Why is eating well so damn hard? (It’s complicated!)

Let’s explore why standard nutrition advice like “eat less, move more” or “just be consistent” doesn’t work for neurodivergent (ND) individuals (nor really for anyone, truth be told!).

As a registered dietitian who counsels dozens of clients each month in my private practice, I understand that it good nutrition is not just about the food.

In fact, the actual food part of nutrition and eating is barely the tip of the iceberg.

What we choose to eat, how we prepare it, when we eat, how much we eat, who we eat with, and why we eat are influenced by complex cultural, psychological, physiological, family systems, genetic, socioeconomic, and neurobiological factors. It’s also highly influenced by our (highly variable) “capacity;” our energy levels and ability sustain a focus on selecting, preparing and eating nutritious meals (which you can see in the accompanying infographic is not a simple or discrete task!)

Food decisions are never *just* about nutrients or even simple hunger and fullness.

Yet social media and even many in the healthcare industry hand out useless and massively generic nutrition tips like Superman band-aids (cute, but largely ineffective).

So, when people come into my office they are feeling bad: like they are failing something that everyone else understands or that somehow our individual habits should look like everyone else’s.

I spend a lot of time on psycho-education and unraveling eating histories and food beliefs. Modeling self-compassion and trying to reduce the shame, guilt and confusion so many people have (especially women). My goal is to help individuals find ways to eat that work for them. Not for someone else.

I use this infographic a lot to highlight just how complex eating can be, especially for neurodivergent individuals. Because we could all benefit from a bit more self-compassion and a lot more enjoyment in our eating routines.

What do YOU find the most challenging about eating well?

Perimenopause for Neurodivergent Women…. How is it different?

In the early 2000s, the Women’s Health Initiative study and its well-publicized concerns around increased cancer risk for women using menopause hormone therapy (MHT) set treatment for menopausal symptoms back decades. (It’s a much longer and more biostatistically intricate story than I will provide here, but you can read about the WHI and its major study limitations in a variety of places, including the fantastically well-researched book “Estrogen Matters,” by Avrum Bluming MD and Carol Tavris Ph.D).

In brief, prior to the problematic WHI study results being released, 29% of menopausal aged women in the UK were using MHT. After the WHI results and the accompanying alarming press coverage, this figure decreased to between 10 and 11% of women in this same age group. Similar decreases were seen in the US and Canada as well. In short, healthcare providers and women alike were afraid to utilize what we now know as health-promoting (and in some cases, lifesaving) treatments.

Without access to MHT, women were forced to largely accept uncomfortable and sometimes debilitating perimenopause symptoms, silently suffering and feeling bad that they were unable to think, feel and perform as they once had. Newer research as well as additional analysis of the original data in recent years has demonstrated that MHT is largely safe, and can be highly protective against chronic disease, some forms of cognitive decline and bone loss. This review article succinctly recaps the issues and why the original data was not sound.

The most recent position statement from the North American Menopause Society (NAMS) now states:

“Hormone therapy remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause and has been shown to prevent bone loss and fracture.

The risks of hormone therapy differ depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used.

Treatment should be individualized using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of the benefits and risks of continuing therapy.

For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio is favorable for treatment of bothersome VMS (vasomotor symptoms, i.e. hot flashes) and prevention of bone loss.” (NAMS, 2022)

As a result of this newer guidance and the growing numbers of women entering the perimenopause years, women are increasingly speaking out -- loudly and widely -- about their symptoms and demanding appropriate hormone treatment.

Because so many women felt “gate-kept,” gaslit or otherwise kept at arm’s length from MHT, there has been a pretty significant groundswell in mainstream and social media, offering up opinions, resources, testimonials and calls to action for women in this age 45–55-year-old (generally) age group.

By 2030, the number of women aged between 45 to 55 will reach nearly 500 million, meaning that roughly 6 percent of the world’s population will be in menopause. (CDC)

In the past several years, dozens, if not hundreds, of books, podcasts, websites and even an Oprah television special have widely discussed the “menopause trend.” (We could now talk about how business is now trying to massively monetize (peri-)menopause, but frankly that will need to have its own separate lengthy post). Clearly, women in their 40s, 50s and 60s are not going quietly into middle age!

