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Hey everybody, it's Mikki here. You're listening to Mini Mikkipedia and today I just want to chat about a couple of health issues which many women experience um as they're going into perimenopause and beyond into menopause and also what they might do to mitigate some of these from a nutritional standpoint.

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what to think about in terms of potential blood testing and things like that. this isn't like a three hour deep dive, but hopefully it just gives you some starting points if you are thinking that this is something that you are experiencing. So the first one that I want to cover off is thyroid health. This is one of the most common worldwide endocrine disorders. And for a lot of women,

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uh or a lot of people actually as we age thyroid function does tend to decline as a function of aging. So this can look overt meaning that in addition to elevated thyroid stimulating hormone you can have low T3 and low T4. T4 is the what is known as inactive thyroid hormone. It does actually do something but it's considered inactive compared to the more active

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T3. So this can on a blood panel look like you're having issues with thyroid or it can be subclinical where you've got normal levels or within normal reference range for T3 and T4 yet you have elevated thyroid stimulating hormone. You can also present with actually normal TSH and normal thyroid hormone markers yet if you were to measure your thyroid

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antibodies, these could look elevated. So one in eight women are at risk of having poor or suboptimal thyroid health across their lifetime. So pregnancy and menopause, have higher risk times. And this is particularly so if you have a low quality diet, ovarian cysts, autoimmune disease as risk factors. And the reason why both pregnancy and menopause tend to give, or perimenopause tend to have sort of more

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more elevation in that risk can well be due to estrogen. So during perimenopause, estrogen levels obviously fluctuate unpredictably. They initially increase before they decline. And that estrogen stimulates the production of something called thyroxine binding globulin or TBG. This affects thyroid hormone availability. Increased TBG binds more thyroid hormone, reduces that free inactive antidepressant hormone levels and potentially can cause sort of subtle hyperthyroidism.

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symptoms. And the thing is, that with thyroid health, is this overlap in symptoms of thyroid dysfunction and menopause, and it can complicate that diagnosis. So in perimenopause as well, you do get these perimenopause related immune changes, which can raise the risk of autoimmune thyroid conditions and often autoimmune

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uh disease does sort of flare up in perimenopause. And then that immune dysfunction can trigger or worsen autoimmune responses which do affect the thyroid function.

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And as I said, those symptoms of thyroid function such as fatigue, weight gain, or mood swings, they often overlap with some of these menopausal symptoms which can complicate that diagnosis. So in essence then, with thyroid health, you want to test and not guess. So not only do you want TSH, which in many of the sort of laboratories, the only thing measured is TSH, you want T3, T4. Ideally, you're going to get reverse T3 as well, which is um what T4.

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can be converted to under significant stress as opposed to T3. Again, reverse T3 is inactive, but you've also got your antibodies there as well, TPO and TG. And this is going to give you a clear idea of what's going on with your thyroid. Also, if possible, in addition to that, you do want to have a look at your nutrient markers, such as your iodine, either urinary or your iodine to creatinine ratio. You want selenium, zinc, your full iron panel, not just ferritin, vitamin D,

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vitamin B12 and folate. And ideally you would also have a look at metabolic markers such as high sensitive CRP, C-reactive protein as a marker of sort of acute inflammation, fasting glucose or HOMA-IR, which gives you an indication of insulin to glucose sort of ratio, a lipid profile to look at what

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is occurring with your cholesterol which can often uh be elevated particularly with thyroid challenges and is also elevated in perimenopause anyway and potentially postmenopause and also sex hormones. And to go one step further having a look at cortisol I think could be really important particularly if you sort of recognize that you are someone in that sort of vital flight.

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uh nervous system response quite a bit. uh Cortisol is often measured in serum or in blood, but that is only giving you a snippet of actual cortisol production in the body. It doesn't give you an indication of clearance. It doesn't give you an idea of that sort of stored

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um cortisol or cortisone. So actually getting a Dutch test, dried urine test for comprehensive hormones um in salivary to look at that cortisol awakening response, which is where 50 % of our cortisol is sort of produced within half an hour of waking up. Like that would be what I would suggest uh if you were going to go down the route of actually looking at cortisol as well.

