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Managing Menopause, The Paleo Way!

Managing Menopause, The Paleo Way!

What exactly is menopause, anyway? Basically defined, menopause a stage of a woman’s life that is technically considered “official” when a woman goes 12 consecutive months without a menstrual period. The average age for this in the US is 51 years of age, though the transition to menopause can begin as early as 35 years of age and then drag on for 10-15 years until full cessation of menses occurs. During this time the ovaries are slowing down their production of two hormones in particular, estrogen and progesterone. Imbalances in these hormones leads to the commonly experienced adverse symptoms associated with this otherwise normal and completely natural stage of life.

What exactly is menopause, anyway? Basically defined, menopause a stage of a woman’s life that is technically considered “official” when a woman goes 12 consecutive months without a menstrual period. […]

In fact, perhaps the first point to be made concerning menopause is the fact that it is not a disease. Women from time immemorial have undergone this transitional life-phase, honored within indigenous societies as a stage of life that invoked great wisdom and was a highly respected right of passage. Only today do women seem to fear this stage of life.

Perhaps one reason why this pervasive attitude among modern aging women seems to have shifted toward one of dread—apart from the cultural value in modern Western society placed upon sexual youth– is the fact that in the modern Western world today women are much more apt to experience adverse symptoms associated with this natural life transition: hot flashes, memory decline, night sweats, depression, thinning scalp hair or increased facial hair, brain fog, weight gain and a greater resistance to necessary weight loss, among other possible unpleasant effects. An estimated 70-85 percent of women today in modern Western society, for instance, experience hot flashes during menopause. Women are paradoxically told that the symptoms they are experiencing are to be considered “normal” at this stage of life, while also simultaneously being led to feel as though menopause is some form of disease– requiring “medical treatment” with a variety of synthetic and/or nonhuman hormones, as well as the overly lauded “bio-identical” hormones. In short, female hormone health care is basically in a state of confusion and women are preyed upon from all sides as they attempt to understand, address or avoid the complexities of this condition in today’s world.

Many textbooks on this subject are outdated, and common mainstream approaches to treating associated symptoms include the use of either synthetic hormones or those derived from horses (more specifically, pregnant mare urine…yikes!). The alternative popular literature isn’t much more helpful, even as it is somewhat seductive. The interest in “bio identical” hormones has been exploding ever since Dr. John R. Lee, MD published his popular book in the ‘80s, “What Your Doctor May Not Tell You About Menopause”, and popular celebrities such as “Dr.” Suzanne Sommers published their popular opinions (and shared them on innumerable talk shows) during the same time period. This new, seemingly more “natural” perspective lead an entire legion of aging (and even relatively young) women to slather themselves with new-fangled over-the-counter “all natural” progesterone creams and gels. The practice continues to be popular today. Nowadays men are following suit with transdermal testosterone gels. I am here to tell you that these creams are a big, big mistake… But we’ll get to that.

Now, because of the fact that the ovarian production of progesterone ceases during menopause, some authorities believe—erroneously– that menopausal women no longer make or need progesterone. This is simply not true: menopausal women both produce and continue to require it. This doesn’t conversely mean they need to be slathering themselves all over with progesterone cream, however.

What is the problem with bio identical transdermal hormone creams and gels? I thought they were more natural… 

Here is the issue:

Unless VERY carefully used and monitored closely with appropriate testing this type of hormone preparation will– after several months or more of use—cause increasing problems in the majority of women who use them. Even though the use of hormone creams and gels seems to be increasing dramatically the majority of practitioners and their patients are still unaware of the potential problems inherent in the use of these topical hormone preparations, as well as the specific testing needed to monitor their use (and what testing fails to accurately monitor the use of topical preparations) or understanding about the normal physiological reference ranges that should not be exceeded.

