Does Diet Influence Menopause Timing?

Last week, I linked to a story about a popular vegan blogger, author, and influencer who found herself going into menopause at the age of 37 despite doing “everything right.” She exercised, she ate raw, she avoided gluten and refined sugar, and, most importantly, she avoided all animal products. Now, this wasn’t a randomized controlled trial. This wasn’t even a case study. But it was a powerful anecdote from someone whose livelihood depended on her remaining a raw vegan. It wasn’t in her interest to make it up.

So, it got me wondering: How do diet and lifestyle influence the timing of menopause?

Now, before I begin, let’s just state the obvious: Menopause isn’t a problem to be avoided. It’s not something to be feared or maligned. It’s not “the end.” I wrote an entire series on menopause last year, and there will always be more to come on the subject because it’s an important time of life with its own questions and possibilities. While it’s a natural, evolutionarily-preserved part of being a woman, it also follows a natural cadence. Menopause at the right time in accordance with your genetics is normal, expected, and healthy. Menopause that occurs earlier than your genetics would direct suggests something is amiss. Sure enough, early or premature menopause—defined in most places as menopause before the age of 40—has a number of troubling links to poor health outcomes.

Early menopause is linked to:

• A shorter life and an increase in the risk of type 2 diabetes.
• Reduced physical function in later years.
• Lower cognitive function.
• Increased heart disease.

Not to mention that all the other things normally associated with menopause, like osteoporosis and changes in mood, also have the potential to occur, only earlier.

Okay, so early menopause can have some health consequences. Is veganism actually linked?

What Research Says About Diet and Menopause Timing

There was one study that found people who’d never been a vegetarian developed menopause at a later age, which is a roundabout way of saying that vegetarianism may increase the risk of early menopause.

Other lifestyle factors linked to later menopause included regular strenuous exercise, never smoking, midlife weight gain, and drinking alcohol. Strange mix of behaviors, both classically healthy and unhealthy.

But then another study in Han Chinese women found the opposite—that vegetarianism was associated with a lower risk of premature menopause.

Those are the only direct (if you can call it that) lines of evidence, and they conflict. No solid answers there. That said, there’s more indirect stuff pointing toward a link between exclusion of animal foods and earlier menopause:

• A high intake of vitamin D and calcium from dietary sources has been linked to a lower risk of premature menopause. Oddly enough, supplemental vitamin D and calcium were not linked to lower risks, suggesting that it’s the food—dairy primarily, but also bone-in small fatty fish like sardines—and not the nutrients alone. So a vegan might not be in the clear simply by supplementing with D and calcium.
• The amount of protein and carbs a woman eats throughout her life seems to predict the age at which menopause occurs. More protein, later menopause. More carbs, earlier menopause. Protein is harder and carbs are easier to come by on a plant-based diet—that’s for sure.
• Another fairly consistent finding is that polyunsaturated fat intake “accelerates” menopause. Women who eat the most PUFA tend to have menopause earlier. High PUFA intakes are pretty unavoidable when your diet is awash in seeds, nuts, and other plant-based fat sources.

Then there was a different connection in another study.

The Nurses Health Study found that women who ate the most plant protein were more likely to avoid premature menopause; animal protein intake had no effect. They even found beneficial links between specific foods and protection against early menopause, including dark bread, cold cereal, and pasta. Those are about as unPrimal as you can get.

How Can We Make Sense of Conflicting Research?

In addition to smoking (which we all know is trouble for almost all markers of health), one thing that keeps appearing in all these observational studies—and they’re all observational studies, unable to prove causation—is that underweight BMIs predict early menopause. In the Nurses Health Study, for example, BMIs under 18.5 were linked to a 30% greater risk of early menopause and BMIs between 25 and 29 were linked to a 30% lower risk. If that’s true, and if that’s actually a causal factor, then the most important thing a woman who wants to avoid early menopause can do is avoid being underweight. In that case, filling up on foods known to cause weight gain in susceptible people like bread, pasta, and cereal would be protective (at least for early menopause).

And that could really explain why the vegan blogger developed premature menopause. In her own words, she “had run out of fuel.”

A big downfall of many plant-based diets is that they starve you. They starve you of vital micronutrients you can really only get in animal foods, like B12, zinc, creatine, cholesterol, and others. They starve you of vital macronutrients, like protein and animal fat. And they starve you of calories. It’s hard to maintain your weight and physical robustness eating a diet of leaves, twigs, and seeds (unless you’re a gorilla). Oddly enough, I think vegans who eat grains and vegan “junk food” like fake burgers and weird nut cheeses are probably better off than the gluten-free ones who live off salads, simply because they’re getting more calories. It’s true that there are many ways to eat vegetarian and even vegan—and some are healthier than others (I’ve written about Primal recommendations for vegetarians and vegans in the past), but the more restrictive a person is with animal products, the trickier it will be to stay well-nourished.

If I had to make a bet, it’d be that any diet that provides sufficient nourishment in the form of micronutrients, macronutrients, and total calories will help stave off early menopause.

What about you? What’s your take on this? Has anyone out there experienced premature/early menopause that didn’t follow natural, familial patterns? What can you recall about the diet and lifestyle leading up to it?

References:

Wang H, Chen H, Qin Y, et al. Risks associated with premature ovarian failure in Han Chinese women. Reprod Biomed Online. 2015;30(4):401-7.

Velez MP, Alvarado BE, Rosendaal N, et al. Age at natural menopause and physical functioning in postmenopausal women: the Canadian Longitudinal Study on Aging. Menopause. 2019;

Sujarwoto S, Tampubolon G. Premature natural menopause and cognitive function among older women in Indonesia. J Women Aging. 2019;:1-15.

Løkkegaard E, Jovanovic Z, Heitmann BL, Keiding N, Ottesen B, Pedersen AT. The association between early menopause and risk of ischaemic heart disease: influence of Hormone Therapy. Maturitas. 2006;53(2):226-33.

Purdue-smithe AC, Whitcomb BW, Szegda KL, et al. Vitamin D and calcium intake and risk of early menopause. Am J Clin Nutr. 2017;105(6):1493-1501.

Sapre S, Thakur R. Lifestyle and dietary factors determine age at natural menopause. J Midlife Health. 2014;5(1):3-5.

Boutot ME, Purdue-smithe A, Whitcomb BW, et al. Dietary Protein Intake and Early Menopause in the Nurses’ Health Study II. Am J Epidemiol. 2018;187(2):270-277.

Szegda KL, Whitcomb BW, Purdue-smithe AC, et al. Adult adiposity and risk of early menopause. Hum Reprod. 2017;32(12):2522-2531.

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