Episode 26 - Nutrition to help you through Perimenopause & Menopause - Part 1 with Angie Clark

Nutrition to help you through Perimenopause & Menopause - Part 1 with Angie Clark

Do you experience hot flushes, night sweats, a rollercoaster of moods and changing periods? Join resident female athlete nutrition expert Angelique Clark as we dive into the roller coaster shit show that is Perimenopause.

How do you know if you are perimenopausal?

What are the symptoms of perimenopause?

What can you do to manage perimenopause?

And nutritionally, what sorts of things can we be doing to help us through this phase of life.

This episode is not just for the 40-50-year-old women out there. If you are a dude and have a special lady in your life, or are a younger female, equip yourself with some knowledge bombs now to help them or get ahead for yourself.

Links:

Connect with Angie: www.angeliqueclark.com.au

Connect with me here:

To learn more about the Triathlon Nutrition Academy, head to www.dietitianapproved.com/academy

To work with me 1 on 1: www.dietitianapproved.com/services

See behind the scenes action on Instagram: www.instagram.com/dietitian.approved

Follow along on Facebook: www.facebook.com/DietitianApproved

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Episode Transcription

Episode 26 - Nutrition to help you through Perimenopause & Menopause - Part 1 with Angie Clark

Taryn Richardson  00:00
Today on the podcast and welcoming back our very first repeat guest, my good friend Angie Clark. Angie is a fellow Advanced Sports Dietitian as well and she's our resident female athlete nutrition expert. Her passion is in understanding the difference in female physiology compared to our male counterparts. And she really has her finger on the pulse with the latest research which is just exploding at the moment.

Taryn Richardson  00:24
I've got her back on the podcast today to give us a bit of an update on where the research is at, at the moment when it comes to nutrition to manage symptoms of perimenopause and menopause. Now, this is not just for women over 50. The age bracket where perimenopause might potentially start is going to surprise you. Now we've split this episode into two parts. Part one, we're purely going to focus on perimenopause, and part two, we're going to deep dive into menopause so you can catch that one next week.

Taryn Richardson  00:56This episode is not just for female athletes. If you're a male listening, you could have a special lady in your life, whether it's a partner, a mother, a sister, a cousin, or even just a training buddy. You're going to hear about some of the things about what's going on in their body at this period of life and some of the things that could help them, so don't tune out if you're listening and you're a dude. Alright, let's do it.

Taryn Richardson  01:24
Welcome to the Triathlon Nutrition Academy podcast, the show designed to serve you up evidence-based sports nutrition advice from the experts. Hi, I'm your host Taryn, Accredited Practicing Dietitian, Advanced Sports Dietitian, and founder of Dietitian Approved. Listen as I break down the latest evidence to give you practical, easy to digest strategies to train hard, recover faster and perform at your best. You have so much potential, and I want to help you unlock that with the power of nutrition. Let's get into it.

Taryn Richardson  02:02
All right, welcome back to the podcast, Angie. I'm so excited to have the female athlete nutrition expert back on the podcast with me today talking all things perimenopause and menopause.

Angie Clark  02:13
Yeah, it's going to be an absolute pleasure. I think this is such a cool, cool little area where not a lot of women have sought to sink their teeth into, and I say that and I'm probably referring to the people that might not be actually quite there yet. Or of course, the ones that are actually in the thick of it, at the moment. We're going to have a good chat today, I'm so pleased we're talking about this topic.

Taryn Richardson  02:37
And even for the men that might have women in their lives that are perimenopausal and going through the crazy time that that is.

Angie Clark  02:43
And that is an absolutely great point. Yes, of course, the men, the support team.

Taryn Richardson  02:48
So let's dive straight in. Can we set the scene and just talk about what perimenopause actually is?

Angie Clark  02:54
Yeah, good start. So basically, we classify perimenopause as this time in a woman's life leading up to her final period. So it could possibly be around about the mid-40s. I'm going to go in to say women, I think are experiencing perimenopausal symptoms around 40 years old. So there's no real definitive age, but it's around about mid-40s that we kind of notice a few of these signs and symptoms coming that could be related to a decline in our female sex hormones.

