need to bring in lifestyle changes because all these symptoms can also be helped when you're doing lifestyle. It's not one or the other.
Vai Kumar:It's very important. I think it couldn't have been underscored better. I think it's very important that people seek the help of their OBGYN and go for regular visits. The annual visits are much more important.
Vai Kumar:Getting a mammogram, getting everything taken care of and discussing you also give a nice cheat sheet for people to go prepare for appointments, right, because this lack of sleep again say, for example, if we were to focus on that one symptom, someone has lack of sleep that can have a rippling effect in terms of mood and anxiety and stress and so on.
Dr.Nitu Bajekal:Right, because anxiety, depression and, yes, some women do need antidepressants, but a lot of women in perimenopause and menopause may actually all they need is hormone replacement. So it's so important to have a ob-gyn who understands, who's willing to acknowledge the symptoms and accept and their own limitations and if they don't have the expertise they should be able to refer on. And also, if you as a patient are sitting there thinking I don't think I've been heard, then do ask for a second opinion. It's really important and the reason I've written my book really important and the reason I've written my book and because of my website, which is completely free neethubhajekalcom. What I try and explain is have your questions ready, know your medical history, know your surgical history, know the medications you're on.
Dr.Nitu Bajekal:Be careful of taking supplements that are not scientifically validated, because you'll spend a lot of money and they can actually harm you in the longer run. You know collagen supplements and you know all kinds of these menopause relief supplements. They are all not natural because they're in the form of a tablet, so you're better of standardizing it, regulating it and looking for the right stamps so that they are absolutely, you know, fda approved or any big society approved, because I see every week I see women with 10, 15 supplements sitting in front of them, spending $100, $200. And I'm thinking you were so much better spending that money on buying soybeans and fruits and vegetables and dals. I do want to highlight that as well, because women are very vulnerable when they're having symptoms, so it is whether it's with the health professionals or whether it's with the industry so, and then there's social media, to promote everything.
Dr.Nitu Bajekal:You know promising all these cures. So it's so, so important to actually take those things with a pinch of salt. Some supplements, of course, are vital vitamin D and B12 and possibly algae derived omega-3. And you know, for sleep, like you were talking, there are some of my patients who find benefits with magnesium. Not everybody does. The studies are not great.
Dr.Nitu Bajekal:But having a sleep pattern, a regular sleep pattern, sleep routine, making sure that if you are stressed, learning to do some de-stress techniques of breath work, or going for a walk, or talking to a friend, making sure that you don't eat too late, making sure that you go for a little walk or do some little exercise for five minutes to help your insulin levels settle down after a meal, you know eating early in the day these are all simple things. Having an eye mask, thick curtains, layering your clothes, you know. Just having thin sheets so that you can move them away as you feel hot at night, you know. Having a fan turning the heating down I have all these suggestions and different things will work for different people and I know they sound very oh. Everybody knows that, but you'd be surprised.
Dr.Nitu Bajekal:For me, that is my weakest pillar. Sleep has always been as a when I was an obstetrician I just practiced gynecology now but you know I used to be woken up several times at night. Every second or third night I have had a very poor sleep. Then add on top of that the early menopause. That was a real issue, and so it is so important to prioritize that because, as you said, when you have sleep issues, you will tend to wake up stressed. When you are stressed and anxious, you tend to eat the donut rather than the apple, and then when you're eating those foods, you don't feel like exercising, you don't feel like remaining your friends, you don't want to go out of the house. So it's a domino effect for all the six lifestyle pillars. So it's so important to try and find one pillar that you want to make a little difference, whether it's the food pillar, whether it's the exercise pillar, whatever it is and then slowly build it up and that's the same for any hormonal health condition to optimize one's health, or whether it is perimenopause or menopause.
Vai Kumar:Okay, and you said erratic bleeding. Even that's not to be ignored, right? Because sometimes a physician may order a pelvic ultrasound, and that can reveal so much more information. Is that?
