Reducing Vegan Osteoporosis Risk -- Interview with Brenda Davis

In this episode, I met with Brenda Davis, a registered dietician, plant-based trailblazer and an internationally acclaimed speaker. Brenda has been a featured speaker at medical, nutrition, and dietetic conferences in 28 countries on 6 continents. As a prolific nutrition writer, Brenda has authored/co-authored 13 books with over a million copies in print in 12 languages. Her latest book, Plant-Powered Protein, was released in 2023. Brenda has also authored and co-authored numerous professional and lay articles and is a past chair of the Vegetarian Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics. Brenda was the lead dietitian in a diabetes randomized controlled trial in the Marshall Islands. In 2022, she was the 7th recipient of the Plantrician Project’s Luminary Award. Brenda lives in Calgary, Alberta Canada. In this episode we discussed important topics such as protecting against osteoporosis, the many benefits of vegan protein, managing hot flashes, and navigating diet strategies to minimize weight gain during menopause. We also explored topics like micronutrients, omega-3s, and how to adjust your diet for cardiovascular health.

AP: Hi, Brenda. Welcome to the podcast.

BD: Well, thank you so much for having me Anna. It's really a pleasure to be with you.

AP: Yeah, I'm really excited to learn from you and I have lots of questions to ask about all kinds of things related to menopause.

BD: Oh, awesome. Looking forward to it.

Is There a Vegan Osteoporosis Risk?

AP: So, I want to start off by talking about osteoporosis. How can menopausal and post-menopausal women protect themselves against osteoporosis, especially if they're vegan?

BD: Yeah, so I think the first thing that people know is that studies have shown that vegan women are at increased risk of both hip and total fractures. And Epic Oxford was kind of shocking. And these are large studies that kind of look at incidence of disease in similar health-conscious individuals who consume different dietary patterns.

And so they compare, you know, omnivores with semi-vegetarians, pesto-vegetarians, lacto-ovo-vegetarians, and vegans. And generally, vegans do the best in terms of hypertension and heart disease risk and diabetes risk and so on. But for fractures, that isn't the case.

And in fact, Epic Oxford found hip fracture was 231% higher in vegans. That's 2.3 times higher compared to similar health-conscious omnivores. And the risk of total fractures was about 43% higher.

But the one thing that you need to note is that this increased risk was actually only observed in vegans with a BMI of less than 22.5, so very thin individuals. And it was strongest for post-menopausal women. The risk wasn't increased at all for men, and it was less for pre-menopausal women.

And then in the Adventist Health Study 2, another study, same kind of metrics and, you know, very large study, the risk in female vegans was 55% higher than similar health-conscious omnivores. But the women who were taking calcium and vitamin D did not have an increased risk. And in both studies, men didn't have an increased risk.

And so I think we just need to recognize that we may be at increased risk being vegan. And part of it's because we're slimmer, but part of it's because we eat less protein and maybe less calcium and vitamin D and, you know, omega-3 fatty acids and B12 and so on. That can all contribute.

How Can Vegans Minimize Osteoporosis Risk?

So there are a lot of things that we can do to minimize our risk. And so, you know, some of the most important strategies are, number one, we do need to make sure we're getting enough calcium and vitamin D. And calcium, what's recommended for women over 50 and men over 70 is 1200 milligrams.

And so how do we do that? You know, to me, one of the easiest ways is to include fortified plant-based milk. So I include soy milk and I have probably a cup and a half or two cups a day, you know, a cup with my breakfast and a cup in preparation of foods and different things -- chia pudding and, you know, gravies and things like that. But that provides about 600 milligrams of calcium. So getting to that 1200 milligrams is pretty easy if you're including at least one or two servings of these kinds of fortified non-dairy beverages; calcium-set tofu; dark, leafy greens that are low in oxalic acid (things like kale and bok choy and a lot of the other Chinese greens). But not spinach, Swiss chard and beet greens because they're so high in oxalates that we don't absorb much of the calcium that's there.

And then other foods like chia seeds, almonds, tahini, dry figs, there are quite a few other foods that provide you a little bit of calcium. And if you get little bits over the course of the day, you actually absorb a lot more than if you had, you know, 500 milligrams in one sitting. So little bits over the day is really the way to do it.

