My Personal Story

I changed to a vegan diet around eight years ago, mainly for environmental reasons. Quite quickly, though, I realised it suited me well — I wasn’t as hungry as before and I lost some weight without trying.

I went through a relatively early menopause at about 48. I had a few symptoms, but nothing too bothersome, so I decided not to start HRT at the time.

A few years later, I had routine blood tests with my GP and was shocked to be told I had type 2 diabetes, high cholesterol, and extremely high triglycerides. My GP suggested starting statins and diabetes medication, but I wasn’t comfortable with that straight away and asked for a few months to try to improve things myself.

To be clear, my diet is already very low in processed food. I rely mostly on beans and legumes for protein and eat  large amounts of fibre. I do enjoy alcohol most weekends, but otherwise my diet felt “healthy.” Since the initial diagnosis, I’ve cut out pasta, rice, and white potatoes, though I still eat bread and sweet potatoes.

These changes did help — my blood sugars have improved and I’m now classified as prediabetic rather than diabetic. However, despite all of this, my LDL cholesterol, ApoB, and triglycerides remain high.

What I didn’t realise was that menopause doesn’t just change hormones — it changes metabolism.

Oestrogen Loss Is a Metabolic Shift

Oestrogen plays a critical role in how women regulate fat, glucose, and inflammation. When oestrogen levels fall during menopause, the risk of metabolic syndrome rises — including insulin resistance, higher triglycerides, fatty liver, and increased abdominal fat.

But there’s a lesser-known piece of this puzzle that many women (and clinicians) are never told about: choline.

Choline, the PEMT Gene, and Menopause

Choline is an essential nutrient needed for:

• Liver fat export

• Insulin sensitivity

• Brain and nervous system function

Before menopause, women are partially protected because oestrogen helps activate the PEMT gene, which allows the body to make some of its own choline.

After menopause, that protection largely disappears.

For many women, especially those with certain PEMT gene variants, this means:

• Reduced internal choline production

• Higher dietary choline requirements

• Increased risk of fatty liver and metabolic dysfunction — even without weight gain or dietary changes

This is where genetics becomes important. When I had my genetic profile tested I found out that my PEMT gene variant made making choline endogenously  ineffectual and I need to rely on external choline sources. Being vegan this was definitely not happening. 

Why Diet Alone Isn’t Always Enough

Choline intake varies widely by diet. The richest sources are eggs, fish, and meat. Plant-based and vegan diets often provide significantly less choline, even when otherwise nutrient-dense. You can get choline from soy beans (tofu), sunflower seeds, shitake mushrooms, wholegrains , nuts and seeds and cruciferous vegetables.

For premenopausal women, oestrogen may compensate. For postmenopausal women — especially those with PEMT variants — it often doesn’t.

This can create a perfect storm:

• Oestrogen deficiency

• Low endogenous choline production

• Inadequate dietary choline

• Rising metabolic risk

And yet, many women are told to simply “eat less and move more.”

The Role of Genetic Testing

Genetic testing can help explain why two women following similar diets and lifestyles have very different metabolic outcomes.

Testing for genes like PEMT can identify:

• Higher choline requirements

• Increased risk of fatty liver and insulin resistance

• Why standard nutrition advice may not work

This isn’t about labelling or fear — it’s about personalisation.

When patients understand their genetic predispositions, nutrition and lifestyle strategies can be targeted rather than trial-and-error.

A Reframe for Midlife Women

Learning about the interaction between menopause, choline, and genetics was a turning point for me. It shifted the story from self-blame to self-understanding.

Menopause is not a failure of discipline.
It is a biological transition with real metabolic consequences.

Genetic testing doesn’t replace good nutrition — it helps refine it. And for many midlife women, that insight can be the difference between frustration and finally feeling supported by their healthcare plan.