Dr.Nitu Bajekal:correct? Yes, so any woman who has bleeding after sex. Even if you had a clear pap smear, if you're bleeding after sex, is there an area on the cervix that is causing problems? Is there a polyp? Whatever it is.
Dr.Nitu Bajekal:So bleeding after intercourse should never be ignored. Bleeding in between your cycles should never be ignored. Bleeding more than seven days not be ignored. If you're passing clots which is bigger than the size of your thumbnail, if you're having to use double protection, if you're having to have painkillers all the time, if it's affecting the quality of your life, you should not be ignoring any of these, because there may be background conditions that have not been picked up. So conditions like chronic inflammatory conditions, like adenomyosis, endometriosis, fibroids, which are benign growths, but if they are in the cavity, they can cause a lot of bleeding as well. You also may have conditions like polycystic ovary syndrome, so that it's so, so important that you don't ignore these symptoms and have a health provider who listens and arranges the right test.
Dr.Nitu Bajekal:That is why I have those chapters in my book to say this is what you should be asking if you have this and there are a lot of case studies as well so you empower yourself with the knowledge from the website, from good resources, the NHS website, the Royal College website, good resources, the nhs website, the royal college website, the american college of lifestyle medicine and, you know, the mayo clinic sites.
Dr.Nitu Bajekal:They give you good advice. You can always go to chat rooms because, of course, patients and people can give you a lot of good advice which doctors can't. But you do need to make sure that you is individualized. It's right for you and you're getting that information because the number of women I see why who come with having gone to these bio-identical hormones, which are, you know, custom compounded, because they think it's better for them but actually they're not regulated at all and no expert will recommend them. So you always want to choose standardized, regulated HRT that is FDA approved and NHS approved in the UK, in Australia as well, because you want to make sure you're getting the right dose of estrogen, the right dose of progesterone, rather than hit and miss amounts. And they are also bioidentical, or we call them body identical, which basically means that they mimic the same hormones that our bodies produce, whether it is progesterone and estrogen. So, again, a lot of women listening here will be seeing people who are giving them bioidentical hormones from unregulated sources and I want to call that out yeah, clear.
Vai Kumar:And the most important thing with that as well is when you are under the care of an OBGYN, who is giving it. They have your whole history to kind of go off of and not just something that you do from unregulated sources. Correct.
Vai Kumar:Back in a moment with our guest on Freshly, forever and weight gain in menopause yes, I know you have a whole chapter on that you have a whole chapter and you again, you beautifully bring out why body neutrality is so significant there yes, because you know it's very well to keep saying, um, body negativity women struggle with anyway.
Dr.Nitu Bajekal:They're always being told by society you're not too thin, you're not too, you're too big or whatever you know it is, you're too thin, you're too fat, whatever it is. Body positivity can also be quite toxic because, you know, sometimes you do feel like I don't want to be positive about my body. It's letting me down right now. But body neutrality is actually accepting that this is the body that we've been given. It's so lucky, it works and you know, even if you have a slight hangnail, you know that whole day you'll be thinking about it. Or if you have an ulcer in your mouth, but we don't even think about those parts of our body when they're functioning okay. So I do want people to be aware.
Dr.Nitu Bajekal:And weight gain is an issue. It's an issue for all genders, as after the age of 30 you steadily put on weight and but it's particularly more prominent for women in perimenopause and menopause with the way the hormones shift and things. So we know that that can be an issue. And also there are several other social factors also that increase our weight. For example, you may be stressed, you may have issues with. You know, food regulation. You may be, as I said, having these, you know, carer issues, looking after parents and children. You don't have time to look after yourself. You may be, as I said, having these carer issues looking after parents and children. You don't have time to look after yourself. You don't have time to care for yourself. You don't have time to do exercises. So these things are important. Plus, we may have more finances and more money to spend, so we may be eating out more often. And, of course, if you eat out, what is there? Oil, fat, sugar, salt, and so we know that that can slowly creep up.