Vitamin D for Vegans

And then vitamin D, well, most of us will not get enough vitamin D from fortified foods. And, you know, the main sources in a non-flat based diet are fish and eggs and things like that. Dairy products that are fortified.

We get some, of course, about the same amount you would get from fortified dairy

products from fortified non-dairy milks. But it's really hard to meet the RDA of 600 IUs a day for people under 70 and people over 70, 800 IUs a day. It's very difficult from food alone.

So you need to either be exposed to warm sunshine, which we live in Canada -- we do not produce vitamin D during the cold months, which can be six or seven months or more in a lot of places. And so we pretty much have to take supplements and so do many omnivores as well.

And, you know, recommended like even the Endocrine Society just recommends the RDA of 600-800 IUs depending on your age. But a lot of experts recommend more 1000-4000 IUs. And I know some people do get their blood levels where they want them to be in the right range.

They have to even go slightly higher than that. But personally, my levels are good and I just take 1000 IUs a day.

Vegan Protein and Osteoporosis

And then the other things that, you know, are interesting with osteoporosis, for a lot of years, people in the vegan community believe that protein intake was associated with increased osteoporosis risk because protein can actually increase the loss of calcium in our urine.

But we have known for many years now that protein is actually protective. Well, protein does increase urinary calcium excretion. It also enhances calcium absorption that promotes bone formation.

So it actually has a net positive impact on bone health. And this has even been quantified. There was a study that showed for every one gram increase in protein, calcium absorption is increased by one percent.

And we just need to recognize that, you know, most of the studies on on vegans, people that are at the higher end of protein intake do better in terms of bone health. So we need to make sure we get enough protein.

Other Nutrients to Minimize Vegan Osteoporosis Risk

We need to make sure we get enough omega 3s. They reduce inflammation and that helps with bone health.

And then the other nutrients that we might want to just be aware of are vitamin K. Now, we get lots of K1 from leafy greens and from some other foods as well.

You know, not very many people eat natto, but natto is actually one of our few sources of vitamin K2 in plants. But basically, you know, K2 is the form of vitamin K that seems to be very important to protecting bones. And so if you're a person who is at risk for osteoporosis, if you have osteopenia or if you already have osteoporosis, I would consider taking K2 because there's no guarantee you're going to be efficiently converting K1 to K2.

Many people do, but some people don't. And so you want to aim for about the RDA, which is 90 micrograms for women above the age of 19 and above. So somewhere around 100 to 200 micrograms is probably in a reasonable range.

And then other nutrients like magnesium and potassium are important, but we tend to get enough of those. And then you want to avoid too much sodium, too much phosphoric acid from soft drinks, and too much alcohol. All of those can have a negative impact.

Weight-bearing Exercise for Osteoporosis Prevention

And then finally, you know, last but not least, you need to be doing more than just getting the nutrients your body needs to maintain strong bones. You need to be telling your body that your bones need to be strong, and you do that by doing weight-bearing exercise. And the importance of this just can't be overstated.

It stimulates bone remodeling. It increases bone density. And so you want to be doing weight-bearing cardio exercises like walking, jogging, hiking, dancing, cardio classes, HIIT classes, class training, whatever.

But you also want to be doing resistance training at least two or three times a week with weights or resistance bands. And I think balance and flexibility exercises like yoga and tai chi are also important because they can help you to reduce your fall risk. They help you maintain strength and flexibility, both of which are important.

And you also want to undergo some sort of testing to see where your bone mineral density is at. And I think that kind of sums it up for osteoporosis. Any questions?

Dairy Intake and Osteoporosis Risk

AP: What about the relationship between osteoporosis and dairy? Is dairy actually harmful for your bones?

BD: It's interesting that in some countries that have high dairy intakes, they also have high osteoporosis risk. But it doesn't mean dairy causes osteoporosis. In fact, if you look at dairy intake in certain countries where part of the country isn't dairy consuming, the other part is the part that consumes dairy has better bone health because they're getting calcium and vitamin D and protein and all of these things that they need for building bones.

So it's a bit of a myth that because countries that have high dairy intake have higher osteoporosis rates, that dairy causes osteoporosis. They also have more cell phones and more of all sorts of things. So the evidence just isn't there to say that dairy increases osteoporosis risk.