Transdermal hormone creams and gels deliver “free” (non-protein bound) and active hormones directly into the tissues and bloodstream. This might sound like a good thing until you realize that transdermal hormone creams and gels are also absorbed into subcutaneous fat tissue where they can build up and eventually saturate this tissue. After several months of transdermal hormone cream or gel use the subcutaneous tissue stores start to leach into the system, resulting in potentially dramatic and progressive overdosing of this “free” or active hormone fraction. It can literally take months, in fact, after completely stopping the use of these creams and gels for this ongoing dispensing of active hormone into your system to actually stop. In the meantime, it has the potential to cause tremendous problems that can be very difficult to fix. How long it takes an individual system to overdose on hormone creams or gels depends on their fat cell content and overall metabolic rate. The more fat cells and the slower the metabolic rate, the faster the overdosing can occur. Routine blood tests measuring the protein-bound form of hormones do not accurately monitor hormones that are administered in their “free” form (as with transdermal preparations). Not only do transdermally delivered hormones and gels enter into the bloodstream in their “free” form initially, but they tend to continually leach into the system from the subcutaneous stores in their “free” and active form, as well. In both instances, the liver was initially bypassed and no normal serological binding of these hormones ever occurred (as would naturally be the case so your body could naturally decide what to “un-bind” and when, as needed), meaning that these hormones don’t even show up in routine serological blood tests.

Also, fat-soluble hormones like steroids–particularly progesterone–also travel through the blood stream in an unbound state on your red blood cells. These reserves are also not detected with routine blood tests. In other words, routine blood tests measuring serum bound hormones absolutely cannot accurately monitor the use or results of transdermal creams and gels. A person will be profoundly overdosed with “free” hormone levels by the time routine blood tests show any significant changes. –NOT good.

SO IF I NEED TO TAKE FEMALE HORMONE REPLACEMENT, WHAT IS THE BEST FORM FOR ME TO USE?

The most effective and least problematic method of bioidentical hormone delivery nowadays seems to be sublingual, either through liquid drops or small tablets that are crushed and held under the tongue for several minutes. Sublingual (meaning “under the tongue”) versions of various hormonal preparations also deliver hormones in a “free” active form, but they do not build up in your subcutaneous tissues.   It is much easier to regulate their use and they tend to provide much better results for many people. Of course, there are pluses and minuses to any form of hormonal supplementation. This, of course, is something to be taken up with your functional endocrinology-savvy healthcare provider and the relative advantages and disadvantages of different forms of hormonal supplementation should be rationally and carefully considered—along with the relative need for actual hormone replacement in the first place.

Whenever possible it is always best to strengthen and balance the body’s own glands and systems to better optimize hormonal output rather than using even bio-identical hormone replacement. If you are forced to use exogenous hormones it is always best to follow the body’s natural designs and stay within functionally normal physiologic reference ranges. Too much of any hormone can cause problems that are much worse long term than the effects of any hormonal deficiency.   Your body is naturally obsessed with maintaining its own very specific dosage amounts as minimally needed at any given time and your richly complex endocrine system strictly controls and monitors their activities.

When practitioners casually prescribe hormones (or women casually self-prescribe over the counter creams/gels), believing that “as long as they’re bio-identical they must be safe”, countless problems can arise over time—even if they do initially result in you feeling better. This feeling of initial improvement seldom lasts, however. In fact, if the HRT you are taking is excessive or imbalanced (or just not right for you) over time a regression or worsening of problems and symptoms can occur. Keep in mind, too, that even a very small physiologic dose of any hormone can be excessive if your body didn’t need it in the first place! Only the smallest effective dose should ever be used, and monitoring things carefully with appropriate routine testing should be mandatory.

The foundational idea should be to support the gland in a way that helps best facilitate and/or restore it’s own natural functioning and natural hormone production over time.