Dr.Nitu Bajekal:Alcohol again. Not only is the increased risk of alcohol with every glass of wine you drink in the menopause and perimenopause significant increases after the first couple of units. So there's no safe limit for alcohol, no safe limit for smoking, tobacco, vaping all these things are, you know, things that you really need to focus. Have a celebratory drink, if you want, but regular alcohol is also is quite high in calories and, of course, causes seven different types of cancers, affects sleep and menopause worsens hot flashes. So there are so many aspects that can affect sleep, can affect weight, you know, and so I have lots of suggestions there and of course one of the ways of trying to mitigate that weight gain is by trying to focus on a plant forward diet. So the more large you eat they tend to be light in calories, very nutrient dense, so you tend not to put on the weight. For your same friend who would be having a baked potato with uh, which is very popular in the uk, so maybe for y'all oh, it's the same here.
Dr.Nitu Bajekal:Baked potato is quite potatoes are great source of fiber, potassium. You know it's very satiating, it's a delicious dish and it's actually low in calories. But your friend may be putting a dollop of butter or cheese or tuna mayonnaise, while if you have it with hummus and a big salad and baked beans and you know, or make a curry on your own and put it on that, you will find that that is actually a very satisfying meal which is not high in calories. And for every tablespoon of oil that you consume, which is about 120 calories, you can eat a large salad with some hummus and things like that. So it's making these smart swaps, uh, so that you know how to increase the nutrient quality of your food but at the same time reducing the calorie content.
Dr.Nitu Bajekal:So you know I try and talk about this. I have chapters on various things like work, menopause in the workplace. You know we talk about the various minority communities that are affected by menopause. You know very harshly actually. So I hope that all these different chapters people can read, pick and choose whichever chapters they want. But for those who don't like reading, then of course, you know, maybe printing out just the small sheets from my website can help.
Vai Kumar:Oh yes. And what about the role of exercise? I do want to go into the plant forward diet a little bit more. The role of exercise. And Dr Rajiv Bajaykal, your husband, an orthopedic surgeon, has written a beautiful chapter in your book on bone health and how resistance training and all of that can help.
Vai Kumar:So, with low estrogen and estrogen deficiency, as we start from perimenopause going into menopause and you already said, we all live the lifespan into our 80s and about 35 years we are all in menopause. So how important, how much can we just talk about, yeah, exercise.
Dr.Nitu Bajekal:I have dedicated a whole section to exercise. First important thing is do not use exercise to lose weight. Do not use exercise to lose weight. You will not lose a gram of weight unless you're exercising like Usain Bolt or Paula Radcliffe or you know one of the top athletes. That's not the purpose of exercise. The purpose of exercise is to increase your endorphins, make you feel better for yourself, so you make better food choices.
Dr.Nitu Bajekal:It helps to reduce cancer risks from coming Breast cancer, which is one in seven or one in eight women in the US will get a diagnosis of breast cancer. So exercising regularly can help with that. And we know that menopausal women are at a greater risk. And especially South Asian women and black women tend to have a much higher risk of getting breast cancer earlier on in age, in their 40s, and often a more aggressive form. So it's really important to bring in exercise to reduce the risk of many cancers, reduce the risk of cancer coming back once if you have got the diagnosis of cancer. But it also helps to maintain weight loss. That's good. It helps you to tone.