Overall, this attention and focus on understanding and treating perimenopause symptoms great for women. At the same time, it’s a flood of information that isn’t always accurate or immediately actionable for all women.

Who’s Still Missing from Much of the Research and Conversation?

While we know so much more about the menopausal transition now than we did 5, 10, 20 years ago, there’s absolutely more to learn to truly support ALL individuals who will undergo this phase, including non-binary individuals born female at birth, trans men, and neurodivergent women.

The rest of this article will focus on the latter group; neurodivergent (ND) women. Neurodivergence encompasses a variety of different neurological and cognitive differences, but for the purposes of this article I am using ND to refer specifically to autistic women, women with ADHD (attention deficit hyperactivity disorder) and women with both conditions (“AuDHD”).

To help you understand why these ND women may require additional resources, supports or treatments during the menopause transition, here are a few important points to consider:

  • Women are grossly under-diagnosed with autism and ADHD (see my upcoming post for history, reasons and data on this maddening and health-depleting situation).

  • Perimenopausal women with ADHD experience increased health risks as compared to their neurotypical (NT) peers, including an elevated risk of cardiovascular disease, increased brain deficits and memory challenges, and an increased risk of developing an eating disorder.

  • Individuals with ADHD tend to have lower levels of dopamine than NT individuals. Dopamine is a key neurotransmitter responsible for things like attention, memory, motivation, sleep, mood and emotional regulation. During perimenopause, dramatic decreases in estrogen levels lead to a corresponding drop in dopamine levels (up to 30%!), leaving ADHD women struggling (even more) to manage everyday life.

“It is understandable that when oestrogen is low or declining in an individual in whom important neurotransmitters such as dopamine are already low or dysregulated, these 'shortages' reinforce each other. Thus, women with ADHD may experience increased impairment in their mood, cognition, memory, sleep, and other domains of functioning.”

  • ADDitude Magazine surveyed 4,000 women with ADHD in 2022 about the impact of (peri)menopause. 70% of women said ADHD had a “life-altering” impact in their 40s and 50s, with 50% of women calling their ADHD “extremely severe”.

  • The National Autistic Society in the UK notes that autistic women may struggle with a number of issues during perimenopause and menopause, including intensified sensory sensitivities, difficulty with mood and emotional regulation, executive function challenges, difficulty with the lack of predictability around bodily or sensory experiences, difficulty recognizing internal body states or needs, difficulty recognizing and communicating emotions, and difficulty seeking support.

  • Women with ADHD and/or autism tend to have heightened reactions to hormonal changes. This may be one of the reasons many girls go undiagnosed until puberty, and why so many ND women struggle mightily with monthly PMS (pre-menstrual syndrome) or its wicked stepsister PMDD (pre-menstrual dysphoric disorder). Post-partum depression symptoms have been shown to be three times more prevalent (58% vs. 19%) in women with ADHD vs NT women.

    While we don’t have a lot of studies specific to women with ADHD in perimenopause, other studies that evaluated the hormonal effects of pregnancy or usage of contraceptive hormones in women with ADHD have shown a marked increase in mental health disorders at times of peak hormonal change. So it stands to reason that the menopause transition may also be much more challenging for ND women than NT.

    (Exciting update: A brand new review article was published this week from a group of researchers in Europe, which sheds some important light on the research gaps and challenges facing ADHD women at various points in the lifecycle. See article #5 below in the section on Sources & Resources).

  • A 2021 qualitative study found that mental illness and suicide risk peak at menopause for Autistic women.

  • Recent studies have begun to look at altered responses to typical menopause hormone therapy in neurodivergent women. Or, put in simpler terms, it’s entirely possible that ND women may require different MHT dosages, formulations or treatment strategies than NT women.

  • Cognitive changes often observed during the menopausal transition may also affect ND women differently, highlighting a potential need for updated medication strategies for ADHD, anxiety or depression as ND women age. Previously effective medications may no longer be as helpful, and individuals may require updated doses or new medications to help manage mental health symptoms.