But that doesn't mean dairy is necessary for strong bones. And I think that's a big mistake, too. We're taught from time we're little kids that dairy equals strong bones.

And if you don't drink dairy, your bones all just collapse. And so that's not true either. There are lots of places in the world where dairy is not consumed and bone health is pretty good.

But they're getting calcium from other places. They're doing lots of weight-bearing exercise. Their lifestyles are conducive to building and maintaining strong bones.

The Roles of Vegan Protein During Menopause

AP: In the vegan community, there's a lot of talk, joking around, "but where do you get your protein?" As a joke, right?

Because all vegans know that it's very possible to get enough protein.

BD: Yes, of course.

AP: But it seems like people think that the only reason to get protein would be for muscles.

BD: Protein, the sort of roles of protein in the human body are just endless. It's not just building and maintaining body tissues. It's building and producing all of these enzymes, and hormones, and bones.

And there's so many other roles of protein. It's carriers for fats. The proteins are just needed in so many respects.

So we need to get enough protein. And in the vegan world, the mantra is, "if you get enough calories, you get enough protein". And that is usually true, but it's not always true.

So for example, in younger people who eat junk food diets, they're eating pop and French fries and living on junk food. They're not going to get enough protein. And for athletes, it's not usually a difficult thing if they're eating a healthy diet because they eat so many calories.

Protein Requirements for Vegan Seniors

But for seniors, especially senior women who require fewer calories, especially in the older stages of the latter stages of life when they're in their 80s and 90s and so forth, they're eating few calories, but their protein needs actually increase. So the RDA is 0.8 grams per kilogram body weight per day for protein. But the evidence is getting stronger and stronger.

The consensus is building that that's not enough for older adults. And in many groups like the European Society for Clinical Nutrition and Metabolism recommends, I think a lot of experts globally now recommend 1 to 1.2 grams per kilogram per day for healthy older adults. They recommend more than that for those with sarcopenia or certain other chronic conditions.

They're recommending 1.2 to 1.5. And so if you're recovering from an acute injury or something like that, it'll be even higher. So for a 65-year-old vegan whose healthy weight is 60 kilograms, they would need somewhere 60 to 72 grams of protein per day. And that is not that easy to achieve when you're eating 1500 or 1600 calories.

And so that's where the challenge comes in. And that's why often after menopause, you actually need to focus more on high-protein foods than you need to in your younger years. So for example, with each meal, you want to include at least one concentrated source of protein, like legumes, soy milk, tofu, tempeh, seitan, some seeds, like hemp seeds, chia seeds, pumpkin seeds are all pretty good sources.

Some people will use some protein powders. That's not my preferred source of protein. But definitely including more protein-rich foods makes a lot of sense at this stage of life.

And so what you're looking at for most people is around the 25 to 30 grams of protein per meal, and you want to include leucine-rich foods as well. So the soy foods and seitan are particularly leucine-rich, as are pumpkin seeds and hemp seeds. But for older adults, it's like a double whammy because they're eating fewer calories.

They need more protein to build and maintain muscle, but they experience anabolic resistance, meaning that their bodies are somewhat resistant to muscle building. And so that's challenging. But the other key here is in terms of preventing sarcopenia and muscle wasting for older women, and men for that matter, is the weight-bearing exercises and strength training at least two to three times a week.

And so I am very confident that aiming for 1 to 1.2 grams per kilogram per day of protein is a very reasonable thing to do for older vegans. And I can tell you, I've had a number of vegan older women clients who say, my skin's breaking, I'm bleeding, it just bruises easily, I'm tired, my hair's falling out. All of these things that are associated with my moods changing, associated with insufficient protein intake.

And when I analyze their diets, they're almost always getting 35 to 45 grams of protein a day. They're eating a whole food, plant-based diet. Their meals look decent, but they're not concentrated enough in protein.

And so when I take them from 35 to 45 a day to 60 to 70 a day, generally all of those things clear up.

How to Boost Your Vegan Protein

And so let's say if they're having steel cut oats with almond milk and banana or blueberry on top, they might be getting 10 grams of protein in that meal. But if we swap out the almond milk for soy milk, we add in a couple tablespoons of hemp seeds, we're adding 15 grams of protein instantly.