Dr.Nitu Bajekal:But strength training is particularly important because one in three women often will have a hip fracture because of osteoporosis. So it's important to bring in from the age of 30, our bone loss starts. So you want to start doing strength training from early childhood. But it's never too late at all to start making changes at all. To start making changes so you know doing weights, either with the help of a personal trainer if you can afford it or if you have any health issues, making sure that you get okay from your doctor or otherwise. Looking at youtube and doing initial five minute exercises and slowly building up with small weights or even like bottles of water and things like that, and using your own body weight. So strength training is really important, helps with managing things like that and using your own body weight. So strength training is really important, helps with managing things like type 2 diabetes, insulin resistance, but also helps to strengthen your bones and then adding that with certain foods will allow the bones to be even healthier. So when you drink soy milk, when you eat soybeans, when you have prunes, these are things that will help your bones and make it much more healthy. But at the same time, strength training at least twice a week, 30 minutes minimum, is what you should be trying to do. But even if you do five minutes, 10 minutes a day, it doesn't matter. Every little bit helps so, and you're never too old to do them as well. So it's so, so important, because one in three women will have a hip fracture and half of those women will be dead by the first year after a hip fracture. So we really don't understand the power. Like heart disease is another situation. So exercise can really help improve heart health and cholesterol health, because more women die of heart disease than men with a heart attack. So, um, it's, it's just that we die a bit later, so nobody talks about it.
Dr.Nitu Bajekal:So with exercise, I really want people to think whether it is a walk, and find an exercise that you enjoy and then bring in some strength training. So it may be. You know reformer pilates or you know doing your own body weight and planks and things like that. But find things slowly, but don't try and rush. I always say, if you're somebody who's never exercised, start by maybe getting help and then slowly doing five minutes. Even doing 15 minutes reduces death rates, we know that. So slowly do that rather than trying to run a marathon on day one. So always try to slowly build it up over a period of months, because it's really shout.
Dr.Nitu Bajekal:South Asian women are the world over, tend to be the most sedentary and our jobs tend to be quite sedentary. So if you are I have a desk job I would suggest standing up every hour so that you go do a walk, do some burpees, maybe do some calf raises while you're waiting for your tea to be made, or whatever. Try and bring in on in a daily way some ways of acting, uh, action, so that you're not sitting for long periods of time. We sit at desk, then we come home and we sit in front of the television or in front of our phones, you know, and all of us are guilty of doing that. So exercise is so, so important, which is why rajiv, who's my husband he's a back surgeon sees a lot of back aches, and that again is from sedentary sitting. So posture is so important. So I we discuss all that, all the science behind, why it is so useful for menopause, perimenopause and actually all age groups oh yes, and movement is anti-inflammatory, correct?
Vai Kumar:absolutely okay okay, and let's delve into workplace dynamics and accommodation for menopause.
Dr.Nitu Bajekal:Yeah.
Vai Kumar:What are some factors you think are important? And in fact, right along this, as a coincidence to this conversation yesterday here on Morning Show, there was talk that it's going to be all over linkedin in 2025, that accommodation for menopause is important and I believe even insurance companies are like offering support forums and support groups and things like that, which will be fantastic.
Dr.Nitu Bajekal:So I'm really looking forward to 2020 we have a long go, though we have a very long way to go. Studies have shown, even amongst doctors, that most female doctors don't get hurt. They don't get any allowances, and one in four will have severe symptoms with menopause, and those women often end up leaving their job. And so one in 10 women leave their job and they're not meant to leave their job. And so one in 10 women leave their job and they're not meant to leave their job. So you know, it is a real issue, and with 60 to 70 to 75 percent of women in their 50s 60s still in the workplace, and we're talking about, you know, 12 women out of 100 having early menopause between 40 and 45. We have four in 100 under the age of 40. And then you have the rest between 45 and 55, all still at work. And work is not only the paid work, don't forget. There's also work at home, okay, work at caring. So we do have to realize women have been bottom of the pile for a very long time, and so making these changes that are coming in through government, in the UK especially, is very good, but all employers should be aware, and it is important to have a person who's a menopause um, you know? Spokesperson, if possible in bigger organizations, so that you can see whether you need leave. Are you somebody who's has disabilities? Are you somebody who's from a minority community? Are you somebody who has disabilities? Are you somebody who's from a minority community? Are you somebody who has got who's? For example, you know trans and so is not able to tell people that they actually have menopause issues because that's not how they're known in the workplace?