The Big Picture

All of this is to say that neurodivergent women — who already struggle with executive function, memory issues, sensory challenges or mental health issues — are not just rolling into perimenopause on Easy Street. It’s really f-ing hard out there and most existing resources are not tailored to their needs.

And, most healthcare providers are not well-attuned to a) the menopause transition in general, b) how ND women’s learning styles and brains differ from those of NT women, and c) how ND women experience perimenopause and menopause differently; emotionally, physically and cognitively.

While I’m not a medical doctor, I am a healthcare provider and I see these women in my office EVERY. SINGLE. DAY. They are frustrated. They are confused about what is happening with their bodies and brains. They are either told to be REALLY SCARED of the body and health changes coming their way in the menopause transition (“omg your cholesterol! omg your blood sugar! omg your weight!”) or told “It’s no big deal” when it comes to symptoms and they should just tough it out.

They are also struggling to make diet and lifestyle changes, take prescribed medications and supplements, or figure out what their most pressing concerns are, because their brains are maxed out. And then they are shamed for not doing what they were told to do by the “experts.” (As if it’s all as simple as turning on a light switch). Grrrr.

My goal, in the coming months, is to build resources to support these women in a way that “meets them where they’re at.” To help them create and sustain changes to diet, exercise, sleep and lifestyle that can have real and lasting benefits on health, well-being and quality of life. Without making people feel like garbage. There’s enough of that in our lives already.

I’d love to hear from other women who relate to this topic about what’s hard for you, what might help, and just to commiserate. Message me!

*Important disclaimer: Not every can, should or needs to take menopause hormone therapy. Menopause transition symptoms can be highly variable and each woman’s genetics, health history, age, stage of life and lifestyle will factor in. Talk with your healthcare team about specific treatments for your individual needs.

Sources / Resources / Read More About This Topic:

  1. Stute P, Marsden J, Salih N, Cagnacci A. Reappraising 21 years of the WHI study: Putting the findings in context for clinical practice. Maturitas. 2023;174:8-13. doi:10.1016/j.maturitas.2023.04.271

  2. Gunter DJ. ADHD and Menopause: What We Know and What We’re Learning. The Vajenda. July 1, 2025.

  3. 3. Osborn C, PsyD MJ, Lin J, MS RJ. ADHD and aging. Understood. March 25, 2025. https://www.understood.org/en/podcasts/missunderstood/adhd-in-women-menopause

  4. 4. ADHD and hormones in women. https://www.drlouisenewson.co.uk/knowledge/adhd-and-hormones-in-women

  5. Kooij JJS, de Jong M, Agnew-Blais J, et al. Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Front Glob Women’s Health. 2025;6. doi:10.3389/fgwh.2025.1613628

  6. Moseley RL, Druce T, Turner-Cobb JM. 'When my autism broke': A qualitative study spotlighting autistic voices on menopause. Autism. 2020 Aug;24(6):1423-1437. doi: 10.1177/1362361319901184. Epub 2020 Jan 31. PMID: 32003226; PMCID: PMC7376624.

  7. Understanding ADHD in Women with Dr Jessica Agnew-Blais.; 2024. Accessed July 23, 2025.

  8. “Why ADHD Is Different for Women: Gender-Specific Symptoms & Treatments” ADDitude. October 22, 2020. https://www.additudemag.com/webinar/adhd-in-women-symptoms-treatment-support-podcast-337/

  9. Dorani F, Bijlenga D, Beekman ATF, Van Someren EJW, Kooij JJS. Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of Psychiatric Research. 2021;133:10-15. doi:10.1016/j.jpsychires.2020.12.005

  10. Craddock E. Being a Woman Is 100% Significant to My Experiences of Attention Deficit Hyperactivity Disorder and Autism: Exploring the Gendered Implications of an Adulthood Combined Autism and Attention Deficit Hyperactivity Disorder Diagnosis. Qual Health Res. 2024;34(14):1442-1455. doi:10.1177/10497323241253412

If Not Weight Loss, Then What?

If you read my last past, you know that weight gain during many phases of life is 100% normal for women. For example:

  • Girls gain on average 21-26 kg between the ages of 10-16 (CDC Data)

  • During pregnancy, the recommended/anticipated amount of weight gain varies, but is generally in the 9-15 kg range.

