A second study evaluated the effect that Black Cohosh, Red Clover and Prempro has on a woman’s cognitive abilities. Again, “none of the botanicals had either a beneficial or a detrimental effect on memory.”  However, “the specific hormone therapy used in the trial, Prempro, had a slight negative impact on memory.”

So, the researchers at the University of Illinois at Chicago concluded that “only hormone therapy had a beneficial effect on vasomotor symptoms, but this benefit was at a cost of a slight decrease in memory.”

You can listen to an explanation of the study’s findings here.

I was surprised to read Dr. Andrew Weil’s comments about the fallacies of taking some natural remedies to alleviate menopausal symptoms in his “Dr. Debunker” column in the latest issue of AARP Magazine. After all, isn’t he known as a leading proponent of natural medicine?

In short, he says there’s little scientific evidence to support claims that common menopausal complaints, such as hot flashes, insomnia and low libido, can be helped by most herbal products. He also states that women should avoid all products that contain isolated soy isoflavones, such as red clover. Here is a list of other natural remedies that Dr. Weil says won’t do much to alleviate menopausal symptoms:

• Wild Yam
• Ginseng
• Licorice
• Gotu Kola
• Saint Johns Wort
• High does of Vitamin E

What does he recommend? Black cohosh, ground flaxseed (see my earlier blogpost about Flax), a healthful diet that includes plenty of fruits, vegetables and omega-3 fatty acids and regular physical activity and stress-reducing practices.

A good place to begin your research on the efficacy of any complementary or alternative medicine or therapy is rVita, a free website that evaluates claims based on available clinical data and users’ experiences.

I guess if ED can be talked about in TV ads, so can menopause. The company that makes Estroven, a natural OTC supplement that claims to alleviate menopausal symptoms, will soon launch a $20 million TV, print and online advertising campaign beckoning us to visit Menopauseland. They describe it as a “cool and calming destination… lush instead of flushed,”  presumably where you can enjoy life symptom free - if you take Estroven, that is.

Estroven contains all natural products — soy, vitamin D and black cohosh.  It competes with another natural product, Remifemin, which contains only black cohosh. Both are worth trying if you are experiencing hot flashes and are reluctant to take hormones. 

It’s not often that we see natural and botanical remedies being advertised nationally simply because manufacturers of “alternative medicine” products don’t have the marketing dollars that companies like Wyeth have to promote their synthetic products such as Premarin.  The result is that many women are not aware of – or comfortable with – natural solutions for their menopausal symptoms. Hopefully the makers of Estroven will also target medical professionals with an education campaign so our physicians no longer refer to natural products as “that stuff.”

By the way, if you find menopause funny in any way, you can contribute a story or joke to their website.

If you are experiencing menopausal symptoms typically associated with estrogen deficiency, such as hot flashes, mood swings, and food cravings, you may want to try increasing the amount of plant-based hormones – or phytoestrogens - in your diet.  Phytoestrogens are chemicals that are found in plants that may act like the estrogen produced naturally in the body.  Consider adding these foods to your weekly visit to the farmers market or grocery store.

1. Soy milk, tofu, edamame beans

2. Fermented soy foods such as miso and soy

3. Flaxseeds and sesame seeds

4. Wholegrains – such as oat bran, whole wheat and oatmeal

5. Peppers

6. Red grape juice and cranberries

7. Cranberries or red grape juice

8. Green beans, chickpeas, kidney beans

9. Broccoli

10. Celery

There are several herbs and plant roots, including dong quai, black cohosh, ginseng and red clover, that have also been reported as effective in menopause, but you should have the advice of an herbalist or naturopathic doctor before you add this to your diet.

Last weekend, while shopping at Costco, I purchased a 40-oz container of organic, cold-milled, quadruple-cleaned, ground, golden flax seed with 2700 mg of Omega 3 and 800 mg of Omega-6 per serving of two tablespoons. Was this typical of all flax seed brands? Or, had I stumbled upon a super, high-quality processor?  I purchased it and called the manufacturer’s toll-free number to find out.

I had expected to reach a call center in India, but much to my surprise, I reached Stephanie Stober at her family’s farm in North Dakota, where most of this country’s Flax crop is grown. The Stober farm has been in their family for five generations and growing consumer awareness of Flax as a “super” food has propelled their business, Flax USA, over the last few years.  In addition to Costco, the  Stober’s Flax product can be purchased at some Sam’s Club, SuperValu in the Midwest, as well as in select pharmacies throughout the country.

