The Impact of a Low-Fat Plant-Based Diet on Postmenopausal Vasomotor Symptoms: Unveiling the Role of Gut Microbiome


Postmenopausal vasomotor symptoms, such as hot flashes, not only contribute to discomfort and a reduced quality of life for women but also serve as crucial indicators of potential health risks, including an increased susceptibility to cardiovascular disease and diabetes.

Recognizing the multifaceted nature of these symptoms, researchers have delved into various approaches to alleviate them, with a spotlight on nutrition as a significant modifying factor. Among the nutritional strategies explored, the Women’s Health Initiative stands out for its investigation into the efficacy of a low-fat diet rich in whole grains, fruits, and vegetables.

The study revealed promising results, indicating a 14% increase in the likelihood of women becoming free of hot flashes at one year, even after adjustments for changes in body weight. Furthermore, women who lost at least 10% of body weight or more experienced a remarkable 23% improvement in their vasomotor symptoms.

Plant-Based Diet and Gut Microbiome: A Nexus for Relief

One emerging area of interest lies in the positive impact of a plant-based diet on postmenopausal vasomotor symptoms, with a potential link to changes in gut microbiome composition. A plant-based diet, characterized by a higher intake of fruits, vegetables, and whole grains, has been associated with a range of health benefits.

Notably, individuals adhering to a plant-based diet are more likely to produce equol compared to omnivores. Equol, an estrogen receptor-β agonist, is thought to play a pivotal role in mitigating vasomotor symptoms, providing a potential avenue for dietary intervention.

The Equol Connection: Insights from Clinical Trials

A previously published 12-week randomized clinical trial sheds light on the remarkable efficacy of a low-fat plant-based diet, which included daily consumption of soybeans, in reducing the frequency of moderate-to-severe postmenopausal hot flashes. The results were staggering, with an 88% reduction in the frequency of such symptoms and 50% of participants experiencing complete relief from all moderate-to-severe hot flashes. This pivotal study not only underscored the potential of dietary interventions but also prompted a secondary analysis to explore the effects of the low-fat plant-based diet on the gut microbiome composition, particularly focusing on equol-producing gut bacteria.

Secondary Analysis: Unraveling the Gut Microbiome Puzzle

The secondary analysis aimed to unravel the intricate connection between a low-fat plant-based diet, gut microbiome composition, and their association with changes in postmenopausal vasomotor symptoms. Specifically, the focus was on the presence and abundance of equol-producing gut bacteria. Understanding the role of these bacteria is crucial as they are believed to mediate the positive effects of a plant-based diet on vasomotor symptoms.


Effectiveness of Dietary Intervention on Hot Flashes

The key finding of the study was a remarkable 95% reduction in total hot flashes, accompanied by a 96% decrease in moderate-to-severe hot flashes. Both daytime and nighttime hot flashes exhibited significant reductions of 96% and 94%, respectively. These results emphasize the potent impact of the low-fat vegan diet in alleviating postmenopausal vasomotor symptoms.

Gut Microbiome Changes in Response to Dietary Intervention

Species-Level Changes:

  • The intervention induced increases in Clostridium innocuum and Fusicatenibacter saccharivorans, while decreasing Clostridium asparagiforme, Bacteroides thetaiotaomicron, Intestinimonas butyriciproducens, and Prevotella corporis.
  • Notably, the decrease in Prevotella corporis, associated with severe day hot flashes, is a novel finding. Prevotella corporis, linked to rheumatoid arthritis and dental procedures, may play a role in inflammation and dental health.

Genus and Family-Level Changes:

  • Increases in Erysipelatoclostridium, Fusicatenibacter, and Holdemanella were observed at the genus level, along with increases in Enterobacteriaceae and Veillonellaceae at the family level.
  • These changes indicate potential links between the gut microbiome and vasomotor symptoms, suggesting that dietary interventions can influence gut bacteria associated with inflammation, neurological triggers, and metabolic health.

Equol-Producing Bacteria:

Associations Between Microbiome Changes and Hot Flashes

Clostridium asparagiforme:

  • The decrease in Clostridium asparagiforme was associated with reductions in total severe and severe night hot flashes. This is a positive finding given its role in producing trimethylamine-N-oxide, associated with cardiovascular disease and diabetes.

Fusicatenibacter, Holdemanella, and Erysipelatoclostridium:

  • Increases in Fusicatenibacter, Holdemanella, and Erysipelatoclostridium align with previous studies and suggest potential roles in stabilizing estrogen levels, reducing inflammation, and influencing the gut-brain axis.


  • A decrease in Intestinimonas may contribute to improved hot flashes, given its role in butyrate production. The decrease aligns with a reduction in advanced glycation end-products, potentially linking dietary fiber intake to symptom relief.

Veillonellaceae and Enterobacteriaceae:

  • The increase in Veillonellaceae aligns with fiber-rich diets, suggesting potential benefits for gut health. However, the conflicting increase in Enterobacteriaceae prompts further investigation, considering its association with both positive and negative health outcomes.

Streptococcus spp.:

  • The increase in Streptococcus spp. may contribute to gut health, acting as commensal species that defend against opportunistic pathogens and stimulate the immune system.

Limitations and Implications for Future Research

Despite the compelling findings, the study has limitations, including a small sample size, the absence of an equol-producing control group, and the need for cautious interpretation due to multiple comparisons. Larger randomized clinical trials are imperative to validate and expand upon these intriguing associations.

Conclusion: Bridging the Gap between Diet, Gut, and Relief

In conclusion, postmenopausal vasomotor symptoms represent more than mere discomfort, signaling potential risks to cardiovascular health and diabetes. The Women’s Health Initiative and subsequent clinical trials have spotlighted the promising impact of a low-fat plant-based diet, especially when enriched with soybeans, in alleviating these symptoms. The nexus between diet and gut microbiome, particularly the role of equol-producing bacteria, presents a fascinating avenue for future research. As we continue to unravel the intricate web connecting nutrition, gut health, and menopausal well-being, the potential for dietary interventions to offer relief and improve the quality of life for postmenopausal women becomes increasingly apparent.

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