  • During the menopause transition, women will likely gain anywhere from 5-15 kg.

These aren’t failures of control, errors of genetics, or other massive rips in the space/time continuum. It’s biology. Plain and simple.

Yet we fight it (or are taught to fight it) every single step of the way. And it’s exhausting! (And, a bit like pushing the boulder up the hill: pretty endless and defeating).

What if we used all this energy, anxiety, worry, focus, dare I say OBSESSION, with shrinking, controlling, trying to avoid the inevitable that is biology and just, I don’t know, STOP?!

Heresy, right? Unheard of. Because if you’re not trying to change your body, what is the alternative? Do you even care? Have you “given up” or “let yourself go”? Are you going to immediately die of diabetes? HELL NO! But this is what society wants women to think.

So let’s consider what other things we could do with all this energy, time, money. Here are a few ideas. I’d love to hear what YOU decide to do next.

  • Move it! Take up weightlifting, masters swimming, hiphop dancing, open-water kayaking, surfing, or just hiking in the forest. Enjoying BEING in your body versus objectifying and shaming it.

  • Learn to cook foods you REALLY enjoy! Take a cooking class. Travel to another country and take a local food tour. Learn how to make pain au chocolat, baguettes or eclairs. Have FUN with food!

  • Do something creative! Learn to paint, draw, crochet, knit, macramé, sew, throw pottery, play a musical instrument or take voice lessons. Use your body and brain together in a way that lights you up!

  • Connect with others. Dieting, restricting food and constantly worrying about what we eat isolates us, makes our lives smaller. Go have coffee (and a pastry!) with a friend. Meet your partner for lunch on a work day. Throw a pizza party with your friends. Make a sundae bar for your kids. Enjoy the heck out of Taco Tuesday. Make plans and see people. I promise, you wont regret this (even us introverts need this!).

  • Travel, Explore, Learn. There is so much out there we miss when we’re so inwardly focused, self-monitoring and shaming ourselves. It can be easy to lose perspective and miss the wonder, beauty and energy the world has to offer. Getting out of your day to day and testing your own limits, going beyond your comfort zone - these will all give you more satisfaction and joy in the long-run than any diet can.

So what will you do with this one big beautiful life?

More About Menopause and Weight Gain (Let's normalize this shit!)

Let’s just get it all out there:

The majority of women (50-70%) will gain weight during perimenopause and menopause. Some research indicates that on average women gain approximately 1.5kg per year during the perimenopause transition, leading to an average weight gain of 10kg by the time menopause (12 months after the last menstrual period) is reached.*

There are many reasons that women tend to gain weight during this time of life, including:

  • hormonal shifts

  • metabolic changes

  • eductions in muscle mass 

  • changes in activity levels

  • stress and life changes (cortisol!)

Some of these changes we can "manage" and strategize around. But some are going to be (far) less in our control. Let’s normalize staying strong and healthy during this time, instead of just trying to stay thin or lose weight. Especially because thin does NOT equal healthy. 

More specifically, here are some reasons why weight loss and a drive toward thinness may NOT be healthy at this time of life:

  • Decreased bone mass —> increased risk for osteopenia/osteoporosis, falls, fractures

  • Excessive muscle loss —> increased risk of insulin resistance & type 2 diabetes, falls, lack of mobility

  • **Fat (in moderate amounts) is often considered cardio-protective. (Peri-)Menopausal women are at much higher risk of heart disease due to the loss of estrogen. Fat cells, especially those around the midsection, produce a (tiny) bit of estrogen, which can be protective.

  • Increased risk of developing an eating disorder. (These can occur at any time, in any gender, but are increasingly common in women in their 40s and 50s).

  • Diet cycling (frequently losing and regaining weight/constant dieting) itself can lead to increased inflammation; increased risk of insulin resistance, osteoporosis and muscle loss; decreased metabolic rate; and long-term weight gain. (In fact, the single biggest predictor of future weight gain is dieting!).

This doesn’t mean we need to just stop caring about our health or otherwise throw in the towel. It just means that weight loss isn’t necessarily the key to health, and may in fact be problematic.