Stephanie explained to me how high quality Flax should be harvested and processed and why it is such a healthful food.  Our follow-up email exchange follows:

Wendy:  Why is Flax so important to our diets and beneficial for menopausal women in particular?

Stephanie: Flax is one of those super foods that offer multiple health benefits. We’re even starting to see interest in adding Flax to pet food!  The Flax plant is one of the richest sources of Omega 3 fatty acids, which the FDA states is beneficial in reducing coronary heart disease. It also has a high concentration of alpha linoleic acid (ALA), fiber, lignans and other minerals.  I’ve read that it also can help reduce cholesterol and control blood glucose levels.   We use Golden Flax seed in our Real Cold Milled Flax that you purchased at  Costco. It has high levels of Omega 3 oil, 10 grams of protein and 11 grams of Fiber per 1/4 cup serving.

What makes Flax particularly beneficial for menopausal women are the lignans that are found in the outer shell of the Flax seed. They contain a phytoestrogen, which may be helpful in reducing reducing symptoms of menopause, such as hot flashes. They may also help with PMS.  (Women who have or have had breast cancer should check with their doctors before adding Flax to their diets).

It takes about 24 pounds of Flax seed to make 5.3 oz of lignans. So, when you consume our Real Cold Milled Flax Seed, you’ll automatically get the benefits of lignans. We also offer a pure Lignan Flax Hull product on our website.

Wendy:  I’ve seen different types of Flax in the store: brown and golden; liquid and seed; and whole and ground. Does it matter how Flax is ingested? What do you recommend?

Stephanie: Keep in mind that all Flax seed is not created equal. There are two types; brown and golden. Both are about the same nutritionally, but we use the golden variety for the food market and brown for animal products.  Brown Flax has a slightly different taste – it’s not as nutty tasting as our Omega golden seed.

There is also Flax oil and capsules. If you want the BEST, I recommend sticking with the whole food! If you take Flax oil, you are cheating yourself of all the benefits Flax offers your body. The oil is extracted from the seed, but crushing it leaves behind the precious fiber and lignans. By taking the Flax seed in whole seed form (grind it first) or by consuming our Real Cold Milled Flax, you’ll get all the benefits of Flax. As for capsules, I’ve been told that it takes 53 of them to equal just one tablespoon of Flax seed.

If you do buy whole Flax seed, be sure to grind it or it won’t do you any good unless you chew it about 100 times!  Keep in mind that one tablespoon of Flax seed is equal to two tablespoons of our Real Cold Milled Flax. So be sure to take it with a lot of water as Flax is very fiberous.  I personally like to add a little unsweetened cranberry juice. You can use fresh cranberries and the Fat Flush Cocktail that’s posted on my website.

Wendy: What makes one brand of Flax Seed better than another?

Stephanie: At Flax USA, we start with a quality seed, clean it thoroughly using a four-step process for the whole seed.  If you grind whole Flax seed at home, or even if you buy it at health food stores, the grinder will heat up the oil of the seed somewhat, so you only want to grind enough for the day or, at most, for the week, and it must be refrigerated.  That isn’t the case with our product: we use a special grinder process that doesn’t crush or liberate the seed, which could damage the precious oils. It enters and exists the mill at the same temperature of the room so the oil does NOT heat up or turn rancid. That’s why our Real Cold Milled Flax is one of the best out there with a 22 month shelf life, unrefrigerated.

Note: There are testimonials on Stephanie’s website from women who say that Flax has helped them with hot flashes, and reduced cholesterol levels, among other benefits. Let us know if Flax has helped you by leaving a comment here.  Stephanie will gladly answer any questions about Flax that you post.

 

Vitamin D is one of 13 vitamins our bodies need to function properly, according to the American Dietetic Association. It’s a fat-soluble vitamin that promotes the absorption of calcium and phosphorus and helps deposit these minerals in bones and teeth to make them strong. It’s so important to our well-being that a group of prominent scientists have formed The Vitamin D Council, a non-profit organization with a mission to educate the public and professionals about Vitamin D deficiency and its numerous associated diseases (such as heart disease, stroke, osteoporosis, depression).

It’s known as the “sunshine” vitamin because our bodies can only produce it with enough sun exposure – a couple of hours a week is often sufficient.  Foods such as cheese, eggs, fortified milk, breakfast cereals and some fish (such as salmon and sardines) are also good sources for this important nutrient.  If you’re between 51 and 70, the FDA recommends 400 IU daily (and 600 IU thereafter). However, some physicians (including mine) don’t think that’s enough.  As reported in the American Journal of Clinicial Nutrition, physicians at the Boston University School of Medicine recommend that in the absence of exposure to sunlight, a minimum of 1000 IU of Vitamin D is required to maintain healthy concentrations in the blood.