Angie Clark  03:24
So these are oestrogen and progesterone. And it's just a naturally occurring aging process. As we go through our lives, we are generally going to experience between the age of 35 to 50, about a 35% reduction in oestrogen and a 75% reduction in progesterone over around about five to 10 years. So you can see that that's a massive, massive time frame for us to be in what we call this term 'perimenopausal' stage. So it's unfortunately not linear. There's no progressive way to kind of measure the process.

Angie Clarke  03:59
Everybody's different, all women will experience it quite differently. So I think the best, I guess, available reason to believe that we might be in this perimenopausal state would probably be as a result of a couple of clusters of reported symptoms that women experience. And, you know, as it relates to them and what they're doing, they're noticeably observing a few changes with a few other things from a physiology perspective, of course, but maybe also from cognition or a mental or mood perspective as well.

Angie Clarke  04:26
And then things are starting to change a little bit with their menstrual cycle that, these are the sort of tipping point warning signs where we go okay, well maybe we're in this perimenopausal state, on the way to you know, getting to the point where our hormones are going to flat line and we're not going to be able to produce babies as such anymore.

Taryn Richardson  04:43
So what are some of the symptoms people experience during perimenopause?

Angie Clark  04:47
Well, typically, the first and foremost one is probably the hot flushes so that temperature regulation is really impaired. We could be experiencing things such as night sweats, so a lot of my ladies that will come in and report, oh my goodness, like there is no time or reason when this happens. Like yes, overnight, sometimes I could be like ripping the covers off in the middle of winter, I'm sweating, I need the fan on, I need the aircon on. Or they could be sitting at work just generally going about their day and just be experiencing this whole onset of just an absolute rush of heat, where they kind of need to strip off.

Angie Clark  05:19
So we don't know, specifically. We can assume that it's probably as a result of the fluctuation of that lowering of oestrogen and progesterone, and relative to the decline. So, you know, I mentioned that over the ages of 35 to 50, we're on that slow, progressive decline. But what happens is if progesterone is dropping at a faster rate than oestrogen, then by default, you end up with this high estrogen state, even though it's declining, and that's what they believe the reason for these symptoms are occurring.

Angie Clark  05:51
So we don't know exactly, specifically for sure, but we just generally assume that that's probably related to that fluctuation or irregularity. Or if some people like to call it the roller coaster shit show about hormones and what they're doing, which is, you know, a reasonable explanation, I can totally vouch for that. So yeah, so obviously, in combination with things such as night sweats, and that sort of thing, your sleep is going to be disturbed.

Angie Clarke  06:14
We often find that as well, there's a lot of cognitive effects that happen. So we're looking at things such as brain fog, forgetfulness, like headaches, and migraines are coupled in that as well. And then of course, if we look at the mood associated behaviours related to that, we're looking at things such as anxiety, depression. Depression is huge, like when we have a really lowering or drop of oestrogen specifically, it really does affect our mood.

Angie Clark  06:17
And I think most women feel like they are irrational, they feel like they're crazy. Maybe their partners, or the people around them are going, you're just nuts, right. And some of us experience that in the PMS week, if we are eumenorrheic, obviously, this is talking about before we hit perimenopause. These sorts of things I want women to understand and know that don't dismiss them as just being nuts and just being crazy, or you're just being completely irrational. It definitely has a physiological component and something that we should be aware of that could be at play here from a physiology perspective. So yeah, mood swings, and irritability, we can sometimes blame on our hormones, Sometimes we can't, but that's just normal part of life as well.

Angie Clark  07:14
And then I think the other thing is that big sign is that change to your menstrual bleeding or your cycle. Really importantly, if you haven't tracked your cycle yet, I think that that is definitely something that you should be doing. Because then you can start to see if there is any change in what would be normal for you. So this might be either a shorter or a longer time between your period bleeds, and possibly even a heavier period bleed.

Angie Clark  07:34
So remember, like I'm saying there's that relative separation between oestrogen and progesterone. Even though they're declining, the ability of your body to be through that state might actually mean that you're going to bleed a little bit heavier, because you've got a lower progesterone and then a higher oestrogen might actually be symptomatic of actually then having a few more subjective reported symptoms around your period being particularly heavy, particularly painful, and bleeding a little bit more than what you probably would normally have bled.

Angie Clarke  08:03
So that is a really interesting point and something that I think women need to be starting to take a little bit more note of. So yeah, and then obviously, in cooperation with that is the prolonged bleeding time. So maybe you're bleeding for more days of the month than what you would normally as well.