And so with a cup of steel cut oats and a cup of soy milk and a couple tablespoons of hemp seeds and a cup of blueberries, they're getting over 25 grams of protein. So that is a very reasonable breakfast meal.

And then if they're having a big salad for lunch with some starch and a little bit of beans or something, we can up the protein and often non-fat sugar-based dressing.

We can up the protein by adding in some lentils, some tofu cubes, some quinoa, pumpkin seeds, using a tahini hemp seed dressing instead of a sugar-based dressing. You can easily get close to 30 grams of protein in that salad by doing that. And then at dinner, if you're doing whatever, your bean-stuffed sweet potatoes or your tofu stir fry, whatever, you can easily get your 30 grams of protein by including those more concentrated protein foods in the meal.

And so it's not that difficult to meet protein requirements, but protein is something we need to pay attention to.

AP: So for someone who doesn't really like to calculate the grams in their food, they can still definitely do that in three meals a day.

BD: Absolutely. Absolutely. And you don't need to have a calculator in hand.

You just need to include at least one or two decent protein sources with each of your meals. If you're having snacks, then include something. So if you're having an apple, have a little bit of peanut butter with it.

If you're making smoothies, add hemp seeds, add soft tofu, use fortified soy milk, frozen peas. Some people even use cooked legumes in their smoothies, but you can add a lot of protein sources to your smoothies. And then at dinner, just always make sure you're having a decent portion of tofu, tempeh, seitan, beans, lentils, and use the seeds that are more protein rich like pumpkin seeds, like hemp seeds more often.

And nuts provide a little bit as well. They're not as concentrated as seeds, but things like almonds are decent sources of leucine, they're decent sources of protein, just not as concentrated. And even, it surprises people, but even grains can be a contributor to protein.

So, you know, wheat berries, belt berries, kamut berries have about 10 grams in a cup, quinoa has about eight grams in a cup. So those are much more concentrated than grains like rice, for example.

Vegan Omega-3 Supplements

AP: What are your thoughts on omega-3 fatty acid supplements?

BD: Well, I have really strong feelings about this as I do most things, but omega-3 fatty acids are absolutely critical to health. And particularly the more biologically active omega-3s, which are the long chain omega-3s called EPA and DHA, and DPA as well. And while we can make these long chain fatty acids that most people get from fish, we can make them from ALA, which is the type of omega-3s in plants.

The conversion of alpha-linolenic acid or ALA to EPA and DHA is very inefficient. We might convert 5% to 10% for EPA and 1% to 5% for DHA if we're lucky, and our ability to convert wanes as we get older. So, you know, women of a childbearing age are much more efficient converters than older women.

And DHA is really critical for brain health. EPA as well for cardiovascular function, reducing inflammation. So in my view, it makes sense to get your ALA from plant foods, like from chia seeds and hemp seeds and flax seeds and from walnuts.

And these foods are good sources. So we want to get maybe two or three grams of ALA per day, and that's a tablespoon of chia or flax seeds, a couple tablespoons of hemp seeds, a quarter cup of walnuts.

Even canola oil is a decent source. You get about 1.3 grams in a tablespoon of canola oil if you use oils. But even if you do all of that, I think it's really wise to take a supplement of the EPA and DHA. And just so people know, fish get most of their EPA and DHA from micro algae.

So these are little plants that grow in the ocean that we are now culturing to produce EPA and DHA. And so it's not like there's something magical about fish. They just get their EPA and DHA from these plants.

We can get them from these plants as well. Now, there is a lab measure called the Omega-3 Index that's done to test our omega-3 status. And the goal is to have an Omega-3 Index of about 8%.

Now, if you're in the range of about 6 to 8, that's pretty good. The average vegan's around 3. The average, maybe, lacto-ovo vegetarian might be around 4 if they eat eggs with DHA.

Some eggs have quite a bit of DHA. And for omnivores that include a little bit of fish, they might be at around 5%. For big fish eaters, they might be 8% to 10% on the Omega-3 Index.

And the Omega-3 Index is associated with better health, better cognition, better cardiovascular health. And so I actually, this is interesting, but I just had my Omega-3 Index done. I just got the results back two days ago.

And my Omega-3 Index was 5.7%. My husband's was 6.1. And he was taking a little bit more than me. He's a bigger person, so we thought that would make sense. I was taking 500 milligrams a day of EPA and DHA.