All to often, though, conventional medical practitioners fail to take nature and the complexities of female hormone metabolism into reasonable account. For some reason, the fact that women’s ovaries similarly cease making estrogen prompts medical experts to prescribe nonhuman estrogen made from the urine of pregnant horses as a supposedly reasonable substitute. The fact is that these alien hormones do not function normally in the human body and more recent research has repeatedly shown that this type of hormonal supplementation comes with substantial risks.

“It is important to understand the functions and alterations in metabolism and apply conservative therapies such as diet, nutrition and lifestyle changes to optimize and modulate physiology instead of supplying agents that dominate over physiology to manage symptoms. Physicians that provide exogenous hormones without consideration to the reasons related to the imbalance as well as the alterations that will be created from the hormones have narrow understandings or respect for human physiology.”

Datis Kharrazian, D.C., D.H.Sc.

Here here!

A good Functional Endocrinologist looks at feedback loops, circadian rhythms and receptor site sensitivity factors with respect to managing hormones, as well as dietary and lifestyle factors.

WHAT IF I HAVE HAD A TOTAL HYSTERECTOMY?

If you have undergone a total hysterectomy then ongoing HRT may well be absolutely necessary.   Again testing a monitoring is an absolute MUST, as is carefully evaluating the way you feel and function ongoing. Also, all aspects of normal female endocrine function need to be taken into account, and not just estrogen.

Women having undergone total hysterectomies are commonly prescribed what is referred to as “unopposed” estrogen replacement. –The term “unopposed” refers to where estrogen is given on its own, without any form of progesterone. This is a very serious mistake. Ironically, the majority of hysterectomies are done for reasons such as heavy bleeding, fibroids, endometriosis, and/or severe menstrual pain. The irony lies in the fact that these conditions are commonly due to estrogen dominance in the first place! Other symptoms of estrogen dominance include weight gain, resistant weight loss, fatigue/chronic fatigue, anxiety, blood sugar issues, sweet cravings, muscle and joint pains, fibromyalgia, migraines, depression, thyroid problems, gallbladder issues, the increased risk of breast cancer… and more. Up to 50% of the time, hysterectomies are accompanied by the “prophylactic” removal of otherwise healthy ovaries. This just simply takes a bad situation and makes it worse than ever needed to be. The result here tends to be the exacerbation of estrogen dominance symptoms (as previously outlined). How are the subsequent plethora of symptoms then typically dealt with? –With antidepressant and/or anti-anxiety medications, gallbladder removal, pain medications, thyroid hormones, migraine medications and who knows what else. Absolutely none of this corrects the underlying estrogen dominance or progesterone insufficiency that may lie at the root of all these problems. Rationally, accurately and effectively evaluating and addressing female hormone-related symptoms requires a cutting edge expertise in functional medicine. Be sure to choose your doctor carefully!

To make matters worse, it can be difficult to even accurately evaluate your hormonal status to begin with.

TESTING YOUR FEMALE HORMONE LEVELS

There is a great deal of debate about testing and what forms of testing actually provide accurate information about your hormonal status. It’s important to understand what is actually being tested with each approach to testing, as well as what relative merits and disadvantages each has to offer.

Conventional serological testing only measures the protein-bound form of your hormones. The problem with this is that protein-bound hormones are the inactive circulating reservoir of your hormones– In other words, they are mostly circulating in a form that cannot be readily used by your body. More than 99% of most hormones are found in the blood stream in this protein-bound form. If 99% of what you are looking at isn’t even usable, how much value can this form of serological measurement actually offer? –In truth, not much.

There is such a thing as a serum-free or “free fraction” blood hormone testing. This approach measures the un-bound, physiologically active or “free” form of the hormone. Sounds better, doesn’t it? Unfortunately, it is not routinely done because it is very expensive and (let’s face it) insurance companies don’t like paying for expensive tests. This form of testing may be more useful post-menopausally, once a woman’s periods have completely ceased, along with the circadian patterns associated with her normally cycling hormonal production. Until then, even a free fraction measurement physiologically active hormone offers little more than a nearly worthless snapshot in the documentary film of your ongoing female-hormonal story, as these cannot take into account what is happening within their natural circadian rhythms, much less the relative health of your overall female circadian rhythms. Only salivary testing can realistically offer this.