Angie Clarke  08:17
And then you know, there's a couple of different things that we might want to make mention as well is that just, you know, things coupled in terms of vaginal dryness, painful intercourse, I know it's got, you know, not a lot to do with maybe exercise related but it's definitely something physiologically our body's are going through. And I get this a lot, is the increase in belly fat. So that increase in midsection belly weight gain around the midsection, in particular, women report that as they're going through this perimenopausal state.

Angie Clarke  08:43
And then just getting to the point where I think for you, Taryn, you'd probably be really accustomed to this where people when they start to turn 40, I get this a lot in clinic, that they kind of put their hand up and go, I want to run a marathon, I want to do a big endurance event, or I'll sign up to myself for an Ironman or something like that, that sort of celebrates their 40s. But underlying that I often ask the question as to why it is that they're doing these types of things. And they're doing it because they believe that their body is changing. And they need a reason possibly, or an excuse to exercise more because they feel like they're just putting on weight. So that becomes really interesting to explore.

Taryn Richardson  09:16
So, Angie, with all those symptoms, is there any way to definitively say whether you're in perimenopause or not? Or when that time point starts for somebody?

Angie Clark  09:25
Unfortunately, no. There's definitely a way to measure the definitive endpoint and that would be then termed menopause, but unfortunately, no. So perimenopause is this really interesting time, which I think is, once again, probably a little bit frustrating for women because, you know, you can go and get a full panel of bloods and look at your hormones. But at any one point in time that could be changing because of that fluctuation as we mentioned, that rollercoaster that's happening with the hormones. And there isn't a regular decline, it's not linear as we mentioned, so you can't really tell at any one time point exactly what your hormones should be reading at any one certain phase.

Angie Clark  10:01
That being said, though, I think it is actually really important that if you are just before perimenopause, so if you are in your sort of 30s at the moment, I think it's a really important thing to have a discussion with your female physician or your GP or your sports physician specialist, or Gynaecologist to get a panel or a blood work of where your hormones sit anyway. And that will fluctuate determined based on what stage of your menstrual cycle that you are in if you're a eumenorrheic female.

Angie Clark  10:28
So if you are having a normal menstrual cycle as it is now and what you would deem normal and getting a bleed every single month, it's really good info to have that data on you. You remember, like N equals one, so you are your own experiment. So when I said all these things are individual to women, we don't actually know how women are going to cope. Some women cruise through perimenopause, they just rocked up and they're like, yeah, my period just stopped, I'm in menopause now, happy days and others really, really struggle. And I think it's all dependent on the individual.

Angie Clark  10:56
So if you've got that data on what you are like prior to perimenopause, sitting in or going through that phase, and I think that's really good information to have to present to your GP if you start then experiencing these symptoms. And really, they just come from a series of questionnaires that your GP will go through with you to determine okay, yes, we believe that you're in perimenopause, but unfortunately, your hormones aren't low enough to be suggestive that you are in menopause, because you're still getting a period as well.

Angie Clark  11:22
So yeah, lots of data, lots of info. We can't know exactly for sure, we don't know when it's going to come, we don't know when it's going to stop. But there are some things we can do to mitigate this. I know it all seems like doom and gloom, but there's definitely some things that we can use nutritionally and exercise-wise to help us get through this period with a little bit more ease.

Taryn Richardson  11:40
So as that roller coaster shit show that you're talking about, if that's happening, then you know, maybe the question is, are you in perimenopause or not?

Angie Clark  11:48
Exactly right, yeah. And don't think you're just crazy. Like, don't be disheartened if it's been dismissed with, you know, maybe a practitioner or somebody that you had a discussion with. Whether that be your mate or training or something like that is definitely some things that you can bring up possibly with your Sports Dietitian, as well, because this time of your life might mean a few different other things. And remember, this is physiology, we're talking about things that are happening from a biological level, which is the inevitable effect of aging.

Angie Clark  12:12
You know, you've got to also remember your lifestyle factors. So you know, things such as stress could have a massive impact on your hormonal symptoms, and just how you respond to different things in life in general. So, you know, at this time of your life, you know, when you're about 40, so you're halfway through your life, right? We predict that average age of women is about 84.9, I believe in terms of years of life. So you know, you're really halfway through your life. And at this point in time, you're probably kicking goals in your career, you might have dependents in terms of children, they may be younger, or they may be older, depending on when you had your kids.