My recommendations:

  • Focus on habits versus the number on the scale. Aim for your 5 servings of fruit and veg daily, get 2 liters of fluid and 7 hours of sleep each day/evening, eat plenty of protein (1.2-1.5 g/kg body weight) and whole grains, move your body regularly (at least 30 minutes a day), add in some weekly strength training and high intensity interval or sprint training. For extra credit: add in plyometrics and jumping for bone health!

  • Talk with your doctor and your dietitian for a customize healthcare and nutrition plan that fits your unique needs (one size definitely doesn’t fit all!).

  • While body “love” at this age of life can be a struggle, aim for acceptance. We cannot turn back the clock nor should we want to. Try to find ways to feel good versus just focusing on outward appearances. This is your time to shine!

Good stuff to read:

*The British Menopause Society

* Adverse Changes in Body Composition During the Menopausal Transition and Relation to Cardiovascular Risk: A Contemporary Review

**Feisty Menopause, “The Health Benefits of Healthy Body Fat”

Nutrition During a Pandemic: There's no right or wrong way

There’s a meme going around social media right now about “the quarantine 15,” and how everyone is gaining weight because we’re all confined at home due to the COVID-19 pandemic. On the surface, this seems kind of funny, and is analogous to the “freshman 15” that is often discussed when someone goes to university and lives away from home for the first time, gaining 15 pounds their freshmen year due to lots of parties, beer and pizza. But in reality, it’s all pretty shame-inducing. The implication is that we should feel bad about ourselves if our habits have changed or our body has changed. Which is something we don’t need any more of when it comes to nutrition and health.

I say this often, but it bears repeating: No one successfully changes their habits for the long-term based on shame and self-loathing. Long-term change comes from self-compassion, self-acceptance and a healthy dose of motivation and ability. But I digress….

During a situation like our world is facing currently, nothing in our life is “normal.” Our eating habits, work hours, sleeping patterns, exercise options and ability to get to the store to get food have ALL CHANGED DRAMATICALLY. And then there’s the stress of what we are facing in the world right now: A massive pandemic that has affected millions of lives and killed several hundred thousand people in just a few months.

We are not robots. We feel. We grieve. We fear for our jobs, our kids, our families, our own lives. So yes, things will change, and sometimes we will not stick to our healthy eating habits because we are stressed, we are tired, we can’t get fresh food. We may not exercise, because we can’t go outside, to the gym and we live in a tiny apartment with many others. Or we may just be so exhausted we can’t even contemplate it. Regardless of the situation, it is OK. It is OK not to be perfect right now. It is OK to eat less than healthy foods. It is OK if your body changes. You are human.

So please, scroll past those memes. You don’t need that in your life right now. Take care of yourself in whatever way you can. Take care of your family, check in on others and take some deep breaths. We will all get through this. And once we do, we can start to re-emerge and find our healthy equilibrium once again.

The Best Diet in the World

Now that I have your attention, let's talk diet!

But first, let's talk about what "diet" means. To many people, diet means a way to lose weight. In reality, "diet" simply means the kind of food a person habitually eats.  The latter is the definition I wish we'd all focus more on, and then we might not have to focus on the former. In fact, the focus on losing weight is actually making a lot of people even heavier (See below for a few links to studies on this). The ongoing cycle of weight loss and regain can also leave individuals prone to increased risk of high blood pressure, elevated cholesterol, metabolic syndrome or gallbladder disease. But of course, being overweight or obese also increases the risk for many of these same issues. So what's a health-conscious person to do?

1. Focus on overall health (see my previous post titled What is Good Health). A narrow focus on weight or BMI can be counter-productive to our overall health. Look at the bigger picture and take into account your habitual diet, exercise, sleep, stress, cardiovascular health, recent lab values, etc. If you're taking good care of all the aspects of your health and getting regular medical check-ups, your weight isn't as important. Really.

2. Find a way of eating that meets your goals AND your lifestyle. An overly restrictive diet plan that requires tons of meal prep, the purchase of hard to find or prepare foods, or isolates you from your friends and family is not one that you're likely to sustain for a lifetime. Think about what you can imagine eating for YEARS AND DECADES, not days or months. Also, consider your goals. Are you training for a marathon or just trying to find more energy to chase your kids around all day? Do you want to lose weight or are you trying to develop better blood sugar control? Each of these will require a different way of eating.

