Bárbara Munar, dietitian specialising in menopause: "From the age of 40, women need more protein than the general population"

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On the occasion of World Menopause Day, which is celebrated on October 18, we turned to the expert Bárbara Munar (Ibiza, 1982), dietitian-nutritionist, writer and lecturer specialized in this stage full of natural changes in the body.

In the book Queens Without Rules (Ed. Grijalbo), she offers nutritional keys for women's health from the age of 40 as a result of her experience after treating more than a thousand women. The bottom line? A balanced diet, better stress management and exercise as a daily elixir go a long way towards going through menopause with more energy and well-being.

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In his book, he criticizes pseudo-experts and Magufism on social networks. How can we distinguish good nutritional information from so many currents and guidelines? Two criteria must be applied: common sense and avoiding generalizing from the case of a person who has done well based on his experience, but is not trained. Anything that squeaks at us or sounds like magic should lead us to look for other sources. Any practical advice? A phrase I always tell my patients is to trust more than our ancestors did. If our grandparents didn't care so much about whether eating chicken or vegetables was right or wrong, or whether they could drink water before or after a meal, to say some of the claims that run through social networks, think of it as a fallacy. 'What I did from the age of 40 and it worked for me' is a first-person statement but not scientific, by any means. A clean-up must be done so that pseudo-truths disappear. She's especially the before-and-after photos of bodies that flood Instagram. What consequences do they have for women? For those who go through perimenopause, they can do a lot of damage. I see women in their 40s or 50s with a very low fat percentage or an unhealthy body mass index (BMI) and they promote themselves as a model of beauty in menopause. They're not real. We are at a time when we are beginning to talk about this stage both professionally and from the media, so we should get serious about not going for a physical goal, but for the improvement of health. She says that women who come to her office are afraid to take fats and abuse 'light' products that are low in calories but unhealthy. Where does this demonization come from? Part of the 70s, when a very reductionist statement was made based on calories when we saw that we accumulated fat. There are three macronutrients: proteins, fats, and carbohydrates. For each gram, both proteins and carbohydrates provide us with 4 kcal, but in fats it rises to 9 kcal. From this it was concluded that they were responsible for this accumulation, without taking into account that food is transformed. So carbohydrates and proteins can also be converted into fat if they are not 'burned'? Carbohydrates are converted into glucose which, if not used as energy, such as ATP [Adenosine Triphosphate or Adenosine Triphosphate, the primary energy carrier molecule for all forms of life], accumulates as fat. And the same with proteins. The fear of fats is promoted by an industry of light products that sells us very low nutritional contributions but also few calories. This leads us to have very altered blood glucose, and to eat what in the end we did not want, such as that croissant usually with trans or hydrogenated fats, the really harmful ones, not the good ones such as oily fish, avocado, seeds or olive oil. However, proteins are experiencing a boom. Are those products that are enriched with this macronutrient so good? The problem is in the dosage, but all the macronutrients are necessary. It's true that protein is having a sweet moment, after being reviled 20 years ago because it was said to damage the liver due to certain types of diets. From the age of 40, women need more protein than the general population because due to the hormonal decline We lose muscle mass. We are in a continuous muscular catabolism. And, as we lose muscle mass, our metabolism can slow down and the immune system is weakened. We are more likely to get sick, therefore. However, we can perfectly cover these protein needs without buying fortified products at the supermarket. They can be interesting for snacks in women who do not get the necessary daily requirements from the diet. I prescribe protein yogurts to my patients if they can't eat fish and meat for lunch or dinner. There are many women who no longer want to eat carbohydrates at this stage of life, but even earlier, because of bad publicity. But they're not all the same, are they? Without a doubt, it must be explained that carbohydrates are the fastest and most direct source from which our body obtains energy. And we are immersed in menopause, in an aging with a continuous oxidation that demands a lot of energy. But within carbohydrates there are different sources. Fruit and vegetables provide us with glucose, fiber, vitamins, minerals and water, reducing this oxidative stress. They should be the basis of food. I also recommend whole grains. Where we have to be careful, however, is in the refined carbohydrates that we include in the diet: white pasta, industrial pastries... They also contain trans and hydrogenated fats, which increase cardiovascular risk and provide free sugars that quickly accumulate in the form