Salivary testing also measures the “free”, unbound and physiologically active form of your hormones. It is also far less expensive than “free fraction” blood tests and can be sampled at regular intervals in the comfort of your own home in a way that can provide much more information about the relative health or dysregulation of your female circadian rhythms. Most MD’s (for reasons only known to them) don’t like “take home testing”, however.

Urine testing for hormone metabolites can only really look at what is left after the liver has broken down and excreted your hormones. It cannot measure “free” hormone fractions. It offers very little useful information, in truth, with respect to the relative health or issues with hormonal balance.

Another supposedly “natural” method of hormonal measurement is Hair Mineral Analysis. This attempts to evaluate intracellular mineral levels that are theoretically an indication of how effectively your hormones are delivering their messages at the cellular level. This (again theoretically) may purportedly offer some indication of receptor sensitivity and cellular responsiveness. It cannot, however, tell you anything about actual levels of hormones in your blood or saliva.   Interpreting hair mineral analysis can be as much of an art as it is a science and is highly controversial. Many different schools of thought exist when it comes to this approach and finding competent analysis can be a real challenge.

As a matter of practical, accurate and accessible testing is concerned, salivary hormone testing offers typically the most accurate, useful and affordable results. Some labs offer more useful reference ranges than others, which is a valid caveat to be considered.

AS IF THIS WASN’T SO COMPLICATED ALREADY…

Interestingly, when it comes to evaluating blood levels of hormones there are currently no conventional optimized (i.e., healthy, normal and functional) lab range standards for hormone levels for menopausal women used by mainstream practitioners whatsoever. In fact, the ranges used by most doctors are anything but “normal and healthy.” This only adds to the confusion and to problematic symptoms and results received through conventional treatments. The fact is that most blood tests really have abnormally low menopause reference ranges, including those salivary panels more accurately measuring active hormone. Some labs even utilize established ranges that are abnormally high, due to the excessive number of women using over-the-counter hormonal preparations such as creams or gels, which typically lead to chronic overdose.

You see, lab ranges/reference ranges in blood chemistry labs do not reflect what is actually normal—all they reflect is a bell curve that is inclusive of every single woman that went into that particular lab system for blood work. So you’re not getting compared to “normal and healthy”—Oh no! –You’re getting compared to a group of women that are typically struggling every bit as much as you are. Conclusions derived from this are typically anything but helpful. Also, ONLY natural hormones can be measured through lab tests—not synthetic forms. This is deeply problematic, and anything but scientific or based upon researched standards. Its usefulness in helping you determine what you actually need is, well, dubious at best. Not all reference ranges are created equal, or are based on anything even approaching “normal” ranges. It is best to take these ranges with a grain of salt. Only a true functional range can offer a useful comparison. Finding a functional medical specialist is your best bet for more accurate and effective help.

WHERE TO BEGIN WHEN IT COMES TO EVALUATING MENOPAUSAL HEALTH?

One issue that is typically overlooked that should truly be the very first thing considered in evaluating aging female hormone health is the health of your adrenal function. In fact, it is pretty safe to say that the health of your adrenals at the time you reach menopause will absolutely correlate to the health of your transition into and throughout the stage of menopause, itself.

Why is that?

All sex hormones are part of a family of what are referred to as “steroidal hormones”, all of which are in part made from cholesterol (eeeevil cholesterol), and which also happens to additionally include DHEA plus your body the ongoing estrogen dominance all-critical stress hormones, adrenaline and cortisol. To quote one of my favorite former mentors, “Your steroidal hormones are like a family—they function together and they dysfunction together.” In other words, anything you do to any one of these hormones doesn’t just affect that particular hormone— it affects all of them. Yes, this also includes bio-identical hormones.