Dr.Nitu Bajekal:These things are all very important, but for everybody we need to be able to talk about it openly. We need to make sure that you have a toilet. Because you have increased frequency, you know you shouldn't have to trek to different floors to go to the bathroom. If you need to have a fan, if you need to sit near a window simple things they can be brought in. And If you are somebody who's struggling with symptoms and you need to go see your health provider, it is important for the employer to give you time off rather than you having to take annual leave or leave without people knowing.
Dr.Nitu Bajekal:So I think there are a lot of things people can do, including educating your seniors and having you know people come in, like I often do talks for corporate organizations or, you know, for nhs organizations. It's important that you do these things because a lot of men and women who have gone through all that have women will say you know people women of my age will say, oh, that happened a long time ago, let's move on. I didn't have all that support, but that's not. If we have to move forward, we have to make sure that we're bringing all the right changes in. So changing the legislation, changing the paperwork, but also bringing these small workplace changes having bowls of fruit rather than biscuits lying around these are all little things that people can do. Ensure that there's healthy lifestyle promoted, people are allowed to take their lunch break and go for a walk without being made to feel guilty. Little things like that can make a huge difference to experience of perimenopause and menopause.
Vai Kumar:Yeah, and including, you know, the simplest thing right, Providing access to some clean water drinking water right alongside you know your desk area.
Vai Kumar:Yeah, so lifestyle and menopause. You call it age-proofing your menopause. In this beautiful book, we talked a little bit about the influence of plant-based diet, so specifically talking more about it and the role of proteins in terms of, know, bone health, and not just protein, carbs, fats everything good fats and a lot of vitamins and minerals that are inherent in food. Why don't you talk more about that? Because there's so much. I think, yeah, we touched upon it when you were referencing weight gain and how we can sort of combat it yeah, I mean, I personally follow a plant exclusive diet, a fully plant-based diet, and have done for 22, 23 years.
Dr.Nitu Bajekal:But it would be great if people can do that, but not everybody can. So I want to encourage people to have a plant predominant or plant forward diet. So if you're somebody who's eating no fruits because you're scared of sugar in the fruits, let me reassure you that the fiber is there in the fruits you want to be eating to reduce the risk of type 2 diabetes. If you have type 2 diabetes, that will get improved if you want to make sure that you get all the right nutrients and vitamins and calcium in your oranges, so I would suggest starting, if you're not eating any fruits, maybe having one fruit and then a fruit that you like, maybe some satsumas or clementines, and then bringing in some grapes and mango and papaya and watermelon. Watermelon is supposed to help with vaginal lubrication, so you know, eat more of these fruits. So fruits is a very important part of one's diet, especially in perimenopause and menopause. The second group that you want to bring in are lots of vegetables. Find vegetables that you like. Again, if you're somebody who doesn't eat vegetables, maybe start with a small handful of a vegetable that you like and slowly build it up. Some cooked, some raw Green leafy vegetables really help with, you know, heart health and opening up blood vessels. So it's really important that you try and bring in the vegetables Now. The particular foods that are very helpful for menopause and perimenopause are herbs and spices. They can help in a number of ways, whether it is turmeric for joint pains, whether it is cinnamon for blood sugar regulation. So you want to bring in huge amounts of fresh herbs, dried herbs and spices in your diet. You also want to make sure that you're focusing on whole grains, tubers, so whole grains like brown rice and quinoa, millet, amaranth doesn't matter Finding foods like that because they keep you full. They have lots of fiber and fiber helps you lose weight. Fiber helps you your gut health. Fiber helps to prevent constipation. Fiber helps to reduce the risk of cancers and things like that. So you want to bring in whole grains as well.