Angie Clark  12:44
You might have aging parents as well, or people around you, so you've got a lot of responsibilities from a social perspective, that could be impacting a lot on your stress levels. And that could also then be impacting on those symptoms that I just mentioned, as well. So could be a whole cluster of different things that you just need to be aware of that if you aren't functioning great and if you feel like you're not operating at your best, then maybe it's time to have a discussion with your GP first and then bring it up with your other professionals around you that can help support you through this time.

Taryn Richardson  13:14
You're right, women at that age have a lot going on

Angie Clark  13:17
Huge responsibility. And I think a lot of that stress comes from what we termed that 'Rushing Woman's Syndrome' is like you have to be doing everything all at once. You have to have multiple things juggling in the air all the time, and you actually don't. You are totally well within your rights to be able to say, hang on a minute, I don't need to do everything. And we can't, physically we cannot do everything.

Angie Clark  13:36
And then we put that into another basket of valuing our health and anyone that's listening to your podcast, Taryn obviously has an interest in their health. So they're the type of people that are going to be looking for ways to enhance their optimal functioning. So sometimes that could fall under the basket of I need to do more exercise. But without the consideration of nutrition to complement and support that at this time of their life compared to when they were younger. So please don't compare yourself back to what you could do when you're in your youth as well.

Taryn Richardson  14:05
So what nutritionally can women in this time, do to help with those symptoms and manage that for them?

Angie Clark  14:11
Well, funnily enough, it actually comes back to a lot of sports nutrition principles, particularly if I can talk to each one of those symptoms that we mentioned. And I'll start with the first one being maybe heat or temperature change. So of course, we know there's a huge effect when we exercise that we produce heat, right. So we sweat a lot more, we obviously need to cool our core body temperature and by doing so we take onboard more fluid. And that fluid could contain electrolytes, the more that we go out into bigger, longer duration sessions, the more that we sweat.

Angie Clark  14:38
So it's very imperative that we start to look at our hydration and look at some things that we could be improving amongst our hydration if particularly we're going to be experiencing more hot flushes, more elevation in core temperature, and maybe our thirst drives are a little bit affected as those hormones are playing a little bit of a havoc as well. So looking at things such as how often you're drinking water so plain water in general.

Angie Clark  14:59
What are the other dehydrating agents you have in your life, namely alcohol? So you know, possibly looking at that. Now we know caffeine is a dehydrator, specifically caffeine but obviously we understand that when we have coffee or caffeinated beverages with a lot of fluid that actually does contribute to your fluid intake or your hydration, however, I'd be considerate of the heat of those beverages. So something like a hot coffee might actually drive your hot flushes through the roof even further,

Taryn Richardson  15:27
So switch to an iced latte instead?

Angie Clark  15:30
Iced latte would be fantastic, iced long black, dash of milk. You know, whatever that may look like for you maybe having a little bit of a play with the temperature of those beverages. We know that you know, cooling beverages such as iced slushies and just water with ice in it is very effective on helping to cool that core temperature down as well.

Angie Clark  15:48
And, you know, Taryn, you can talk to this and the use of menthol, you know, we've got these sorts of little tricks that we keep in our back pocket when it comes to athletes and cooling them in really hot environment and conditions. Particularly if you're exercising outdoors, like you know, and you live in Queensland, and you're exercising in summer, like all these compounded issues might actually increase your hot flushes and your overall temperature as well.

Angie Clark  16:08
So I mean, they're very good tips, in general, for most athletes that are exercising a lot in the heat and outdoors. But they also relate back to the average woman who's just, you know, maybe a general weekend warrior, an average, you know, punter, when it comes to wanting to be healthy and fit and active, you know, these sorts of principles can actually really apply.

Angie Clark  16:27
And I think sometimes the use of electrolytes, often women are a little bit apprehensive about that, they don't know how to use them, they don't know where it fits into helping their hydration, but using that could definitely improve their hydration as well. Particularly, like I said, if you've had a really rough night of night sweats, and you've really found that you are quite wet, when it comes to like getting up your sheets are wet, your clothes are wet, you know, you need a little bit more fluid on board, obviously, if you're going to be losing a little bit more of that fluid as well.