When a woman reaches the time in her life where her ovaries are no longer able to make her female hormones, the ovaries basically hand that baton over to your adrenal glands to take up the slack. If everything is operating according to plan, this transition is smooth and uneventful (the way it’s supposed to be). If your adrenals are somehow off-line or otherwise not up to the task, then there is bound to be a problem. Needless to say, in this day and age the latter is far too common— but this does not mean it is anything remotely “normal”. I have often found a certain salivary hormone test known as an ASI (Adrenal Stress Index) to be very telling when it comes to evaluating a woman’s perimenopausal and early menopausal woes.

In my e-book, Rethinking Fatigue: What Your Adrenals Are Really Telling You and What You Can Do About It I offer a modernized view of adrenal dysregulation, together with basic descriptions of different types of adrenal problems, together with a variety of suggestions for addressing and supporting them. I also de- mythologized the concept of “adrenal fatigue” or “adrenal burnout”— an idea that has been popularly promoted but has little basis in reality.

Let’s just say that adrenal-related issues rarely pertain to the adrenal glands, themselves. But if you want to address menopausal symptoms, you absolutely must address the quality of your adrenal health. And typically, most so-called “adrenal supplements” are (ironically) seldom the way to do it. Not to sound overly cryptic here, but this part of our discussion can get to be rather involved, and rather than attempt to re-create my book on adrenal health here in this blog post I am forced to defer to my e-book for more in-depth understanding of this incredibly important issue. Trust me, its well worth the time.

In the meantime, there are four foundations upon which menopausal health rests, all of which should be supported for the healthiest possible menopausal transition:

1) Quality digestion/healthy gut:

Many individuals over 40 begin to experience diminished hydrochloric acid and pancreatic output, leading to progressively impaired digestion. You can be eating the best quality Paleo Way diet and get absolutely nowhere unless you are actually able to digest, assimilate and utilize high-quality food you are eating. Learning to recognize when your digestion is compromised is a first step toward addressing that problem: Gas, bloating, feelings of prolonged fullness after meals, and/or (ironically) “acid stomach”/symptoms of reflux all point to potential issues with proper (i.e., sufficient) hydrochloric acid production, in addition to possibly pancreatic enzyme output.  Insulin resistance can all by itself lead to pancreatic enzyme deficiencies.  In addition, dysglycemia (blood sugar problems) cause your body to lose zinc and vitamin C—both of which are needed to be able to effectively produce hydrochloric acid.

Let’s just say that no one has a deficiency of “little purple pills” or “Tums”. If you find yourself reaching for these over-the-counter remedies, it may be time to make an appointment with a natural healthcare provider that can help you restore healthier digestion, as opposed to spending your time symptom chasing while it all gets worse.

Keep in mind, too that gut inflammation associated with food sensitivities is another “deal buster” when it comes to getting uncomfortable menopausal symptoms under control. It’s important that you learn what your particular inflammatory triggers are and absolutely avoid them if you want to get your hormone system under control!

Finally, intestinal dysbiosis (an unhealthy imbalance of gut flora and too many “bad” bacteria in your gut) can also lead to unhealthy estrogen dominance. Making sure you get lots of healthy probiotics through eating cultured vegetables, as well as other sources of good bacteria can be an important part of your healthy menopausal management plan!

2) Blood sugar management

Dietary sugars and starch effectively raise your insulin levels, which in turn promotes weight gain and leads to more fat stores, especially around the abdomen.  Those fat stores in turn can promote higher levels of circulating estrogen, potentially driving your estrogen and progesterone balance even further out of kilter.

