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Q&A with a dietitian: Tips for eating during perimenopause, menstruation, pregnancy and more

It is important to balance blood sugar and manage inflammation, says dietitian.
Eating a balanced diet is key at all stages of life, says dietitian.

Women's bodies go through a lot over a lifetime.

And, until recently, navigating these changes was not something that was openly talked about.

Thankfully, more and more conversations are happening about women's health — both mental and physical.

And yet, there is still a lot of mystery and misinformation around what is best for both.

With that in mind, we caught up with dietitian Joy Zhuang for some nutrition tips for the many stages of a woman’s life.

What follows is an edited version of that conversation.

What are some things to consider regarding nutrition during perimenopause and menopause?

In different stages of life, we need to ensure that we're meeting our nutritional needs. If we're talking about menopause or perimenopause, researchers have shown that if we follow a diet full of whole foods, looking at, for example, fruits, vegetables, whole grains, and protein could really help reduce menopausal symptoms.

For women generally, it is important to balance blood sugar and manage inflammation.

What about things to avoid? One of the anecdotes is that coffee makes anxiety worse. Are there things that are helpful to avoid at this stage of life?

I think one important thing to either manage symptoms that you're experiencing or work towards more healthy eating is looking at how to have a healthy relationship with food.

Acknowledging that individuals can respond differently to the same food.

It is easy to get swept up in the latest food trends, fad diets or everything you find online. But eating habits that are the most sustainable usually do not include elimination.

So instead of thinking, ‘Oh, this might be bad for my health, so I probably should not be eating it,’ do the reverse of that. Think about what benefits you could get from eating the food. 'How do I feel after eating it? How am I supporting health by adding certain foods onto my plate?'

Anything else about food you want to say for menopause? Sleep interruptions and hot flashes are two common symptoms for women at this stage. Anything to suggest to help with those?

A big factor that could contribute to both is your body is experiencing hormonal changes, and oftentimes there's inflammation that comes with that.

A lot of my clients find it helpful to look at stress management, but diet-wise, a low-inflammation diet could be helpful.

Try to include more whole foods in your diet, looking at incorporating more antioxidant-rich foods. For example, the colourful fruits and vegetables. We often say to eat a rainbow  — all the colours actually represent a specific type of antioxidant that could help lower your inflammation and help with symptom management.

For example, tomatoes, broccoli, dark leafy veggies — spinach, blueberries. And in addition, you could also ensure that you're getting enough omega-3s — preferably from real food — fatty fish or shellfish.

And lastly, if you could try to incorporate more fibre, it could also help your body deal with inflammation.

What are some dietary tips for during menstruation?

One big thing is because of the hormone changes, the low inflammation diet is something that you could incorporate to manage symptoms.

Because of a loss of blood, we do want to focus a little bit more on some micronutrients, for example, zinc, folic acid and iron. We are at a higher risk for anemia because of blood loss.

What foods are high in iron?

There are animal and plant-based sources. Red meat can be a good option for an animal source, such as beef or lamb. Organ meats, especially liver and kidneys, are pretty high in iron.

Also, shellfish, for example, mussels and oysters. Canned sardines and other kinds of fatty fish are good sources of iron as well.

The reason we look at animal sources first for iron is that they contain what we call heme iron, which is readily absorbed by our bodies.

There is also plant-sourced iron.

The difference with plant-sourced iron is that bioavailability is lower, which means our body absorbs it less efficiently. So you do need to eat more if your iron is coming from plants.

Beans and legumes will be good, as well as some fruits and vegetables — especially if you look at dark leafy vegetables. They're pretty high in iron as well, and some dry foods, say, for example, dried apricots are great, too.

 Anything else about periods and diet you want to say?

I want to loop back to what we talked about before; adding nutrition to your diet instead of eliminating it. Allowing yourself to have the foods you enjoy and allowing yourself to have the foods that actually nourish and support your body. That decreases a lot of stress. Instead of thinking about what I should be having or what I should not be having, think, 'I deserve to have foods that help support my health.' That would be a really helpful mindset. Like, pampering yourself when you are having cramps, for example.