And it wasn't enough to get me to 8%. And there have been a number of studies showing that we probably need to be closer to 750 to 1,000 to get to that 8%. And then once we're there, we may be able to back off a little bit to 500 milligrams.

Now, full disclosure, I don't always remember to take my EPA / DHA. And when I'm away, I don't take it at all. And that can add up in terms of sometimes being away for three or four weeks at the time.

But I'm going to be more consistent with it, and I'm going to up my intake to 750 milligrams a day because I really want to reach that ideal 8% level. And I know this is a bit of a controversial subject in the plant-based world, but I just think it makes so much sense. And actually, there was just a study done from the Adventist House study too, showing a little bit of an increased risk of some of their neurological conditions in older vegans and vegetarians.

And so there's some concern about that. It just to me makes sense to make sure that our levels are optimal. And so how do we do this?

Well, we make sure we get enough ALA. We don't overdo omega-6s. We want to eat plenty of seeds and other omega-6 rich foods, but I wouldn't be pouring omega-6 oils on my food.

So if you're using oils, use more either omega-3 oils or mono-rich oils, like avocado or olive oil. The omega-3 rich oils would be flax or seed oils. And then just make sure you're eating a good diet so that you have plenty of the whole factors that enhance your conversion to maximize conversion of ALA to EPA / DHA.

You need enough zinc and magnesium and B6 and B12, and all of those nutrients come with a well-designed plant-based diet.

AP: So it seems like a good backup plan to take omega-3 supplements just in case you are eating all the hemp seed and chia and flax and not converting it as efficiently as you thought you might be.

BD: Yeah, and we don't. And some people are concerned, well, if I take it directly, then it's going to down-regulate my conversion. But it doesn't matter because your conversion isn't very good anyway.

So taking the direct sources will help you to get where you need to be. And to me, it seems like it's the only thing that does. I see vegans getting tested all the time, and if they're not taking EPA / DHA, they're low.

Their Omega-3 Index is low.

AP: For people who are unfamiliar with omega-6, which you suggested to not overdo, could you list a few of those?

BD: Yeah, so omega-6... So if you're looking at sort of the fatty foods in the vegan diet, you've got nuts, which are mainly mono. You've got avocados, which are mainly mono, and olives.

Then you have seeds, and seeds are mainly poly. And so polyunsaturated fats, which includes omega-6s and omega-3s. Now, many seeds are richer in omega-6s.

So grape seed oil, corn oil, sunflower oil, safflower oil. Unless they're specifically engineered to be high in oleic acid or high mono sunflower, high mono safflower. Otherwise, they're mostly omega-6s.

And even soybean oil will be mostly Omega-6s. And so the oils that are Omega-3 rich are black, hemp. I don't know if there is such a thing as chia seed oil.

I haven't seen it, but walnut oil will be fair. Walnuts have a ratio of about 4 to 1 omega-6 to omega-3, which is really good. You want something in the range of 2 to 1 to 4 to 1, ideally, as an overall target.

But of course, flax and chia are much higher in omega-3s. But the oils you need to be concerned about are the grapeseed and corn. Canola oil has a ratio of 2 to 1.

It's actually mostly mono. So it's actually a really nice balance of fatty acids.

Phytoestrogens and Hot Flashes

AP: Let's talk about hot flashes. Can phytoestrogens help manage hot flashes?

BD: Well, the research suggests yes. And so it's interesting. So the main source of phytoestrogens, of course, is soy.

And it can help with hot flashes. And it can help with cardiovascular risks. So phytoestrogens are essentially plant-based compounds that look kind of like estrogens in the body, but they're very different in many ways than human-produced estrogen. So they're called SERMs, selective estrogen receptor modulators, and they preferentially bind to estrogen receptor beta or ER beta over estrogen receptor alpha. And this sort of more selective binding allows for the sort of unique physiological effects and explains why soy will act differently than human-produced estradiol, for example.

And so estrogen receptor alpha is found primarily in the uterus, the breast, the liver, and it stimulates cell proliferation, and so it can increase the risk of breast cancer and endometrial cancer. And whereas estrogen receptor beta is found in the bones, the brain, the cardiovascular system, the bladder, and it tends to have more anti-proliferative effects, so it reduces cell growth. And so it tends to be more neuroprotective and cardioprotective.