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And then with regards to thyroid health, like in terms of your diet, like you want to ensure you've got adequate intake of iodine. Now this is largely dependent on soil. There are just some places in New Zealand is one, Australia is another and then in certain areas in the US you'll also see this. Whereas there is just low soil content iodine. So this is why we have iodized salt. You've got kelp, kame, eggs, seafood is another really good

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sort of source of iodine, but you do want to watch excessive intake, particularly if your antibodies are raised in a way which indicates an overactive thyroid. But you do want to ensure that sort of adequate iodine intake.

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um to help sort of optimize a low thyroid function. We want to be eating selenium rich foods such as fish, sunflower seeds, Brazil nuts. Again, you do need to be mindful of the soil with which these sort of like nuts and seeds are coming from because that is their major source of selenium comes from the soil, can be deficient in selenium. Zinc and iron rich foods such as red meat, beef, chicken.

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particularly for zinc, not necessarily iron because it is a pale meat, are eggs and also plant-based sources for iron. And these ideally would be paired either with vitamin C or you're having them alongside a richer source of that iron. And also with thyroid, you do want to consider that um gluten sensitivity as well. Often when people have a gluten sensitivity, their body is going to sort of attack, obviously gluten,

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um proteins and all your immune system raises a response to that but sometimes in some scenarios the body or the immune system can mistake your thyroid tissue for gluten and attack that too. That is why one of the recommendations for thyroid is to have like a low gluten load or be mindful of gluten and being sensitive to it. And then in terms of supplements like

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There are some basic recommendations for supplements such as selenium 100 200 micrograms, vitamin D anywhere between 1,000 to 4,000 international units. And there are lots of preclinical trials um that indicate that we might need vitamin K2 to help vitamin D do its job.

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properly, but there's no human data to suggest that. So my usual recommendation is to have a vitamin D with K2. I haven't necessarily moved away from that, but I do just want to acknowledge that the human data isn't as strong there. You do want a supplement with iron if your ferritin is below 30 nanograms per milliliter, ideally. Ferritin, when you look in the research, often women feel best when their ferritin is at 50. And indeed, there are recommendations for a higher ferritin than that.

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But ferritin is another acute phase reactant which will increase according to inflammation. So this is why getting that full iron panel is really important. But if your ferritin comes back low, you do want to supplement. But you don't want to just go in there supplementing iron without an idea of where your iron level sits. And then a B complex to get your uh

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B12 folate these active B's to help with thyroid function is another key recommendation with that. And of course zinc. So zinc at 10 to 20 sorry 10 to 30 milligrams taken in the evening time. bone density is a huge one as you I'm sure are well aware of and estrogen lost during menopause does increase that bone resorption. So estrogen is really responsible or

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how ore contributes to the resorption and the strengthening of the bone. So estrogen plays a critical role in maintaining that bone density by inhibiting bone resorption and promoting bone formation. During menopause, there's a significant decline

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in estrogen, which does disrupt this balance. So it does lead to this increased osteoclast activity and accelerated bone loss. And in addition to that, we can experience a muscle mass decline and this will reduce mechanical load on bones, which will further accelerate that loss. So it's sort of twofold if you like. So before menopause, we might be thinking maybe we lose say 1 % of bone per decade after the age of 35. Post menopause, this can increase to two to even 5%.

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and your bone loss if you're not looking after yourself. In one in three women over the age of 65 years will have an osteoporotic fracture. So that's really significant because fracture really does impact your overall risk of dying early. And so there is that link between fractures and longevity. So there is increased mortality two to four times in the first year.

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after a fracture for someone who is over 60 and isn't the fracture per se, but it's that loss of independence, the bed rest required, it's a loss of muscle mass and suddenly we are unable to, we don't have the strength and we become very frail. This is an issue of frailty. There's that mobility loss, so there's that deconditioning and you get a decline in that cardiovascular resilience as well. So you just become less fit and

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Cardiovascular health is another area which we need to be mindful of in menopause and this further exacerbates it. There can be some post-surgical complications, pneumonia, embolisms, infections, and it's even worse if you have some pre-existing comorbidities such as coronary heart failure, anemia, or renal dysfunction. But this will really magnify risk of early mortality. And it's no surprise that age and frailty are huge.