Angie Clark  16:54
So yeah, just practical tips about you know, getting you into a cooler environments, if you are more comfortable to be training in air conditioned spaces or in the shade or picking the time of day that you are training is really important if you are experiencing a high level of those hot flushes.

Angie Clark  17:07
And yeah, cold showers, you know, that's another really great recovery technique for women, I think, especially post training. We often vasodilate, so we get a lot more of that blood flow to the surface of our skin, we can try and help that with a cold shower, ice bath. I don't know how much really, you're going to be able to go through with the temperature of that or what's likely available for you. But definitely a cold shower after training, if you're particularly struggling, will help with that respect as well. So yeah, a lot of stuff to do with hydration.

Taryn Richardson  17:35
Or throw a couple of ice bags in your bath and jump in there for 10 minutes. That'll do.

Angie Clark  17:40
100% yeah, and pick your clothing well. I think even something as simple as not wearing like a black singlet out when you're running or something like that might actually really be helpful. So wearing loose clothing or maybe having layers on where you can actually take it off if you need to, that you don't feel like you're this social recluse right? Because you're just like, oh my god, I'm profusely sweating and nobody else is sweating in front of me.

Angie Clarke  18:01
So yeah, just little things like that, that I think are little practical tips that could actually help you mitigate or help you cope through any sort of temperature changes as well. And you know, sipping that water is really imperative over the course of the day as well and combining that with your food will help the absorption of that as well. Food has a natural element of sodium in it. So yeah, definitely some things that I think we can help to improve number one overall hydration, but also effectively to combat the rise in that temperature that might be uncomfortable for women.

Taryn Richardson  18:28
Hot flushes is definitely the primary thing that people complain about that I find. So it's really great to have some really practical strategies there for people to manage that. I did do an episode on some strategies nutritionally to manage exercising in a heat. Which would apply to perimenopausal women, we talked about, you know, hydration, a bit of acute sodium loading, which you would do in a racing situation, not necessarily on a day-to-day basis. Menthols in there, glycerol is in there, so maybe go back and have a listen to that one if that's an area that you need some extra help with. I deep dive into those strategies for you.

Angie Clark  18:30
100%, yeah. And in relation to like maybe talking outside of hydration then because I know you've covered that and you would have covered that in your previous podcast, but foods that affect or have a slight oestrogenic effect are really important to consider. And these are things such as soy-based foods. And so I'm talking about something like edamame, the whole soy bean, tofu, tempeh, these types of foods elicit a weak estrogenic effect. So when that estrogen is starting to lower in these types of phases of our life, it could actually be beneficial to be providing you with an element of alleviation when it comes to these hot flushes.

Angie Clark  19:38
And in combination with that, there are certain proponents that are found in flaxseed called lignans. And these also have been seen in the research to reduce hot flushes. And if you think about most of the studies that have been done using particularly soy-based containing foods in Asian types of cultures, they often report lower hot flushes at this time of their life in terms of the women that's in that culture.

Angie Clark  20:01
So very interesting if we can increase a little bit of those soy based or plant-based proteins, which would be fantastic at increasing once again, our fibre intake as well, which also helps to clear excess estrogen. So remember, like I said, even though it's on the decline, there's this point in time where it could be relatively higher compared to the progesterone drop. And if we can help that through our food, these are really awesome things that we could be looking at nutritionally from our diet.

Taryn Richardson  20:28
Yeah, awesome, and real food-based strategies there as well. It's not about taking a supplement, or going to get hormonal replacement therapy or anything like that. There's some real food options that you could go to first and see if that helps alleviate your symptoms.

Angie Clark  20:42
Definitely. And we have to remember as well, at this time, there's a lot of pain and inflammation that's associated with the lowering of sex hormones. So often women will report that they do feel inflamed, they do feel like they're carrying a little bit more fluid, which is interesting, because we're losing a lot of fluid if we're having these sort of hot flushes.

Angie Clark  20:59
So there's a whole lot of things that's going on and in line with keeping it you know, food first approach. Possibly things like boosting up your unsaturated fatty acids, in particular, your omega-3 fatty acids, I always say help with brain and pain. So these are the two things once again, in terms of cognition, that could be really imperative to be helping you through this phase and to be reducing the inflammatory state that your body's going through, as we're hitting this sort of roller coaster.