And so soy generally has been found to support heart health, reduce hot flashes, help to minimize the risk of breast cancer. And so that's all quite interesting. There was actually a meta-analysis that, or a couple of meta-analyses, I would say, that have shown that soy isoflavones reduce frequency and severity of hot flashes, probably about 20% to 50%.

And the effectiveness is much better in people that consume soy regularly, so about 50 milligrams of isoflavones a day. And so what you're looking at in terms of isoflavones would be like a cup of tofu would provide about 50 milligrams of isoflavones, a cup of tempeh about 60, two cups of soy milk about 50. So half a cup of edamame is about 20.

So you get the idea. If you're eating a variety of soy foods, you'll easily meet that 50 milligrams of isoflavones that seem to be helpful. Oh, and the other thing is that women who are plant eaters tend to be better equal producers.

And that's the more active form of isoflavones, which may provide even greater benefits. Vegetarians, about 59% or close to 60% are equol producers compared to only about 25% of non-vegetarians. And that's because of their gut bacteria.

We have gut bacteria that tend to convert isoflavones into equol, which is really a good thing.

Micronutrients Vegans Might Consider Supplementing

AP: Are there any micronutrients that you would recommend vegans consider supplementing?

BD: Yeah, so we already talked a little bit about calcium, vitamin D, omega-3s. But probably the most critical is B12. Vitamin B12 is not naturally present in plant foods.

Now, it can be present if, for example, tempeh is fermented in unsanitary conditions where there's B12 producing bacteria present, then there might be some B12 there. But generally, you know, sanitary plant foods where we're trying to get rid of potentially pathogenic bacteria, we also get rid of B12 producing bacteria. So we can't rely on plant foods as a source of B12 unless it's fortified.

And so, you know, like certain nutritional yeasts like Red Star Vegetarian Support Formula, for example, will be fortified with B12, fortified plant milks, some fortified cereals, some meat analogues are fortified with B12. But even if you eat a variety of these things, you're not guaranteed to get to where you need to be. So for most plant eaters, especially vegans, it makes sense to take a B12 supplement.

And what is generally recommended is 1,000 micrograms, two to three times a week. Now, for people who are 65 plus, often the recommendation increases because we're not as good at metabolizing and absorbing nutrients. And so many experts are saying 500 to 1,000 micrograms a day.

But it makes sense to get your levels tested so you know kind of where you need to shoot for. If your levels tend to be on the low side, you want to go for that daily 500 to 1,000 micrograms. If your levels are high, that 1,000 micrograms, two or three times a week is probably absolutely fine for you.

And of course, you know, a lack of B12 can be a problem for brain health, for cognitive function. It can increase your risk of cardiovascular disease because it shoots your homocysteine up. So it's just really, really important to get your B12.

Homocysteine and Cardiovascular Disease

AP: You mentioned homocysteine, and I was wondering if you could explain that for the audience.

BD: Yeah, so homocysteine is a breakdown product of methionine. And if it builds up in your body to an unhealthy level, then it's associated with heart disease and it's associated with brain dysfunction and even for younger people with problems with pregnancy. So it's just you don't want homocysteine levels to rise and people that have problems metabolizing methionine and folic acid and, you know, if they have an MTHR issue, then it can be, you know, an even bigger challenge for them.

So then it's really important that they're getting a decent source of B12. So we mentioned B12. Another nutrient you need to think about is iodine, especially if you don't use iodized salt, then you would need to use an iodine supplement or, you know, a tiny bit of seaweed, something like that.

Seaweed is a little tricky because it's so concentrated. You really need to know how much is there. And then above and beyond that, just making sure you get your legumes and nuts and seeds for iron and zinc as well.

Menopause and Cardiovascular Risk

AP: How does menopause affect cardiovascular risk and how can a woman adjust her diet to minimize that risk?

BD: Menopause is associated with a fairly significant increase in risk of cardiovascular disease, and that's partly due to estrogen decline. Estrogen decline means an increase in LDL cholesterol, reduced HDL cholesterol, higher triglycerides, which can increase plaque buildup in your arteries. It can lead to increased blood pressure.