Furthermore, problems with blood sugar basically tend to get worse with age. If you are prone to experiencing fatigue, weakness, brain fog, jitteriness, mood swings, and other unpleasant symptoms of “low blood sugar” between meals, then this issue is paramount for you and really needs to be addressed. The Paleo Way program is geared toward minimizing sugar and starch intake and helping your body switch to a more lasting and stable form of fuel in the form of fat, rather than sugar for your primary energy, brain and metabolic needs. This transition is easier for some people than others, but other articles I have written for this program can help ease that transition considerably using appropriate supplementation and dietary choices. Chronically high blood sugar, on the other hand, can lead to pre-diabetic changes, obesity, blurred vision, neuropathy, memory problems and more. Insulin resistance is another consequence of chronically dysregulated blood sugar that also tends to worsen with age. In either case, you definitely don’t want to waste your life unnecessarily wrestling with these issues and their serious consequences. Fortunately, this version of a “Paleo-friendly” diet and lifestyle program is well designed to help you cultivate a true metabolic advantage.

3) Cultivate healthy avenues of detoxification/elimination—and be good to your gallbladder (if you still have one)

It is often the case in older women in modern society that an almost paradoxical state of estrogen dominance develops, leading to excess weight gain, resistant weight loss, abnormal facial hair growth (due to hyperandrogenism/PCOS) and scalp-based hair thinning. Where does all this seemingly excess estrogen come from if your ovaries aren’t making it anymore? Well, often enough HRT (hormone replacement therapy), for one thing. Also, diets that are or have been high in soy foods, conventional dairy products and feedlot meats, together with chronic exposure to any number of household chemicals or pesticides can all result in abnormal and deleterious estrogen dominance.

Also, estrogen and progesterone need to be in a relative balance– and if that ratio is off due to, say, insufficient progesterone, than the result will also be a state of relative estrogen dominance, even if you don’t actually have that much estrogen. Again, this needs to be evaluated by a knowledgeable health care provider (preferably specializing in functional medicine).

Finally, your hormones are constantly being manufactured (synthesized), activated, detoxified (i.e., metabolized), excreted… And then re-synthesized. This is where your gallbladder comes in. Your liver’s phase I and phase II liver detoxification process serves to help you metabolize excess/spent hormones, which are then excreted mainly through your bile ducts, bowels, plus your kidneys and urine. Your bile serves to conjugate these hormones (turn them from fat-soluble into water-soluble form) so they can be properly eliminated. Unfortunately, if you happen to have poor bile production, biliary stasis, have no gallbladder or happen to be chronically constipated, then rather than get properly excreted these hormones can reabsorb back into your body and go back into circulation yet again, leading to unhealthy excesses/imbalances. Gallbladder problems are commonly related to thyroid issues, as well as estrogen issues and should really be addressed at the foundational source of the condition—This is true and relevant, by the way, even if you no longer have your gallbladder!

Your hormones can really start to interfere with one another when detoxification systems aren’t operating up to snuff and this is a very common problem. Your ability to effectively metabolize and clear these hormone metabolites is a vital part of your endocrine regulatory system. Being sure you are well hydrated, eating sufficient (unadulterated, natural) dietary fat, having healthy bile and gallbladder function and sufficient nutrient density to provide critical nutrients to this process is all-important. By the way, blood sugar stability is also critical to detox! The Paleo Way nutritional plan provides well for all this—but if you have gallstones or experience pain in the area of your upper right ribcage and or ever experience gallbladder attacks you will absolutely need to effectively address these symptoms and restore your biliary health before fully engaging in the Paleo Way menu plan. Until then, your ability to healthfully process dietary fat and/or fat-soluble nutrients is significantly compromised!

The other important factor to consider that is related in part to your liver/gallbladder health is your healthy intake and utilization of essential fatty acids (EFA’s)—particularly the animal source, elongated forms of omega-3’s known as EPA and DHA. You absolutely need healthy bile function to make the best use of these all-critical and anti-inflammatory EFA’s, which are also needed for healthy hormonal receptor site function. Be good to your gallbladder (it’s much more important than you’ve possibly been told) and it will be good to you! If you feel you may not be getting the most from the healthy fats in your diet (and you have ruled out serious biliary issues) than you might consider the addition of non-GMO sources of lecithin to soups and smoothies as a natural emulsifier. –Emulsification can partly help make fat-soluble nutrients a bit more available and better deal with malabsorptive issues.

