Dietary Management of the Menopause

Experience of Menopause varies from one woman to the next and this is partially due to our diet and lifestyle which can play a part in influencing the onset of menopause and the severity of its symptoms.

Factors influencing menopause onset

Low BMI = early onset. Mainly due to women not eating enough to produce the hormones needed for a healthy functioning reproductive system.

High BMI = late onset. Having a high BMI has a negative impact on hormones, more body fat increases oestrogen levels in the body and low levels of leptin and adipokines which are involved in inflammation.

Smoking = early onset, although the mechanism is not clear it is thought that toxins in tobacco decrease oestrogen levels.

One research study showed that a high intake of oily fish and fresh legumes were associated with delayed onset of natural menopause by 3.3 years per portion/day. Omega 3 fats have been shown to improve antioxidant capacity which has a positive effect on hormone balance.

B6 and Zinc are important for antioxidant capacity and healthy ovaries. To find out about dietary sources of B6 and Zinc click here.

Surrey Dietitian

The stages that occur during the menopause:

Peri-menopause

Usually occurs 5 years before going through the menopause.

Symptoms may include:

· Irregular periods

· Hot flashes and sleep problems

· Mood changes

· Decreased fertility

· Changes in sexual function

· Changes in cholesterol levels

· Difficulty losing weight

Menopause

Occurs naturally as the ovaries age and produce less reproductive hormones. Eventually the ovaries stop releasing eggs. Women have reached menopause after 12 consecutive months of no menstruation. The average age at menopause in the UK is 51 years. Premature menopause can occur before the age of 45 and might be brought about by surgical removal or damage to the ovaries.

The symptoms are the same as peri-menopause, with the most common symptoms being hot flashes and night sweats.

Post-menopause

Likely to no longer experience symptoms of the menopause.

Likely to have an increase in risk of health problems, including:

· Bone deterioration.

· Heart disease.

· Changes in body composition, commonly more fat distribution around middle and less muscle mass.

· Higher risk of Alzheimer’s disease.

· Bladder and digestive issues.

What is happening at a hormonal level?

There are 5 hormones involved, follicle stimulating hormone (FSH), Luteinizing hormone (LH), GnRH (Gonadotrophin releasing hormone), progesterone and oestrogen.

Oestrogen and progesterone are the most important because they decrease during menopause resulting in the subsequent effects of menopause.

Oestrogen and progesterone levels decline from the age of 35. Ovary follicles are exhausted and stop releasing eggs. Because they stop releasing eggs, they stop producing oestrogen and progesterone. Oestrogen in-particular is involved in almost every physiological function including weight management, bone health, brain function, skin health, cholesterol, libido and is the main cause of changes.

Although the menopause can be treated by hormone therapy (HRT), dietary changes can also be significant in symptom management.

Menopause and change in body composition

Due to reductions in oestrogen, progesterone and the aging process, muscle mass decreases and abdominal fat increases.

The changing hormone levels during the menopause cause increased glucose levels in the blood which means the body must produce more insulin to keep blood sugar levels under control. This increase in insulin signals for the body to store fat.

The consequence of increased body fat means that menopausal women are more likely to develop pre-diabetes and inflammation in the body. The body is also generally under more oxidative stress.

For the reasons described above, dietary modification should aim to keep blood sugar levels under control.

Surrey Dietitian

A low glycaemic index (low GI) diet

The term glycaemic index refers to how quickly our blood sugars increase after eating a particular food or meal. High GI foods cause our blood sugars to enter a ‘rollercoaster’ cycle where they rapidly increase and decrease, whereas low GI foods keep our blood sugars steadier. The higher our blood sugar levels, the more insulin we produce. As discussed above, too much insulin signals to the body to store fat. Additionally, when our blood sugar levels drop, we produce more of the stress hormones adrenaline and cortisol which signal to our body to break down muscle for energy.

By choosing low GI foods and limiting intake of high GI foods, insulin levels are not as high, resulting in a lower tendency to store abdominal fat. We also reduce production of cortisol and adrenaline therefore reducing muscle breakdown.

High GI carbohydrates include foods with added sugar and refined carbohydrate such as white bread.

Low GI carbohydrates include complex carbohydrates such as granary bread, boiled new potatoes, wholegrain cereals.