So there's an arterial stiffness. There are all sorts of issues. And because cardiovascular disease is the leading cause of death in postmenopausal women, it's an issue.

But eating a plant based diet is definitely a risk reducer. So, you know, you're eating less saturated fat. You're eating more unsaturated fat.

You're eating more fiber. You're doing if you especially if you're including the omega 3s, you're getting more plant sterols and stanols, which can block cholesterol absorption. Of course, that's not a big deal if you don't eat cholesterol.

But even your intakes of magnesium and potassium are often higher. You often are consuming more of the things that will boost nitric oxide production and contain a nitric oxide like, you know, vegetables like beets and spinach and arugula and bok choy. And and so those kinds of things can be helpful as well.

And but as mentioned before, to prevent buildup of homocysteine, we need to make sure we've got our B12. We want to include plenty of antioxidants, but we're at an advantage because antioxidants and phytochemicals are concentrated in colorful plant foods. And and so, of course, this is why vegans tend to have significantly lower risk of a skin heart disease and other types of heart disease as well than non vegetarians.

So that's you know, it's all it's mostly good news for for vegans where heart disease is concerned. But we don't want to shoot ourselves in the foot by forgetting about vitamin B12, because that's critical to cardiovascular.

Brenda's Experience With Menopause

AP: Would you like to share about your own experience with menopause?

BD: Oh, sure. So so I went through menopause -- I'm 66 years of age now, and I went through menopause probably 13 years ago or so.

And I was one of the lucky ones. I mean, about 20 to 25 percent of women really don't have many symptoms of menopause. And I was one of those lucky people.

I did feel warm once in a while, but never this, you know, felt unbearably hot or anything like that. So I was I kind of sailed through with the exception of I noticed that I couldn't eat as many calories. I just couldn't.

I continued the same level of physical activity. I've always been very physically active. So I probably average an hour and a half of physical exercise a day.

And I do a balance of, you know, cardio resistance training, flexibility exercises. I mostly do it in classes like HIIT and step and box and spin and body power and yoga, all of that. But I also do cross-country skiing and hiking and those kinds of things as well.

But even with all of that, even without changing my level of activity, I found that to avoid weight gain during menopause, I had to cut back on my calories. And I did that basically by decreasing my portion sizes of concentrated carbohydrates, like grains and starchy vegetables, increasing my portion sizes, a little bit of protein rich foods like beans and then moderating intake of really concentrated calories like avocados and nuts and seeds and not eating between meals. So I just eat breakfast, lunch, dinner.

I rarely have any snacks. You know, of course, I am flexible if we're having a family occasion or we're watching a movie with the grandkids and having popcorn. That's, you know, a different story, but it's fairly rarely that I would do that.

Menopause and Weight Gain

And so that's the thing that I think people need to really be aware of. Menopause for many women results in weight gain and changes in sort of distribution of the fat in their body. And it's all stuff that they're not very happy with.

And this is really because it brings about hormonal changes that, you know, just slow metabolism and increased fat accumulation and change body composition. And so declining estrogen levels just promote fat storage in the abdominal area and can reduce muscle mass, can increase insulin resistance and those kinds of things. So, you know, we want to prioritize getting enough fiber.

We want to balance carbohydrates and get most of our carbohydrates from whole foods to prevent blood sugar spikes. We want to increase omega-3s to reduce inflammation. We want to do the strength training and cardio exercises and, you know, all of those things.

And of course, we need to manage stress. We need to get enough sleep. Those are really important things as well.

And so I think taking a multivitamin mineral supplement may be a reasonable thing for a lot of people to do just to make sure with the decreasing energy intake that they're still getting enough of these essential nutrients.

AP: Yeah, weight gain in menopause is the number one question I get asked about. So your advice is definitely appreciated.

BD: Oh, thank you.

Managing Fatigue During Menopause

AP: What about managing fatigue in menopause?

BD: Well, I honestly think we need to get enough sleep. We need to get enough of the nutrients. Like like iron and B12 and omega-3s.

A lack of some of these critical nutrients and protein can contribute to fatigue. And so making sure we're meeting our nutritional requirements and getting enough sleep and then getting exercise, too. I think that's really helpful.