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players in this risk of early mortality and mechanical load is key. So yes diet.

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absolutely plays a role here, but the mechanical load of bone and muscle and that strength training is absolutely critical for bone density. From a nutritional perspective, 1.6 to 2.2 grams of protein per kilogram per day. So, you your bone is like 50 % protein. So it is a dynamic tissue. It isn't static and we need to protect that. And this is one of the reasons why there are, you know, increased or accelerated bone loss when someone goes on a GLP and doesn't eat, you know, they're not getting

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in a lot of that structural nutrient that they really require. um But calcium as well, clearly it's the one that we all know about when it comes to bone density and we think it's like super important as it is. 1200 milligrams is the recommendation from food and supplements.

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in doses of about five or six hundred milligrams with meals but with cofactors as well like get one that has a magnesium alongside or a vitamin D alongside if you are going to supplement with calcium. um Obviously you've got dairy, you do have fortified milks but they are typically a calcium carbonate which is less well absorbed. um Sardines with the little bones same with salmon.

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Tofu, if it's set in calcium, is another option. And um you get some in cooked leafy greens. Now look, if you're dairy intolerant, I would say don't force dairy down because that intolerance indicates that you've got some sort of like either immune response or there'll be some sort of gut inflammation occurring. Inflammation itself is a huge risk factor for bone loss. So don't force dairy down if you're not tolerant to it.

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Vitamin D3, again K2, I've got that caveat there with how I addressed that earlier, but you do want your own vitamin D levels to be at least 40 to 80 nanograms per milliliter, which equates to about 70 to 120 nanomoles per litre.

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And having it uh with either with the K2, as I've said, mechanistically it's recommended. No human trials to support that you necessarily need it. And if you're not using, not having vitamin D3 with K2, I would make sure I was having it with some phospholipids in there.

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Magnesium 300 to 400 milligrams a day from a citrate, a glycinate or an amino acid chelate, a malate or a combo of those things. uh Magnesium oxide is poorly absorbed. uh Same thing with a marine magnesium, so that's why it's not recommended. Albeit there are some studies showing its utility in other areas, but I just, I wouldn't go there. I would just go for one that which was easier to absorb. 300 to 400 milligrams of that elemental magnesium.

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So do check that on the label and um it is difficult to get magnesium from food alone. So it is definitely something which I would recommend someone explore. And then omega-3s. So in orthopedics, there is evidence to say that omega-3s can exert some beneficial effects.

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which may include the regulation of inflammatory responses, enhancement of cartilage repair, regulation of bone metabolism, and these effects demonstrate potential for the treatment of conditions such as osteoarthritis, which is super interesting. that's one of the reasons why I would suggest Omega-3s. Now, collagen peptides, there is some research to support

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It's used to help with bone mineral density. There's definitely a use case, I think, for osteoarthritis, looking at Mike Ornsby's lab. They have conducted trials in midlife adults showing that 10 grams a day over six months helps improve pain indicators. So that to my mind is just reason to take it. And creatine may potentially help bone mineral density. There's not a lot of research here, but in combination with that resistance training may help support maybe at the hip, at the lumbar spine.

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So these are all good reasons to sort of suggest taking these supplements. So in terms of the nutritional foundation, there's a lot that you can do to support your bone. So thyroid health and bone density are two health challenges that a lot of women experience, they're often, know, bone doesn't get as much of a look in as muscle does. And people often blame thyroid function issues on just hormones in general without looking a little bit deeper.

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So these are just some of the considerations that come to my mind when I'm thinking about these. Hopefully that's helpful for you. Let me know, hit me up in the DMs. I'm @mikkiwilliden on Instagram X or threads @mikkiwillidennutrition and Facebook or head to my website mikkiwilliden.com. All right team, you have the best week. See you later.