3. What way of eating actually makes you feel good? Everyone is different. Some people are "grazers" and prefer to eat 5-6 small meals per day, while others find that something like intermittent fasting works well for them (e.g. 16 hours of no food, an 8 hour eating "window" daily). Some people function really well on a very low carbohydrate diet, while others can't make it through the day without a regular influx of carbs. The point is, there is NO ONE SINGLE WAY OF EATING THAT WORKS FOR EVERYONE. (Did I sound like I was shouting? Yes, kind of). This is incredibly important. There is so much hype and so much crazy "diet evangelism" (e.g. the "I lost some weight, I published a book and my diet is the best.") in this world. It can get confusing and hard to decipher all the conflicting information. But you don't need to worry about everyone else. Pay attention to how *you* feel. YOU DO YOU!

4. What does your doctor or healthcare team recommend for you and your specific body, health status, age and lifestyle? Notice I said *your* doctor. Not your mom, your aunt, your co-worker, your friend's cousin's daughter's best friend, Dr. Oz...  If you have diabetes or insulin resistance, you should follow a specific plan that makes sense, is based in science and will meet your needs. Or, if you have GI issues or food allergies, work with your dietitian on identifying trigger issues and develop a plan to avoid those. Heart disease? Look towards a lower fat plan and talk with your team about what works best in this case. Don't go it alone and don't self-diagnose. Your health is yours alone, and it's precious.

So what is the best diet in the world? The one that works for YOU.

-DR

p.s. If you want a list of good dietary plans that are well-balanced and sustainable, check out this review from US News and World Reports, http://health.usnews.com/best-diet/best-diets-overall.

References:

https://www.ncbi.nlm.nih.gov/pubmed/21677272

http://onlinelibrary.wiley.com/doi/10.1111/obr.12255/full

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241770/

IMG_6353.JPG

Eat what you enjoy.

And enjoy what you eat.

What is Good Health?

The phrase "good health" or "healthy" are thrown around a lot in modern media and every day conversation. But what does this really mean? For (perhaps too) many, it's about being the "correct" weight or constantly striving to lose weight. For other people, "healthy" might mean lack of illness, which certainly sounds like a good thing. Or, healthy can mean that someone eats a very careful diet and buys only organic or non-GMO foods and never touches refined sugar. This sounds pretty good too. But is it a sign of good health? Not necessarily.

Let's unpack some of these concepts. Can health be boiled down to a single indicator like weight or BMI (body mass index)? Often, popular media and even medical professionals will focus on these metrics and then make recommendations based on the "need" to increase or decrease weight. Is this the right choice? Well, maybe. But not in isolation. Someone with a higher than normal BMI might also be very athletic and carrying a lot of muscle, so their weight and BMI aren't indicative of excessive fat mass or some of the health risks that go along with that. Someone with a very low weight or BMI may be suffering from a serious disease or malnutrition. One single number just doesn't tell us enough.

What about the person that eats "clean" (one of my least favorite terms)? Are they in great health? Maybe, and maybe not. Do we know what their blood sugar levels are? Is their cholesterol high? Do they have a family history of heart disease? Do they sit for hours and hours at a time or have very little physical activity?  Eating a diverse and balanced diet IS really important to good health, but food/diet alone also doesn't tell a particularly rich story.

Similarly, the person that exercises daily and takes a multivitamin and drinks 2 gallons of water each day sounds pretty healthy, right? And they might well be. But is their life filled with extreme stress? Are they hitting the fast food drive-through daily and not getting much sleep? That certainly isn't goin to lead to long-term good health.

The bottom line is that good health (and maintaining it) isn't a single number. It's not a diet plan. You can't outrun bad health or an over-stressed lifestyle. A true healthy lifestyle includes a focus on eating well, exercise and activity, stress reduction, regular medical care/assessments and proper sleep. Sometimes we'll have to sacrifice one or the other, because let's face it life gets crazy. But we should always remember that good health isn't defined or created by a single action or metric. It's integrative. It's cumulative. And it's important.