Thinking about diet and fertility, what do you suggest?

One thing a lot of people don't think about is balancing blood sugar.

Ensuring your blood sugars remain balanced could help with managing energy dips, cravings, as well as menstruation, and ovulation, fertility. And it could also help with egg health, implementation rates, symptoms — like headaches and reducing pain during ovulation and menstruation. Because you have a more regulated and healthier cycle, this could help with fertility.

How about when you are pregnant? It can be a really tricky time, and there’s so much advice out there. What should expectant folks be thinking about in terms of their food intake?

There's recommended weight gain depending on where you're at before you get pregnant. So that is something to keep in mind. There is that risk of getting gestational diabetes, which would affect the baby and the delivery, and if you do get it, it increases your risk of getting Type 2 diabetes later on in life.

Also, you have increased dietary needs during pregnancy, not just energy and caloric wise, but also you need more iron, calcium, and vitamin D, for example, especially towards the later stages.

And when we are thinking about cravings, I think acknowledging that you do have cravings for certain foods is important. And as long as that food is not causing you discomfort from eating it, there's nothing wrong with eating what you crave. And again, just pampering yourself. Giving your body what nourishes it. You're baring another human being, so you totally deserve it.

Some women are really nauseous or sick during pregnancy, and it can be stressful because everyone is saying to eat for the health of the baby. What is your advice there?

I think it again comes back to what is working for you. Do what works for you, and don't worry too much. I think a big thing about managing pregnancy sickness is making sure you're hydrated to start with. I have found with clients that colder water or colder fluids are easier to keep down — even things like popsicles and creamsicles worked with some clients.

Whatever you can keep down, that is what you should have.

What are some tips for moms who are breastfeeding?

Again, general tips for healthy eating are best. You need extra fuel while breastfeeding, so looking to protein-rich foods and more whole grains. Also, decreasing consumption of seafood that is high in mercury.

One big thing about breastfeeding is ensuring hydration — having enough fluids. Looking at the colour of urine could be a good indicator. With a new baby, it can be stressful, so sometimes moms don't notice their thirst as much because they are prioritizing the baby.

I usually tell my new mom clients to look whenever they go to the washroom. If the urine is darker, it's time for you to drink more. That is a better indicator than how you feel because it's so overwhelming during this time.

It is recommended to choose drinks with lower sugar content for blood sugar management. Those drinks could contribute to weight gain.  However, if drinking sweeter drinks helps you to have more fluids, go for the ones that you prefer.

Also, watch your caffeine intake because it could agitate the baby. It does go through in your breast milk. Our goal is to have no more than about two to three cups.

Eating different types of foods does expose your baby to different tastes, which could help them more easily accept solid foods down the line.  One thing I have talked to my clients about is you don't have to change your diet too much just because you feel like you're trying your best to cater to your baby and give the best food to them.

Eating as close to how you would eat usually would make introducing solids easier down the road easier because it will be a familiar flavour for them.

We have talked about a lot; any last words of advice for women regarding food?

People tend to want really specific and unique advice for different kinds of health conditions, and definitely, there are things that we need to look at for specific conditions or specific needs.

The general rule of thumb, though, is aiming for a healthier, more balanced diet. That can often help a lot. So, looking at Canada's Food Guide, and looking at your food labels. And thinking about what small steps you could implement starting this week. And that is actually more sustainable and practical than thinking, 'Should I limit my caffeine,' or  'Should I have this supplement?'

And definitely, if you feel a little bit puzzled or overwhelmed by the information online, you could always talk to a dietitian. Registered dietitians like me could help you navigate through all that information and take into consideration your individual needs, your lifestyle, and what could actually fit in your day-to-day life.

There are free 15-minute consultations available. Go to for more information.