You can also help to lower the GI of a meal or snack by adding protein and fibre. Protein and fibre take a long time to be broken down into sugar so will help to prevent rapid increases in blood sugar levels.

Surrey Dietitian

Be smart about the timing of your starch

Eating more of your starchy carbohydrate portions earlier in the day is another effective method for keeping blood sugar levels under control.

If you were to eat a high carbohydrate meal shortly before going to bed, your insulin levels would be higher because you are inactive and therefore not using up the sugar in your blood for energy.

You might want to start by swapping starches such as pasta, rice and potatoes for pulses and beans.

Doing some form of exercise, even going for a short walk after a meal can also help to improve insulin sensitivity.

Low carbohydrate diets

Low carbohydrate diets can be effective in the short term for weight loss and improving blood sugar control but unfortunately, evidence has shown that sticking to a low carbohydrate diet long-term is not sustainable. Carbohydrates remain an important part of our diet. They are our primary energy source so without them we would likely feel low in energy and potentially quite hungry. Restricting whole food groups is also likely to lead to increased cravings.

Carbohydrates are a rich source of fibre and micronutrients and help to optimise the good bacteria in our gut therefore aiding digestion, immunity, and mood.

If you are considering trialling a low carbohydrate diet, it should only be considered short term and I would recommend discussing this with a dietitian first.

Further tips for improving body composition:

· Reducing alcohol consumption.

Alcohol is a source of carbohydrate and is high in calories and therefore likely to increase visceral fat and decrease muscle growth. It also has a negative impact on sleep which can increase production of the stress hormone cortisol.

· Limit intake of trans fats.

Trans fats increase fat storage around stomach.

· Combine resistance training and cardiovascular workouts.

For muscle maintenance try to do resistance training once a week or three times a week to gain muscle mass.

Cardiovascular exercise can help to burn calories and therefore shift visceral fat. As mentioned above, exercising after a meal may also be beneficial.

· Intermittent fasting (time restricted feeding).

The most common type is 16:8 – which involves a 16-hour fast each day, and an 8-hour eating window. The post-menopausal benefits are particularly high due to the potential to improve insulin sensitivity.

Heart health

Heart disease is the leading cause of death in post-menopausal women, this is due to reduced oestrogen levels. Oestrogen plays a role in normalising blood lipid profiles and reduces blood pressure.

As discussed above, weight gain is common during the menopause and being overweight increases risk to heart health.

Tips to optimise heart health:

· Reduce your intake of salt by adding less salt to food and eating less processed food and takeaways.

· Aim for at least 5 portions of fruit and vegetables per day. Learn what counts as a portion here.

· Include omega 3 fatty acids contained in oily fish, rapeseed oil, flaxseed and avocado.

· Cut down on your intake of saturated fats found in butter, cheese and fatty meat.

· Choose wholegrain options such as wholemeal or granary bread, brown rice, oats and quinoa.

· Swap butter for a plant-based spread.

· Limit your alcohol intake to no more than 2 units per day and include 2 alcohol free days a week. Learn your units here.

· Maintain a healthy weight. For more information about weight loss click here.

· Do not smoke.

Surrey Dietitian

Bone health

During the menopause women have reduced calcium and vitamin D absorption, resulting in increased bone deterioration and weaker bones.

It is recommended that all women (and men) in the UK take a daily Vitamin D supplement throughout the Autumn and Winter months as a minimum. This should provide at least 400IU or 10mcg of vitamin D daily. If you get little skin sunlight exposure in the Spring and Summer, then you should continue to take the supplement all year round.

Enough calcium is also important, but avoid over-supplementing due to risks to heart health. Over-supplementing with calcium can lead to calcification of arteries which means more plaque is likely to form. Plaque formation in the arteries can lead to a blockage and increase the risk of a heart attack or stroke.

The recommendation for calcium is 700mg per day. Calcium is more bioavailable when we consume it in our diet rather than through supplementation. Aim to include 3 portions of calcium rich foods in your diet per day. You can find out more about how to get enough calcium in your diet here.

Intake of added sugars and alcohol should be limited, and smoking should be avoided. Studies have shown that too much sugar and alcohol and smoking can cause diminished bone health.

Take part in weight bearing exercise which will exert force through your bones and help to strengthen them.