Vitamin D supplementation is beneficial throughout our lives, but it is particularly important for women in mid-life. Why? Because it…

• aids in the absorption of calcium, which helps prevent osteoporosis

• is a critical factor in bone health

• enhances muscle power

• promotes normal cell growth throughout the body- a key factor in maintaining hormonal balance and a healthy immune system

• may protect against some cancers

• helps women fight fat in menopausal years (when combined with calcium)

There has been a lot of research and discussion about the benefits of Vitamin D (search Google for “vitamin D and menopause,” and you’ll see 423,000 articles on this topic), and I have been asked by more than one doctor if I’m taking enough of it.  It does seem to be the new “it” vitamin: remember how we were inundated with data about Vitamins A (for skin), B (for energy), and C (for colds) – we’re clearly teed up for a barrage of information about the merits of D and we’ll be seeing more and more foods in the grocery store that are fortified with it.

P.S.   For more information about the importance of Vitamin D in our diets, be sure to read Jane Brody’s “Personal Health” column of 2/19/08, “An Oldie Vies for Nutrient of the Decade.”

I mentioned several weeks ago that I had begun a daily regimen of Black Cohosh, Flax Seed and Fish Oil.  I’m happy to report that the hot flashes that I had been experiencing for more than a year have completely stopped.  Based on everything I’ve read, I  attributed this to the Black Cohosh, while the Flax Seeds have undoubtedly benefited me in other ways.  But a new study suggests that it could have been the flax seed after all. 

Granted, the study, reported in the Journal of the Society for Integrative Oncology, was small - 21 women participated – but the results were promising. Each participant ate four tablespoons of crushed flaxseed daily for six weeks (double what I am presently taking). Half of them had a drop in hot-flash frequency and the study concluded that “this reduction is greater than what would be expected with a placebo.”

Even if Flax Seed does not eliminate hot flashes, the plant, which contains Omega 3s, Lignans and Fiber, certainly has other benefits that make it worth taking including; 

• Lowering cholesterol

• Stabilizing blood sugar

• Reducing certain inflammations

In fact, it’s being called a new wonder food that may help fight a number of diseases from breast cancer to diabetes and heart disease.

Since our bodies can’t breakdown whole flaxseed, purchase it already ground (I found organic ground flaxseed at Whole Foods) and stir them in yogurt or smoothies. If you like to bake, you can also add ground flaxseed to muffins and breads.  You’ll find lots of recipes using Flax as an ingredient in Elaine MaGee’s “The Flax Cookbook” and in “The Amazing Flax Cookbook” by Jane Reinhardt.

Botanical Medicines, specifically uterine tonics, contain phytoestrogens that improve blood flow to the female organs.  Some common and very helpful herbs that have been used with great success include:

1. Angelica sinensis (dong quai) – used to treat hot flashes mainly
2. Cimicifuga racemosa (black cohosh) the most widely used and thoroughly studied natural alternative to HRT- for improving hot flashes, depression, and vaginal atrophy. 
3. Vitex agnus-castus (chasteberry) has a profound effect on pituitary function, specifically altering LH and FSH secretion, and likely the cause of its beneficial effects on menopausal symptoms
4. Valerian root, a calming relaxing sedative works wonders when combined with Black Cohosh for women who are up all night with flashes. 
5. Glycyrrhiza glabra (licorice root) restores hormonal balance by adjusting estrogen-progesterone levels.
6. Ginkgo biloba extract improves blood flow throughout the vascular system, making it helpful for cold hands and feet, and forgetfulness that accompanies menopause.  

It is important to look for a qualified practitioner when developing a treatment plan for menopause.  Drug-Herbal interactions are extremely important in the treatment of all cases, not just for menopause.  Herbal products and supplementation must come from a quality source which passes pharmaceutical standards.  Quality products are third party tested, and are free of heavy metals, dioxins, and PCBs.

You’ll find good information about these and other botanical medicines at The National Center for Complementary and Alternative Medicine website (At the Nat’l Institute of Health).

Shaila Schwartz, a naturopathic doctor in San Francisco recommends ways you can minimize these common effects of menopause: 

For insomnia and other sleep disturbances: don’t let this get out of control!  The longer or more frequent the insomnia, the more it leads to poor coping skills, fatigue, and depression.  Various things can alter brain chemistry and sleep patterns including sleep apnea, chronic pain, thyroid conditions, restless leg syndrome and asthma.  Look for the cause and establish good sleeping routines such as : hot baths and herbal teas before bedtime, as well as reading and breathing exercises for relaxation and calmness.