Angie Clark  21:25
So omega-3s where do we find that? Oily fish, so fatty fish, there's some plant-based sources of omega-3s, which funnily enough, are those flaxseeds that we just mentioned, that has those lignans in them, chia seeds, walnuts are wonderful, you know, any type of fish related food. So yes, salmon is definitely in there. But I have to say as well, there's some really awesome fortified products that are coming out now. I think John West has a tuna that has calcium fortification in it. Which could also then be a double whammy effect, when we're looking at a couple of that lowering of estrogen, the importance of calcium intake goes up. But pairing that with an omega-3 source is a wonderful thing to be doing.

Angie Clark  22:03
So you know, these types of things are available in our supermarket. They are available for us to be accessing and to be boosting that omega-3 content is really imperative. If you can't get it from your food, I would possibly then consider the supplementation of that and looking at a high quality fish oil supplement, if you're not sort of getting it from a dietary perspective.

Angie Clark  22:22
But it's something to consider with your Sports Dietitian and assess your nutrition overall to be okay, well, do we need supplementation? Or can we get most of this from our food. And in that case, well, then we might not need as much supplementation in that instance, as well. So that could be really interesting to sort of focus on as well.

Taryn Richardson  22:37
Somebody that doesn't eat fish, for instance, might need a supplement. But generally, if you're eating fish, it's just about getting some more into your diet and having that really good quality, like you said, of omega-3s from our deep-sea fatty fish like salmon and tuna, herring and mackerel, which are all quite available these days, particularly in a can.

Angie Clark  22:54
Yeah, definitely. That's exactly right. The availability I think is fantastic and we often you know, it makes our job easier when we're looking at prescribing food for these types of nutrients, for sure.

Angie Clark 23:05
And then I think the other thing to also mention is those high antioxidants foods, so the colourful fruit and veg, the deep red skinned fruit and veg are really important when it comes to providing those antioxidants to help combat that inflammation and in particular, also the cruciferous veggies. So once again, that has the ability to bind to any excess oestrogen and reduce that as your body's going through that slow decline as well.

Angie Clark  23:29
So we're talking things such as broccoli, Brussel sprouts, cabbage, cauliflower, kale, you know, those phytochemicals can definitely help with the whole overall process, and also look at reducing breast cancer risk. So this is where this proportional increase in estrogen becomes a little bit problematic and increasing our risk of breast cancer. So you know, having these beautiful foods within our diet is really nice to know that we are reducing our risk of these types of possible diseases that might come as a result of being in this phase of our life and possibly having a little bit of too much estrogen as well.

Angie Clark  23:59
Tart cherry, tart cherry concentrate, I know this is a supplement, but it does come from a fruit. So the Montmorency tart cherry is another really good one that I found with women, particularly they are struggling with sleep at night time and temperature is 30ml in 100mls of water just prior to bed. And that will help hopefully increase what we know of it to increase melatonin, which will help our sleep a little bit more and also to help with that temperature regulation.

Angie Clark  24:27
Because of course, if we're overheating at night time, we're not going to fall into that deep REM sleep and it's not going to be comfortable enough for us to go through to that beautiful sleep pattern. So yeah, maybe thinking about something such as a tart cherry concentrate just before bed might actually help with that as well.

Taryn Richardson  24:42
Great, Angie, thank you that's some really good practical, wholefood strategies that people going through perimenopause may be able to try and change and implement into their diet to see if they get any of that symptom resolution.

Angie Clark  24:55
Absolutely.

Taryn Richardson  24:56
Okay. We're going to hit pause in this conversation today, to wrap up some great advice and tips from Angie, for what you can do to manage the roller coaster ride that's perimenopause. Next week in part two, we're going to dive into nutrition to support women through menopause. So I'll see you next week.

Taryn Richardson  25:16
Thanks for joining me for this episode of the Triathlon Nutrition Academy podcast. I would love to hear from you. If you have any questions or want to share with me what you've learned. Email me at [email protected]. You could also spread the word by leaving me a review and taking a screenshot of you listening to the show. Don't forget to tag me on social media at @dietitian.approved so I can give you a shout out too. If you want to learn more about what we do, head to dietitianapproved.com. And if you want to learn more about the Triathlon Nutrition Academy program, head to dietitianapproved.com/academy. Thanks for joining me and I look forward to helping you smash it in the fourth leg - nutrition!