Surrey Dietitian

Soy and phyto-oestrogens

During menopause a woman’s ovaries stop producing the hormones oestrogen and progesterone. A decline in these hormones can cause menopausal symptoms such as hot flushes, anxiety and low mood, all of which can contribute towards disrupted sleep.

Plant oestrogens called phyto-oestrogens may help to reduce the severity of night sweats, changes in mood and help you to get a good night sleep. Plant oestrogens are very similar to human oestrogens, which if eaten regularly, and in sufficient quantities can partially mimic the action of human oestrogen.

Soya beans, soya-based foods and linseeds are sources of plant oestrogens. Soya-based foods include tofu, tempeh, edamame beans, soya drinks and soya yoghurts. Consuming these foods several times per day has been shown to be more effective than consuming one daily large dose. Soya can also help the body to absorb calcium and therefore strengthen bones.

It can take a few months to start seeing a benefit and consuming plant-oestrogens is more effective in some women than others.

Mental health

During the menopause many women experience emotional highs and lows, this is because oestrogen regulates many of the hormones which influence our mood such as serotonin, norepinephrine, and dopamine.

It is normal to experience memory loss, lack of clarity and trouble sleeping. Mood may be further affected by changes in sleep pattern, reduced energy levels and stress due to weight gain.

Tips to improve your mood:

· Blood sugar control is very important so that stress hormones can be used to manage things that are actually stressful.

· Try to moderate caffeine intake because caffeine is a stimulant, and it therefore puts pressure on adrenal glands which produce stress hormones. Drinking too much caffeine is also linked to increased anxiety.

· Increase your intake of omega 3 rich foods. This may be of benefit as omega 3’s are the building blocks of neurones in the brain which can help to improve mood.

· Supplement with vitamin D because low levels are linked to poor mood.

· Consider mindfulness or cognitive behaviour therapy (CBT).

· Take part in regular exercise.

Surrey Dietitian

Sleep quality

Drinking alcohol, particularly shortly before going to bed is likely to disrupt sleep. At lower doses, alcohol has a stimulating effect due to the release of dopamine in the brain. This takes effect about an hour after consuming the alcohol. Drinking alcohol at higher doses has the opposite effect and is likely to make you feel more tired. Although this may help you to fall asleep initially, this is shortly followed by a rebound stimulant effect 2-3 hours later which could then lead to you waking in the night. Either way, you are unlikely to wake in the morning feeling well rested.

Caffeine has a similar stimulating effect. If you struggle to sleep, I recommend you aim to stop drinking caffeinated drinks after 3pm.

A few studies have shown that consuming large quantities of refined carbohydrates just before bed can cause a decline in the levels of the sleep hormone serotonin in the brain. This suggests that it would be better to avoid consuming foods such as cakes, pastries, biscuits and chips just before bed.

Emerging research has however shown that consuming small quantities of food containing the sleep-inducing amino acid tryptophan may help promote sleep. Tryptophan helps with the production of sleep hormones serotonin and melatonin. The best sources of tryptophan include eggs, fish, meat, soya beans and cheese. Tryptophan containing foods do need to be consumed with a carbohydrate food to have a sedative effect.

Melatonin supplementation has been demonstrated to improve sleep quality. In the UK, melatonin is only available on prescription. Consuming certain foods however can help to increase our levels. Foods containing melatonin include nuts, seeds, strawberries, grapes and oats.

Studies have also shown the importance of having a high enough intake of vitamins and minerals. For most people, it is possible to achieve a sufficient intake of vitamins and minerals by following a well-balanced diet, including consuming a variety of fruits and vegetables. For some people who struggle to meet their requirements for certain vitamins and minerals, I may recommend supplementation, but this would be recommended on an individual basis.

What is Polycystic Ovary Syndrome and how can diet help to manage the symptoms?

What is Polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS) is a very common condition, affecting approximately 1 in 10 women in the UK.

A diagnosis of PCOS is likely to be made in women who have 2 or more of the following:

1) The presence of fluid filled sacs known as follicles surrounding the eggs on the ovaries.

2) Irregular periods due to not ovulating (releasing eggs from the ovaries).

3) Higher levels of male hormones known as androgens (e.g., testosterone) which may cause physical signs such as excess facial hair.

What are the symptoms of PCOS?

If you have PCOS then you may experience some or all the below symptoms.