For hot flashes/night sweats: balance stress, avoid hot drinks and hot and spicy foods, remain cool (avoid high temperatures), and decrease, or avoid alcohol and caffeine.  Most importantly maintain hormone balance as much as possible through the use of nutrition and clinical supplementation, herbal medicine, and homeopathy.

To prevent osteoporosis and improve cardiovascular health: to prevent and treat bone loss, maintain sufficient intake of: calcium, vitamin D, essential fatty acids, and dark leafy green vegetables.  Weight bearing exercises are also important in building bone mass and strength.  To maintain good cardiovascular health: increase your intake of fiber, fruits and vegetables.  Avoid diets high in cholesterol and saturated fats.  Supplements and herbs can be used to maintain healthy, protective cholesterol levels.

Forgetfulness and inability to concentrate: These symptoms are often due to decreased oxygen and nutrient supply to the brain, not caused by menopause, but by atherosclerosis (hardening of the arteries).  Regular exercise, a diet low in saturated and trans fats/alcohol/sugars/refined foods, and botanical medicines (ie. Ginkgo biloba) will significantly enhance the supply of oxygen and nutrients to the brain.

For bladder infections: drink large amounts of fluids, minimize consumption of sugars and refined foods.

Feeling daunted by the huge number of products to choose from and well-aware that not all botanicals would be right for me, I consulted Shaila Schwartz, a naturopathic doctor at the Noe Clinic in San Francisco, to develop a customized plan for me. As a result of our work together, I have seen a huge improvement in the way I feel.  So, I asked her to share some of her wisdom in treating the effects of menopause on this blog.  Here is the first part of my interview with her.  I’ll post more of her advice later this week. She welcomes your comments and questions. 

First, define naturopathic medicine.  What is different about how you practice medicine?

Naturopathic Doctors (ND’s) are primary care providers who integrate standard medical diagnosis with a broad range of natural therapies.  We treat by addressing the mental, emotional, and physical aspects of an individual while looking for the “root” cause of illness to obtain optimal health for each person.  Individualized treatment plans are implemented to address the “whole person”, rather than simply suppressing symptoms.
 
How can a Naturopathic Doctor help women who are experiencing menopausal symptoms?

We take a natural approach that first focuses on improving physiology through diet, exercise, nutritional supplementation, botanical medicines, and homeopathy.  Effective assessment and laboratory testing can also provide important information for ND’s and their patients to avoid the negative side effects associated with hormone replacement therapy (HRT).

Comprehensive lab testing can be done through various integrative laboratories. Hormone levels are evaluated through serum (blood) or saliva testing.  Estrogen (estradiol, estrone, and estriol), progesterone, and testosterone levels are all measured.  In some individuals, testing of DHEA, Cortisol, and Melatonin activity provides the most clinically relevant information, especially for women experiencing fatigue, sleep disorders, or depression as part of their clinical presentation.  Ideally, having levels testing in the “normal”, perimenopausal and premenopausal state would be best in order to obtain a baseline to compare previous hormone levels in the body. 

What would a typical natural treatment plan look like?

Based on what is happening with a patient’s hormone levels, I customize a plan that includes diet, exercise, nutritional supplementation and if necessary, something to help promote sleep. Here are some specifics:

Diet: Increasing the amount of plant foods, especially those high in phytoestrogens, consumption of soy foods for some women (note: depending on how the body metabolizes estrogens, soy may NOT want to be increased in large quantities for some women).  

Nutritional supplementation – such as a good quality multi vitamin/mineral formula, Vitamin E, Calcium/Magnesium for the prevention of osteoporosis, hesperidin (flavonoid), and gamma-oryzanol (ferulic acid) assist in the maintenance of adequate nutrients in body, protection of cancer and heart disease, and lowers hot flashes and lowers cholesterol levels. 

Help with Sleep – Depending on the results of the comprehensive lab panel some women may require melatonin for a peaceful nights sleep.  Cortisol and DHEA levels may also require support based on the labs through adrenal tonics and supplementation.  
 
Regular exercise – a minimum of 3-4 hours per week is recommended.  Impaired endorphin activity within the hypothalamus is a major factor provoking hot flashes. Exercise increases the production and secretion of endorphins, reducing the frequency  and severity of hot flashes.