Dear Laura... Do we really need 100g of protein in peri-menopause?

Welcome to ‘Dear Laura’ - a monthly column where I fashion myself as an agony aunt and answer the questions that readers submit. If you’d like to send in a question for me to answer next month, you can submit it here.

I’m happy to answer Qs about anti-diet nutrition, developing a more peaceful relationship to food and weight-inclusive health, annoying diet trends and news stories, body image challenges, and, of course, challenges with feeding your kiddos. Please give as much detail as you’re comfortable with and let me know if you’d like me to include your name or keep it anon.

Please remember that these answers are for educational purposes only and are not a substitute for medical or nutritional advice; please speak to your GP or a qualified nutrition professional if you need further support.

Let's take a look at this month's question:

I keep seeing on social media that ‘women age 40+ need 100g protein’ followed by recipes for high protein meals (which look kinda gross, ngl). I know protein hype isn’t anything new, but there seems to be a lot of content targeted at women entering the perimenopausal stage, but only vague notions of why it’s beneficial like ‘being less hungry’ and ‘displacing carbs’. Influencers also push really high animal protein diets, suggesting that plant-based foods like lentils and beans were not the ‘right kinds’ of protein. Is there anything to this 100g number? Where did it come from? Why is social media obsessed with middle-aged women and protein? Is it all just diet culture messing with our heads?

Just a quick note on language. I want to acknowledge the range of experiences and identities who go through (peri)menopause. For that reason I will refer to ‘people’ in general rather than a specific group. My intention is not to erase or minimise the injustices that cis-women face in patriarchal medicine, but to address that the gender binary is itself a construct of hegemonic patriarchal medicine. That said, where I have referenced a study using cis-men or women, I will use the language that the study has reported. 

A note on numbers. This article will discuss specific weights of protein and nutrient recommendations, as well as example body weights. I want to make it clear at the top that I am not recommending you weigh yourself, nor am I suggesting that you should count grams of protein. I’m using numbers to illustrate my points and I will write a separate piece about achieving protein recommendations through the lens of intuitive eating and gentle nutrition. If numbers are tricky for you, please sit this one out.

First of all, thanks for this question; it’s something I’ve wanted to look more closely at since I’ve started strength training to support chronic pain. I was experiencing killer DOMS after sessions and wanted to know if there was anything I could do to support my recovery. I asked the sports medicine doctor I'm seeing and he told me I should eat more protein and started throwing out random numbers, despite not having asked what my baseline was. So I politely told him to fuck off.*  And I think this is pretty typical of how people approaching or in the peri stage are treated. You’re tired? Eat more protein. You’re in pain? Eat more protein. You’ve got a squirrelly brain? Eat more protein. Your hormones are going ballistic? Eat more protein. Protein seems to be the answer for just about everything.

I’m becoming increasingly skeptical of the perimenopause-industrial-complex (PIC) and the way it intersects with diet culture. Predatory marketing, pseudo-science, and creating fear and disgust of our bodies is diet culture’s bread-and-butter. Folks aged 40+ are probably less interested in getting bikini bodies, or shredding for the wedding. Nor are they on the market for strollers and those spinny cribs that cost the equivalent of a month’s salary. But they have some disposable income making them rife for exploitation. It makes sense that the PIC and diet culture get together to sell us a bunch of supplements and books and various other things we don’t need. 

I’m not dismissing or downplaying the ways that ‘women’s health’ has been neglected by the medical establishment. But I think it’s important to acknowledge that patriarchal medicine is exactly what makes us vulnerable to exploitation from bad actors; our experiences are so often written-off as ‘hormonal’; our pain ‘in our heads’. It makes so much sense to me that we would try and take matters into our own hands. But, that also opens the door to mis- and disinformation filling the gaps that medicine has abdicated responsibility for. 

A primer on protein

I want to attempt to understand where the idea that you need 100g of protein a day comes from. But in order to do that, I think we need to understand why people even care about protein in the first place. 

Protein is one of three macronutrients we need for survival, the others being carbohydrates and fat. They all provide us with energy, as well as serving specific functions. The ‘macro’ part of macronutrient refers to the fact we need it in large quantities, as opposed to vitamins and minerals which we need in smaller amounts, hence micronutrients. That should already be a clue that we need it in relatively high quantities. Proteins have three broad functions in the body: structural, regulatory, and energetic.

Structural: The most abundant protein in our body is collagen which is found in skin, tendons, cartilage, heart, and bone tissue. Another structural protein is actin which helps our muscles contract. Essentially structural proteins help maintain the elasticity and shape of cells and tissues. 

Regulatory: A number of hormones are composed of proteins; things like pro-lactin, growth hormones, insulin, and thyroid-stimulating hormone. These hormones have an important role in the endocrine system and communicate with the immune system.

Energetic: Finally, protein that isn’t used for structural or regulatory purposes can be used as a source of energy (like carbs or fats). Protein that isn’t immediately used for structural, regulatory, or energy needs can’t be stored in the body so is converted to fat and stored for future energy needs. 

The point in me telling you all of this is that diet culture has us believe that protein is just about building muscle and that building muscle is an exercise in aesthetics. But protein supports a wide range of bodily functions; we’ll come back to why that’s relevant in ageing soon.

Protein in perimenopause

The first thing to make clear is that there is virtually no evidence looking at optimal protein intake for people in the ten to fifteen years before menopause. The vast majority of the evidence looks at younger people (under 40), older adults (65+), athletes, and various disease states. 

Any recommendations you see that specifically target perimenopause are based on extrapolation of data from other groups of people. And honestly, sometimes, just vibes.  

From what I can tell, the evidence that does exist in this age group is primarily concerned with maintaining muscle mass during weight loss, and increasing protein intake to induce fullness after a meal in an attempt to get you to eat less. In other words, it’s more concerned with the project of thinness than with supporting optimal wellbeing as we age. It’s also only looking predominantly at white cis-women, again leaving a huge gaping hole in our understanding of this life stage. 

Now, the paucity slash fatphobic nature of the evidence doesn’t mean that protein is something we should ignore, but I think it does make it difficult to ascertain what’s actually helpful. 

What we are pretty confident about is that as we age, we lose muscle mass and strength, a condition known as sarcopenia. We also lose bone mineral density and strength, a condition called osteoporosis. Both of these things are related to higher risk of falls and fractures, disability, loss of independence, reduced quality of life, and increased mortality. We don’t fully understand why this happens; it’s likely a combination of things including: less protein in the diet, reduced capacity for building muscle as we get older, low vitamin D intake, menopause, and lower physical activity (particularly resistance exercise). Post-menopausal people over 65 are most at risk and risk continues to increase as we age.

But, osteoporosis and sarcopenia aren’t acute onset diseases; they progress over decades. Early-midlife is considered an important time to establish supportive practices in hopes of preventing or delaying age-related musculoskeletal problems down the line. So there is some rationale for increasing our protein intake as we enter mid-life.

How much protein do we need each day though?