1) Irregular periods

2) Excess hair growth

3) Weight gain or difficult losing weight

4) Fatigue

5) Acne

6) Hair loss from head

Having PCOS can also increase your risk of developing type 2 diabetes and heart disease, particularly if you have high cholesterol, high blood pressure and/or carry excess fat around your middle.

Insulin resistance

Many of the side-effects associated with PCOS are because of insulin resistance. Insulin is a hormone that is released by the pancreas when we eat. Insulin allows the energy from our food to be used for fuel by moving the sugar from our blood into our muscles and tissues.

Most women with PCOS have a 35-40% decrease in insulin sensitivity which means that they must produce more insulin for it to do its job correctly. Unfortunately, insulin increases the production of the male hormone testosterone which causes a hormone imbalance and contributes to the above symptoms.

Weight loss

If you are overweight, then losing weight (even just 5-10%) is likely to help manage the symptoms of PCOS. Unfortunately, weight loss in PCOS can be more challenging for 2 reasons…

Firstly, research has consistently shown an association between insulin resistance and having a higher body fat percentage.

Secondly, women with PCOS are likely to have a lower basal metabolic rate (BMR, the number of calories burnt at rest). One study showed that BMR can be 14-40% lower compared with women who don’t have PCOS.

As we know, to lose weight we must be eating in a calorie deficit. Having PCOS means that to lose weight, fewer calories must be consumed, or more calories must be expended through exercise. Although the exact cause of this is not known, one study suggested that it may be due to lower lean body mass observed in PCOS.

Weight loss is not an easy thing alone, but when you add in the complications of PCOS, things get even harder. I can certainly empathise with women with PCOS who struggle with their weight. However, being armed with this information can help us to better understand how to tackle weight loss.

A healthy diet

The general guidelines for managing PCOS suggest following a healthy diet and this is certainly a good place to start.

Aim to have a varied diet, focusing on increasing your intake of fruits and vegetables and limiting your intake of foods high in fat and added sugar.

A Mediterranean style diet, high in omega 3 fatty acids, wholegrains and antioxidants has been suggested as one of the best diet types for managing PCOS.

Oxidative stress (antioxidant imbalance) has been associated with PCOS and therefore including plenty of antioxidant rich fruit and vegetables may be significant in symptom management.

If you are trying to conceive, it is especially important to make sure you are following a well-balanced diet.

As a starting point, try the following tips to help you improve the balance of your diet:

1) Base your meals on high fibre starchy carbohydrate

2) Eat a variety of different fruits and vegetables

3) Eat more fish, including one portion of oily fish per week

4) Cut down on saturated fat and added sugar

5) Eat less salt

6) Maintain a healthy weight

7) Aim for at least 6-8 glasses of fluid per day

8) Eat regular meal patterns

Low Glycaemic index

The term glycaemic index refers to how quickly your blood sugars increase after eating a particular food or meal. High GI foods cause our blood sugars to increase rapidly, whereas low GI foods do not (as illustrated below). The higher, our blood sugar levels, the more insulin we produce. As we know, PCOS is associated with insulin resistance which means that even more insulin is released and along with that comes the symptoms of PCOS.

By choosing low GI foods and limiting intake of high GI foods, insulin levels can be reduced and in turn symptoms are improved.

High GI carbohydrates include foods with added sugar and refined carbohydrate such as white bread.

Low GI carbohydrates include complex carbohydrates such as granary bread, boiled new potatoes, wholegrain cereals.

You can also help to lower the GI of a meal or snack by adding protein and fibre. Protein and fibre take a long time to be broken down into sugar so will help to prevent rapid increases in blood sugar levels.

Low carbohydrate diets

Many studies have shown that reducing carbohydrate intake can be a very effective method for improving insulin sensitivity, but carbohydrates, however, remain an important part of any diet. Carbohydrates are our primary energy source so without them we would likely feel low in energy and potentially quite hungry. They are also a rich source of fibre and micronutrients and usually quite an enjoyable component of the diet.

A low carbohydrate ketogenic (AKA keto) diet has been researched extensively and some research has linked it to reduced blood sugar levels and improved insulin resistance. This is however likely due to taking in fewer calories resulting in weight loss.

The standard version of a ketogenic diet recommends limiting your carbohydrate intake to 10% of your total energy and aims for 70% of total energy from fat.