Dr.Nitu Bajekal:You want to bring in legumes, which are the star of menopause and perimenopause. What are legumes? They are basically lentils and pulses which you want to start with if you're not used to eating beans. Start with the soft dals and lentils. Cook them really soft. Rohini has written a full chapter. My daughter, who's a nutritionist, she's written a chapter on bloating and things. It's important that you bring in these lentils and pulses. Don't be scared. Start with a small amount and slowly increase it. Then move on to the beans. Beans are again very rich in fiber and the king all beans. You want to eat chickpeas and burlotti beans and kidney beans and all kinds of beans and try to eat two or three times a day over time as you slowly get used to it. We know that those communities that eat a lot of beans tend to live the longest and the healthiest.
Dr.Nitu Bajekal:But soybean is particularly important for menopause. It has a very good protein profile. So it is. You know, all the people who go to the gym are always talking about egg white. Egg white has got so many um, non good health issues with it. So you want to be focusing on the soybean because it has got the same plant, same protein profile, same amino acid profile, without any of the nasties. It helps reduce cancer risk of your liver cancer, bowel cancer, ovarian cancer, you know what else Breast cancer, prostate cancer. So really you want to be focusing on the protein profile of the soybean.
Dr.Nitu Bajekal:How do you eat soy? You want to have it in the form of edamame beans, mature soybeans, you want to have it in the form of tofu and tempeh and soy milk and soy yogurt. You don't have to go specifically for the organic or the gmo, non-gmo version. But if people are anxious and they can access that, that's fine. I'm not fussed about it because that is not a real risk as such. But soy itself has been around for 5000 years In China. Huge populations have already always eaten it with huge benefits for overall health heart health, cholesterol health, brain health, weight loss as well as menopausal symptoms. Neil Bernard did a wonderful study where people ate about 50 milligrams of isoflavones, which are the plant estrogens that you know kidney beans have, blueberries have, pistachios have. But soy has it particularly healthy and so men and women who eat it and the earlier you start eating, lower is the risk of prostate cancer and breast cancer. So we know that will help. But having half a cup of mature soybeans or having a handful of edamame beans, a cup of soy milk, maybe a handful of tofu, will give you the 55 milligrams of isoflavones, which are the plant estrogens, and that will help to reduce the risk of your hot flashes by 84 percent. So that's a huge benefit, you know, other than for women who can't take HRT, who don't want to take HRT.
Dr.Nitu Bajekal:I personally tend to take between three to four portions of soy every single day, because I do a lot of strength training, so I will have some plant protein in the form of soy protein, a tablespoon of it, some days. Some days I'll have pea protein, brown rice protein. I mix all my different proteins to get the, because, you know, as you get older, you want 1.4 to 1.6 grams of protein, sometimes a little bit higher, but this is a good amount. So you want to get it from uh, you know the soybean, which has got a very good source of protein. Also all your lentils and legumes, and very rarely are people allergic to soy, so it's really a very good way of getting tofu. Tempeh, seitan is another one, which is wheat protein and, of course, protein powder.
Dr.Nitu Bajekal:So we have a whole chapter focusing on protein, because, as you get older, as you become menopausal, focusing on protein. But plant protein is more important than animal protein and so you want to focus on that. So we've talked about fruits, vegetables, whole grains, we've talked about green leafy vegetables, herbs and spices. We've talked about legumes, including soy, and I really want people to take away nothing else you remember from this chat. Remember that soy is safe for you. I have a whole fact sheet on my website. I have a whole chapter on my book, but I don't get paid by anybody, it's just.
Dr.Nitu Bajekal:I see the benefits of soy, so it's really important, and, of course, things like potatoes, sweet potatoes, yam these are all very important foods. They keep you full, they have low calorie, they're very rich in fiber, but you don't want to chip your potatoes and you don't want to fry your potatoes. You want to have them, you know, baked, or have them, you know, boiled and mashed and things like that. And when you eat this kind of way, your inflammation levels reduce. So we know the chronic inflammatory conditions like adenomyosis and endometriosis and type 2 diabetes and heart health and all can improve because you're reducing the advanced glycation end products, which are called AGEs.
