The Nutrient Women in Perimenopause Are Missing

Ever wondered why you can eat well, train hard and still feel like you're wading through treacle? Folate might be part of the answer. It's one of those quiet nutrients nobody talks about after their last pregnancy, and it turns out to matter a great deal in perimenopause and menopause.

What it is

Folate is vitamin B9. You get it from food: leafy greens, lentils, beans, asparagus, broccoli, eggs, and liver if you eat it. The word comes from the Latin for leaf, which tells you where to find it.

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It's worth knowing the difference between folate and folic acid. Folic acid is the synthetic version you find in cheap supplements and fortified cereals. Your body has to convert it before it can use it, and a lot of women don't convert it well. So you can be taking folic acid every day and still be low in usable folate. That confuses a lot of people, and I don't blame them.

Why it matters in perimenopause and menopause

Folate runs a process called methylation. Plain English: it's how your body switches things on and off, repairs cells and clears out what it doesn't need. One of the things it clears is used oestrogen. If methylation is sluggish, oestrogen gets recycled instead of removed, and that's when you see heavier periods, tender breasts, mood swings and that stuck, puffy feeling.

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It also makes your feel-good brain chemicals. Low folate and low mood go hand in hand, and I see so many women told they're depressed when actually they're depleted.

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Third thing. Folate keeps a substance called homocysteine down. High homocysteine is linked to heart disease and bone loss, and once your oestrogen drops you lose the protection you had. So folate becomes a heart and bone nutrient for us, not just a pregnancy nutrient.

The signs you're low

Tired all the time, foggy, flat, mouth ulcers, breathless on the stairs, irritable for no reason. Sound familiar?

What drains it

Alcohol, stress, the pill, metformin, acid reflux tablets, a gut that isn't absorbing properly, and years of eating on the go.

The bit nobody tells you: it has to get in first

Here's where it gets interesting. You can eat all the spinach in the world and still be low, because folate has to be released from your food and absorbed through your gut before it's any use to you. That takes two things.

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The first is stomach acid. Folate is bound up inside your food and it needs a properly acidic stomach to start pulling it apart. Stomach acid naturally drops as we age, stress switches it off, and acid reflux tablets are designed to shut it down. So the very tablet you've been given for that burning feeling is quietly cutting off your folate supply. I see this all the time, and it's a big reason those signs above hang around even when someone is eating beautifully.

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The second is your microbiome. Folate is absorbed in the small intestine, and it needs healthy gut lining and the right enzymes to cross over. On top of that, some of your friendly bacteria actually make folate for you, which is a lovely bonus if you've got them and a loss if you haven't. Bloating, loose stools, constipation or that "everything I eat upsets me" feeling are your clues that the gut isn't doing its part.

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So when a woman tells me she's taking a good quality methylated folate and still feels flat, my first question isn't about the supplement. It's about her stomach, her gut and her stress.

A few practical starting points

1. Eat your folate foods with something bitter or sour first, like rocket, lemon in water or a little apple cider vinegar, to wake up your stomach acid.

2. Sit down and chew. Eating on the go is how we got here.

3. If you supplement, choose methylfolate rather than folic acid, and get your levels checked rather than guessing.

4. Feed your bacteria: fibre from vegetables, beans and lentils, plus a little fermented food if your body tolerates it.

5. If you're on acid reflux tablets long term, ask your GP about a review. Don't stop them on your own.

The bridge

You cannot get fit and strong in a body that isn't fuelled. My ladies come to me lifting weights, walking 10k steps, doing everything right from the outside in, and they're running on empty underneath. Folate is one of the nutrients that's quietly missing, and a gut that can't absorb it is the reason the supplement in the cupboard hasn't helped. When we work from the inside out, the results come faster and you don't get injured.

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Get in touch if you'd like to know more.