One issue with the keto diet is that generally it is quite difficult to stick to due to the reasons mentioned above. It tends to work in the short-term but longer-term studies have shown reduced compliance and a tendency to regain any weight that was lost.

Another downside to the keto diet is that it is low in fibre, generally high in saturated fat and due to its restrictive nature may leave you lacking in some micronutrients. This is likely to increase the risk of certain cancers, heart disease and digestive issues. For these reasons, I would not recommend doing the keto diet long-term but for most people it would generally be considered safe to do in the short-term and may be a useful tool to help kick-start your weight loss journey. You should always consult with your dietitian or GP before considering a keto diet.

Reduced carbohydrate diets which allow for higher carbohydrate intakes than the keto diet have also been studied with some promising results.

A 2019 meta-analysis study involving 327 women with PCOS concluded that a reduced carbohydrate diet (45% of total energy or less from carbohydrate) combined with a reduced fat diet (35% of total energy or less from fat) was the most effective dietary method for improving insulin sensitivity and promoting weight loss.

Exercise

Exercise improves insulin sensitivity because it encourages sugar to move from our blood and into our muscles to be used for energy. Research has shown that high intensity aerobic exercise is particularly beneficial.

Given that individuals with PCOS are likely to have lower BMR’s, if you are trying to lose weight it would also be sensible to include resistance training exercise as part of your routine. Resistance training exercise helps to build muscle and having a higher muscle mass means your BMR increases, making it easier to lose weight.

Supplements

Vitamin D

Women with PCOS are at an increased risk of vitamin D deficiency. Vitamin D helps to reduce inflammation which is a contributing factor to the symptoms of PCOS. And although the mechanism is not fully understood, it has also been shown to improve regularity of periods.

Given that our main source of vitamin D comes from the sun and in the UK sunlight exposure is limited, I recommend taking a daily 10mcg vitamin D supplement. It may also be worth asking your GP to perform a blood test because if you are vitamin D deficient then you may need a higher dose initially to restore your levels to within the normal range.

Inositol

Inositol is a sugar alcohol (type of carbohydrate) which plays an important role in insulin sensitivity. Many randomised control trials involving inositol supplementation in women with PCOS have shown positive outcomes such as improved fertility, reduced insulin resistance and decreased testosterone production.

Vitamin E

Vitamin E has been shown to have antioxidant effects. More recent evidence has also shown that vitamin E can improve endometrial thickness in women with unexplained fertility. One study showed that combined vitamin E and omega 3 supplementation for 12 weeks resulted in significant improvement in insulin resistance and reduced testosterone levels in women with PCOS.

Dietary sources of vitamin E include plant oils such as rapeseed or olive oil, nuts and seeds and wheat germ (found in cereals and cereal grains). If you are unlikely to consume these foods on a regular basis then you may want to consider a vitamin E supplement.

Chromium

Some women with PCOS show reduced chromium levels which has been linked to insulin resistance and reduced testosterone. The recommended dosage is 200µg of chromium picolinate per day for 3 months to observe the benefits.

Zinc

Women with PCOS who do not eat a varied diet are at increased risk of zinc deficiency which has been linked to insulin resistance and high cholesterol. Studies have shown improvements in both factors by taking 50mg of zinc sulphate daily for 8 weeks.

As a first line approach I would not recommend zinc supplementation, I would encourage you to try and get enough zinc through diet. Dietary sources of zinc include meat, beans, pulses, nuts, wholegrains, and milk.

N-acetyl-L-cysteine (NAC)

NAC has antioxidant activity and, in many studies, has been shown to reduce inflammation and oxidative stress and consequently improve fertility and ovulation rates for women with PCOS. In most studies, the suggested dosage is 600mg per day.

Carnitine

A 2019 study involving 80 women with PCOS found that supplementing 3g of L-carnitine daily for 3 months showed significant improvement in insulin sensitivity and reduced BMI. More regular menstrual cycles and reduced presence of facial hair also occurred.

Supplements, the bottom line

In the first instance, I tend to recommend addressing diet before considering the use of supplements. As a second line approach supplementation is another tool that may also help to relieve some of the symptoms of PCOS. If you want to try a supplement, then always consult with your GP or dietitian first. I would also always recommend trying one supplement at a time, otherwise you won’t know which one has or hasn’t worked for you.