Dr.Nitu Bajekal:Ages are found in meats and in highly fried foods and things that tend to damage your arteries, your ovaries, your heart. So it's so important to try and eat as much as possible. Start your day with a big porridge with lots of berries, flaxseed powder to increase your omega-3s, and your soy has that as well, so have it in soy milk. Lunch can be a big salad or a soup, you know, with lots of tofu on the side, or as croutons. Evening can be you know, big stir fry with, you know, soy noodles, or you know big stir fry with you know, soy noodles, or you know peanut sauces and different things. So it's really important to have lots of recipes in my book and on my website as well. So it's a very joyful way of eating and people often think, oh, I can't have this and I can't have that, so slowly start eating this way, and when you look down on your plate, there should be color.
Vai Kumar:Yeah, very well said. And oil, sugar, salt everything.
Dr.Nitu Bajekal:You know, like it's they should be. Yeah, they should be condiments. They should not be central focus.
Dr.Nitu Bajekal:As I said, one tablespoon of oil extra virgin olive oil can be really good for you, but if you're somebody who's trying to lose weight which is 70 of the population think about do you want to have that, or would you rather have your salad with some olives and hummus and things like that?
Dr.Nitu Bajekal:So you know, it's just finding things, but for people who need to put on weight, who don't have a weight issue, children, all these people extra virgin olive oil has got a lot of benefits as well as well, but by and large, the use sugar and salt, as you know, little additions rather than having huge quantities of these free sugars, rather than focus on fruits and, you know, have a couple of dates with some nuts that will usually satisfy most people's sweet tooth over time yeah, and if there is one thing you would love to see change, I know with all your advocacy efforts with your book and everything, and you're also very conscious of how we are progressing on the climate front and you also advocate that eating plant forward is so good and I I eat a plant-based diet and I know for a fact I did a whole season on sustainability on this show.
Vai Kumar:So if there's one thing you would love to see change, what would that be in terms of everything that you have written and in terms of what you see out there from your practice?
Dr.Nitu Bajekal:I think I would like women to acknowledge themselves and realize that they're very valued members of the world and community and we are the force for change, and that change happens within ourselves first. So don't worry about your partner, don't worry about your community. You, yes, you do need to change them, but first, when you make those changes, you will feel so much better for yourself. Don't be harsh on yourself if you slip up. I think that's important and really, if I had to make one change, I would say start eating more soy, eat less animal foods. If you can achieve those two things, you will help climate change, you will help the rainforest, because most of the soy that's produced is for animals. You will help your health, you will help, uh, animal suffering and you will also help you know your um the climate. So that's what I would say eating plant forward every time you eat. Think about what you're putting in your mouth, think about the future generations that you're going to leave this beautiful earth to which we are rapidly destroying.
Vai Kumar:Well, fascinating conversation, and my takeaway is knowledge is power and all unpleasant symptoms are not to be endured. So those are the biggest takeaways. And neethubhajekalcom, that's a website, right. I'll be sure to include it in the show notes.
Dr.Nitu Bajekal:I have about 15 different fact sheets all free and lots of recipes and podcast links and things, so I hope people will access that.
Vai Kumar:Wonderful, so I'll be sure to include the link to the book. And is it available on Amazon and where else? Would you like to add anything else?
Dr.Nitu Bajekal:Yeah, no, not at all. And do follow me on social media because I'm quite active generally, although I'm taking a little break over Christmas, but TikTok and Instagram, I tend to be sharing quite a lot of information.
Vai Kumar:Excellent. I'll be sure to include everything in the show notes and thank you, Dr Neetu, for a fascinating conversation on how best we can help women equip themselves and empower themselves into their transition from perimenopause to menopause Listeners as always follow the podcast. Rate the podcast. Leave a review from your podcast app of choice. Follow me on Instagram and YouTube at YP Kumar. That's V-A-I-P-K-U-M-A-R for all things digital media and lifestyle. Until next time with yet another interesting guest and yet another interesting topic. It's me, mai, along with Dr Neetu, saying so long Bye-bye.