of fat and increase inflammation. This leads to more hot flashes and insomnia. But within the stigma of carbohydrates, you have to know how to differentiate them. What signs can be noticed when the metabolism slows down? We begin to notice an increase in fat in the abdominal area and, at the same time, we feel softer because we lose muscle mass. In addition, we have slower and heavier digestions. And we suffer from constipation. There are women who also tell me that they always eat without hunger. Only out of obligation when the time comes. A combination of all of this can make us intuit that the metabolism is slowing down. With metabolic rehabilitation, which takes months. Improving muscle mass by eating enough daily protein and also working out. It is already very clear to us that alcohol and tobacco are enemies of health. But why especially at menopause? Women who smoke are more likely to get hot flashes, and alcohol is a direct inflammator. They are direct triggers that increase chronic low-grade inflammation, and that affects irritability and insomnia, studies show. It links hot flashes to higher blood glucose levels. Can strength training help reduce them? By having more muscle mass, we will have more stable glucose levels and, therefore, less inflammation and fewer hot flashes. Intermittent fasting is often used as a weight loss tool. But perhaps, without a calorie restriction, it may not make sense at a stage where a lot of fatigue occurs. Does it depend on each woman's particular case? Menopause doesn't make you fat, but our lifestyle. Even if you fast for 16 hours, if you eat badly then it's useless, just like if you don't exercise. I think it's a helpful tool to consider, like supplementation, but not the basis on which we rely to improve lifestyle and symptoms. One of the misconceptions is that it is a diet, when it is a protocol for ordering meals in which we go between 12 and 16 hours without eating. The remaining eight hours have to have professional supervision so that the diet is correct. What if you eat less than you need in those eight hours with the aim of calorie restriction? If our idea is to do it as a diet, we can have altered blood glucose and make us feel altered by eating little. That leads us to give up or to rebound effects, hence my insistence on doing them well guided by the professional.What do you do wrong after the age of 40 to always live on a diet? We are the generation of women with the most nutrition information, but we are not able to meet our needs well because we have read many myths. So we arrive at this stage with a list of forbidden foods and paying attention to headlines that create a decompensation. Apart from eating badly, we are women with work obligations, family responsibilities, such as children and elderly people in our care, with pets, and we put ourselves at the end of an endless list. We never dedicate a space reserved for ourselves. And physical activity is paramount, just as important as food. If we are still all day we atrophy our muscle mass, which we do not move, and if we add to this the hormonal decrease, it causes muscle to be lost quickly and fat to increase more. And we have tremendous stress, which increases cortisol and causes inflammation and more alterations in blood sugar, insomnia and mood. We do very poorly when it comes to managing our anxiety. All it describes is a circle. Does menopause also cause more hair loss? Estrogen improves skin quality and maintains scalp hydration. When there is a hormonal decrease, this scalp that nourishes the hair root is altered. But hormones don't have the last word. There are factors, such as the lack of quality nutrients and stress, that lead to more hair loss and finer hair. And can you do something about it, besides improving the menu and trying to relax, which doesn't seem so simple? Try to reduce the use of dyes, blow dryers and do not overuse tied hair too tightly. Now that the period has entered the legislation without as many problems as initially intuited, what effects does menopause have on the workplace, with women aged 40 and over accounting for 30% of the active population? I recently did a survey in which 68% of women notice that menopause interferes with work performance and they feel very insecure. That's 7 out of 10. Companies are already realizing that women need information to be able to alleviate the symptoms that, in the long run, affect the work environment as well. We have to raise awareness in order to reduce them. The more physical activity there is, the better the blood supply and the greater the ability to concentrate. And there are foods that improve cognitive performance, such as nuts, olive oil, avocado and eggs. What can you say to those women without rules who don't recognize themselves in the mirror and feel bad or have a low sexual appetite? There are very profound changes that, if we don't accept, can affect our libido. It's a very deep topic, because no matter how well you eat and exercise, even with hormone therapy you can stillIf you feel insecure about how you see your body, you're not going to improve it. We have to work with ourselves on reaffirmation, knowing that beauty is not only in our physique, but in our experience, in the way we speak and behave. If self-acceptance does not come with this work, we may need the help of a therapist or sexologist to help us in the couple.

• nutrition
• Feeding
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