Sources

BDA. 2019. Polycystic Ovary Syndrome (PCOS). Accessed 1st November 2021. Available at: https://www.bda.uk.com/resource/polycystic-ovary-syndrome-pcos-diet.html

Bhasin, G., Wang, ET., Alexander, CJ., Pal, M., Azziz, R and Pisarska MD. 2013. Women with polycystic ovary syndrome (PCOS) have lower basal metabolic rates compared to eumenorrheic controls. Fertility and Sterility 100(3): 38-39.

Chmelik, M. 2015. N-acetyl-cysteine to treat polycystic ovarian syndrome? Natural medicine journal. 7(6). Accessed 1st November 2021. Available at: https://www.naturalmedicinejournal.com/journal/2015-06/n-acetyl-cysteine-treat-polycystic-ovarian-syndrome

Georgopoulos, NA., Saltamavros AD and Vervita, V. 2009. Basal metabolic rate is decreased in women with polyscystic ovary syndrome and biochemical hyperandrogenemia and is associated with insulin resistance. Fertility and Sterility 92(1): 250-255. Accessed 1st November 2021. Available at: https://www.fertstert.org/article/S0015-0282(08)01008-X/fulltext

Gunalan, E., Aylin, Y and Yilmaz. 2018. The effect of nutrient supplementation in the management of polycystic ovary syndrome-associated metabolic dysfunctions: A critical review. J Turk Ger Gynecol Assoc. 19(4): 220-232. Accessed 1st November 2021. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250088/

Mavropoulos, JC., Yancy, W., Hepburn, J and Westman, EC. 2005. The effects of a low-carbohydrate, ketogenic diet on polycystic ovary syndrome: a pilot study. 2(35). Accessed 1st November 2021. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1334192/ 4

Mohammadi, M. 2019. Oxidative stress and polycystic ovary syndrome: a brief review. International Journal of Preventative Medicine. 10(86). Accessed 1st November 2021. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547785/

NHS. 2019. Polycystic Ovary Syndrome. Accessed 1st November 2021. Available at: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/

Paoli, A., Mancin L., Giacona, MC., Bianco., A and Caprio, M. 2020. Effects of a ketogenic diet in overweight women with polycystic ovary syndrome. Journal of translational medicine 18(104). Accessed 1st November 2021. Available at: https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-020-02277-0

Salehpour, S., Nazari, L., Hoseini, S., Bameni, P and Gachkar, L. 2019. Effects of L-carnitine on polycystic ovary syndrome. JBRA Assist Repod 14;23(4): 392-395. Accessed 1st November 2021. Available at: https://pubmed.ncbi.nlm.nih.gov/31294953/

Thakker, D., Raval, A., Patel, I and Walia, R. 2015. N-acetylcysteine for polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled clinical trials. Obstet Gynecol Int 817849. Accessed 1st November 2021. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4306416/

Zhang, X., Zheng, Y., Guo, Y and Lai, Z. 2019. The effect of low carbohydrate diet on polycystic ovary syndrome: a meta-analysis of randomized controlled trials. International journal of endocrinology. Accessed 1st November 2021. Available at: https://www.hindawi.com/journals/ije/2019/4386401/

Your guide to eating out whilst trying to lose weight

Don’t arrive famished

A common mistake people make is trying to eat less during the day leading up to going out for a meal…

Unfortunately, this results in your blood sugar levels dropping and increased hunger. The body’s “survival mode” kicks in and tells you that you need high calorie food to survive…

As a result, when you finally eat, you are most likely to choose high calorie options, refined carbohydrates and eat very quickly…

The consequence of this, is that you will probably consume more calories for that day than you would have done if you had just eaten your usual regular meals.

Eat mindfully

Mindful eating is about paying attention to your food and physical cues when you are eating. Those who eat mindfully are more likely to eat slower and experience a greater level of satisfaction from eating…

This often results in greater recognition of hunger and satiety, eating fewer calories and a reduced tendency to over-eat or binge eat.

Try the following:

1) Put your knife and fork down between mouthfuls.

2) Chew your food well.

3) Savour the first few mouthfuls as this is when your taste buds are heightened.

4) Check in with yourself after each course and ask yourself, am I hungry?

5) Reflect on how you feel after over-eating. Did you feel more satisfied? Did you feel comfortable? What will you do differently next time?