And I think it's really interesting that all of the things we talked about are interconnected. You know, they're they're connected to our nutrient absorption, our hormonal balance, our metabolic changes. And so the nutritional strategies that we, you know, we need to implement are will help for all of these things.

And so we want to be eating a diverse variety of whole plant foods. I always say aim for at least nine or ten servings of veggies and fruits a day if you can. You know, make sure you're getting at least three servings of protein rich foods.

And then your grains and starchy vegetables will sort of vary depending on your caloric requirements and then include nuts and seeds. These are really important sources of trace minerals and essential fatty acids. And so you want to include those.

You don't want to be eating them by the bowlful. One of my strategies to eat nuts and seeds is to just sprinkle the seeds on cereal and salad. And then for nuts, I have a bowl of nuts in the shell on, you know, my kitchen counter.

And if I, you know, want to have a nut or two, even after a meal as part of dessert. So with a piece of fruit or something like that, you know, you crack open two or three nuts and that's plenty. And it takes time and it's sort of fun to do.

So that helps to control your portion sizes.

AP: You have to work for it.

BD: You have to work for it.

Brenda's Books and Programs

AP: Can you talk a bit about your books and programs?

BD: Oh, sure. So I am I have written now or either authored or coauthored 13 books. And the most recent was called Plant-Powered Protein. And my I've written many of these books with Vesanto Melina, who I believe you've already interviewed.

My son was a coauthor on Plant Powered Protein. And then the other books. I've written three diabetes books. The two most recent are Kick Diabetes Essentials and the Kick Diabetes Cookbook.

And then the other books are Becoming Vegan and Becoming Vegetarian and Becoming Raw, the Raw Food Revolution Network. And there's, you know, Becoming Vegan and Becoming Vegetarian. And then the other book that was done in, I think 2020 was Nourish.

And I wrote Nourish with a pediatrician. Her name is Reshmah Shaw. And she's a pediatrician from San Francisco.

And that, I think, was really one of the first books that was written for families in the sort of vegan plant based world. Now I'm working on my 14th book, which is a book for seniors. So I'm also doing that with Vesanto Melina and UBC professor Charlene Black.

And so that we've just kind of started that project and hopefully be out within the year or so. And then other things that I do, well, I actually just got back from speaking in Hawaii. I speak at conferences quite often.

I'll be speaking at Plantrition Project this year again. I spoke at the Mayo Clinic in Rochester last year and will be back in Rochester speaking again in April. And then I also involved in a few courses.

So the Food Revolution Network has just the most incredible resources. They have wonderful courses such as Tackling Type 2, which is a diabetes course. They have a brain health course with Dean and Ayesha Sherzai.

They have a wonderful coaching program, which I'm on the faculty for. I've also been on the faculty for courses with the American College of Lifestyle Medicine.I just had two research articles come out last year, one on hypertension with a team from Yale and then another one from the randomized control trial I was involved with on diabetes in the Marshall Islands.

So I keep very, very busy writing articles, writing and doing, you know, education programs and speaking. So, yeah, that's kind of the summary of what I'm up to.

AP: Awesome. I can't wait to read your new book. I'll be keeping my eyes peeled for it.

BD: Oh, thank you. Thanks, Anna.

Where to find Brenda Davis Online

AP: Where can people find you online?

BD: Well, my website is brendadavisrd.com. We have websites for almost all our books as well. And for plant-powered protein, the diabetes books, the vegan books but brendadavisrd.com.

And if you want to email me, it's brendadavis@telus.net. So those are the best ways of getting a hold of me.

AP: Great. Well, thank you so much for your advice and information. And thanks for being here on the podcast.

BD: Well, thank you so much for having me and thanks for all you're doing to spread the word and to provide reliable education for your listeners.

AP: Thank you.

Like this post and want to read more? Check out these other resources:

Becoming Vegan, Protein in Menopause, and How to Live to be 100 Years Old - Interview with Vesanto Melina

Five Things Vegan Women Need to Know about Protein During Menopause

25 Vegan-Friendly Tips - How to be Healthy During Menopause in 2025

If you need more support on your vegan menopause journey, join me inside my 12-week one-on-one coaching program.

DISCLAIMER: This website's information is general in nature and for informational purposes only. It does not constitute medical advice and is not intended to substitute for professional medical advice, diagnosis, or treatment.