4) Stress management

In many ways, this is perhaps your single most important menopausal management tool, as your adrenals are either your best friends or your worst enemies during the perimenopausal/menopausal phase of life. In women, the stress response suppresses luteinizing hormone (LH), leading to decreased progesterone levels. Also, prolonged elevated cortisol (your body’s primary stress hormone) will deplete and place great demands on your liver’s phase-I as well as and phase II glucoronidation and sulfation pathways, which allows fat soluble hormones to be properly conjugated (become water soluble) so they can be safely eliminated.

Learning to manage your body’s stress response more healthfully through regular daily practices such as meditation, biofeedback, neurofeedback, yoga, diaphragmatic breathing, getting sufficient sleep, and getting your life’s demands under better control can pay great dividends long-term. Dr. Herbert Benson, the founding president of The Mind/Body Medical Institute and the author of the book “Relaxation Response” found that various relaxation techniques have served to improve hot flashes in over 90% of women without any hormonal therapy of any kind.

A word about “hot flashes”:

Conventional medical authorities tend to believe and will typically tell you that hot flashes are caused by a deficiency of estrogen.   It turns out that this is not necessarily the case at all. Hot flashes are not caused by an estrogen deficiency, per se, but instead (most commonly) by erratic fluctuations or spikes/surges of estrogen, together with imbalances surrounding progesterone. The answer isn’t always a need for “more estrogen”.

Interestingly, women in Western cultures are far more likely to experience hot flashes during menopause then those women living in other non-Western societies, including Japan, China (Hong Kong), Pakistan and Mexico– where no more than 10% of menopausal women present with this issue! In modern Western society 70 to 85% of women struggle withhot flashes regularly during perimenopause/menopause. This is clearly much more complicated than simply some increased need for estrogen.

In fact, it is possible to have entirely normal estrogen levels and experience hot flashes and even night sweats due to comparatively low progesterone levels. Also, there are other hormonal imbalances potentially involved in this equation, including depressed testosterone levels, surges of luteinizing hormone (LH), excess follicle-stimulating hormone (FSH), depressed beta-endorphin levels, and excesses of cortisol and other stress hormones. By no means is this a necessarily simple equation solved by taking exogenous hormones–bio identical or otherwise. In fact, hot flashes can even be caused by certain illnesses (such as anorexia nervosa), as well as adrenergic-type medications (including over-the-counter medications used for things like allergy and sinus problems). Individuals more prone to anxiety, depression and panic attacks tend to also be more prone issues with hot flashes.

It’s all far more complicated than meets the eye.

Foods that can seemingly exacerbate or trigger hot flashes include caffeine, alcohol, and high glycemic foods (like sugars and starches). Tobacco can also similarly have a triggering/exacerbating effect on these symptoms. Some women find that cutting back on stimulants, as well as spicy foods and hot beverages (along with staying out of hot weather, hot tubs and saunas) also often help minimize the severity of these episodes.

Are there any supplements that can help with menopausal symptoms? 

Well, yes—but this also depends on who you are and what the nature of your menopausal issues might be. I also always urge anyone with symptoms of almost any kind to work at getting to the foundations of their symptoms, rather than simply seek out a quick Band-Aid-type solution in the form of even a general nutritional supplement, much less a hormone cream. Remember that you will always get much better results long-term by addressing the actual source of whatever is dysregulating you. –To get there takes some patience and accurate testing by a qualified specialist in functional endocrinology (and not just some mainstream prescription-happy hormone specialist). Functional endocrinology takes into account the complex system of hormonal interrelationships existing throughout your body and tends to yield a much more sophisticated appreciation of the need to get to the bottom of things.