Get the balance right

Try to make sure that your meal includes a source of protein, a portion of starch and some vegetables or salad. This will help you to feel satisfied after your meal and to meet your body’s nutritional needs.

If your meal doesn’t come with vegetables or salad, then ask for some on the side. Commonly when we eat out, we are given 2 portions of carbohydrate for example, a burger bun and chips or naan bread and rice. Think about swapping one of these starch portions for some vegetables or salad.

If you only eat out occasionally:

Make satisfaction your goal

If you only eat out once a month or less, then 1 meal out is not going to make much difference to your weight loss journey, so you don’t need to worry so much about your choices. You can still however, try and apply the above suggestions.

Choose something from the menu you know you will really enjoy and give yourself full permission to eat it without feeling guilty.

If you eat out frequently:

When we eat out, we typically consume more calories than we normally would. This is because the food tends to contain extra fat and the portion sizes are often large…

If you eat out every week or more often, then you are going to have to have a think about your choices to keep you on track with your weight loss journey. The following suggestions may help…

Plan ahead

The good news is that many restaurants these days put their menus on their website so you can decide what you’re having in advance. Many will offer lighter options on the menu or even better will list the calorie content to help you with making an informed decision.

Don’t have the bread

Some restaurants will give the option to have bread or other “nibbles” before your starter or main course. A couple of slices of bread with butter before your meal is likely to add an additional 300 calories, which is a small meal on its own. As long as you don’t arrive feeling famished, then it should be easy enough to decline this. You will probably find that if you don’t have the bread, you will enjoy your main meal more because your taste buds are heightened in the first few mouthfuls of any meal.

Choose low calorie or no calorie drinks

If you were to have a couple of soft drinks such as coke or lemonade with your meal this would add approximately 250 calories to your meal. A pint of lager or large glass of wine would add about 200 calories…

Try and stick to low calorie soft drinks such as coke zero, diet lemonade or water. If you want to have alcohol, then try lower calorie options such as a single spirit with diet/slimline mixer or a glass of prosecco.

You don’t have to eat everything on your plate

Society tells us that we should always try and finish everything on our plate. Many of us were told growing up that leaving food on our plate is wasteful and should never be done…

In truth, if we eat something when we are not hungry then that food is wasted regardless of whether we eat it, or if it goes in the bin because it was more than our body needed. You can probably reflect on times when you may have eaten too much in one sitting, not wanting to waste food and you may have ended up feeling quite uncomfortable.

If you are presented with a large portion of food, then start by only eating half of what’s on your plate. After doing this, decide if you are still hungry. The chances are you will feel satisfied by eating only half, if this is the case ask the waiter to take your plate away as soon as possible. You can take the leftovers home with you to have the next day if you like.

Divide dessert

If you have had your main course and still feel hungry, then try sharing a dessert with someone else. If you don’t feel hungry but other people are ordering a dessert, then order a hot drink such as coffee or tea instead. You will save a lot of extra calories, whilst still feeling like you are having something enjoyable.

Plan to say no

You may find that the minute you tell others you are trying to lose weight, people feel the need to try and persuade you that it’s not necessary. They might say things like “it’s only this once” or “go on enjoy a dessert with me” …

Yes, their intentions are probably in the right place, they want you to enjoy yourself, but this is not particularly helpful when you are trying to lose weight. You might even find yourself eating or drinking things you didn’t really want or enjoy.

If you think that your friends, family, or work colleagues are likely to try and persuade you to have that extra glass of wine or tuck into a dessert then be prepared…

It helps to have a couple of phrases in mind that you will say in response. For example, you might say “that was delicious, but I am so full I couldn’t eat another thing” or “I had a big lunch earlier so I will stick to one course”.

Ask for sauce on the side

Sauces such as salad dressings, peppercorn sauce and mayonnaise are often very high in fat. Fat contains twice as many calories as carbohydrate and protein. Without doing much to the volume of your food you could be taking in a lot more calories than you realise…

By asking for your sauce on the side you can be in control of how much fat you are having.

Avoid fried options and creamy sauces

Instead of choosing fried foods which are high in fat, try to have grilled, steamed, or baked options where possible.

Choose tomato or other vegetable-based sauces rather than creamy of cheesy sauces. Not only will this help to reduce your intake of fat, but it will also add an extra healthy vegetable portion to your day.