Understand that hormones are actually measured in nanograms (ng) and picograms (pcg)—literally billionths and trillions of a gram! –They are NOT supplements… They are extremely powerful substances naturally produced and used by the human body in almost incomprehensibly small amounts. Not even the most talented endocrinologist in the world could ever hope to replicate (using any type of exogenous hormonal preparation) the delicate and intricate dance achieved through normal and natural endocrine processes, receptor sensitivity and feedback loops. We get into trouble when we arrogantly assume our body is too stupid to know what it needs and then attempt to supply with what we (or our doctors) think it should be making without first understanding why it arrived at a state of imbalance in the first place. I’m not saying that exogenous bio-identical hormones are never the answer– far from it. But I am saying that they should always be a last resort and only after meaningful, rational effort toward healthy endocrine restoration or improvement has been accurately evaluated and attempted.

That said, numerous supplements can offer significant support in the process of addressing uncomfortable menopausal symptoms and may be worth considering.

Maca root (sometimes called “Peruvian ginseng”) is a functionally adaptogenic botanical, helping to gently balance female chemistry a bit more specifically than many other adaptogens might. Angelica (Dong Quai) has also proven to be beneficial in a number of instances as a female-balancing herb. Chaste Tree Berry (Vitex) may help stimulate LH, thereby improving progesterone levels. Other adaptogens such as schizandra have also demonstrated positive effects.

I typically recommend caution when it comes to phytoestrogen use from things like soy (genestein), black cohosh and others; as adding anything estrogenic to the mix has potential implications with respect to increased hormonal imbalances and complications. Black cohosh (Cimifuga racemosa) seems to have fewer potentially adverse estrogenic effects than other phytoestrogens, but I am always cautious about this. One very good friend of mine suffered debilitating migraines while attempting to use black cohosh for her hot flashes. If you must use phytoestrogens use them sparingly and be absolutely certain they come from non-GMO sources. If they help—OK; but if they don’t seem to offer much in the way of relief then don’t persevere in taking them in the hope that they “might” kick in at some point.

Magnesium (preferably ionic and/or transdermal forms, along with magnesium glycinate) is necessary for both healthy phase I and phase II liver detoxification and can have a broadly beneficial effect.

Vitamin K2, together with its companion fat-soluble nutrients, vitamin A (retinol) and vitamin D3 (cholecalciferol) is utterly critical for healthy bones and for staving off potential osteoporosis concerns. These fat-soluble nutrients are far more important than dietary calcium ever could be in the battle for your bone health in any stage of life—but particularly during menopause.

LAST BUT NOT LEAST: CHOLESTEROL, NOT DIAMONDS, ARE A GIRL’S BEST FRIEND!

Among the most important companions for a woman in her menopause years is her cholesterol. Far from being a threat to cardiovascular health (at any age), robust cholesterol levels have been clearly associated with improved longevity in older women in particular…with literally no down side. Recent studies have confirmed cholesterol’s important role in a woman’s health with decisive clarity.

A highly publicized meta analysis study done in Norway back in 2011 (dubbed the HUNT 2 Study) which looked at the impact of cholesterol on the health of 27,000 women showed conclusively that not only did women with higher cholesterol levels (over 6.9 mmol/270 mg/dL) live longer, they actually suffered fewer strokes and heart attacks than women with lower cholesterol! (Peturrson H., Sigurdsson JA, Bengtsson C, Nilsen TL, Getz L. “Is the use of cholesterol in mortality risk algorhythms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study.” J Eval Clin Pract 2011 Sept 25).  In fact, their risk of heart disease got lower as their cholesterol levels rose!! Also, their overall rate of mortality was also a whopping 28% lower than women whose cholesterol was in the more conventionally recommended range of 5.0 mmol/193 mg/dL! The lowest CHD risk was seen in those women whose cholesterol levels were between 5.0 mmol and 6.9 mmol. –And higher was better!   The researchers concluded that: “Our study provides an updated epidemiological invitation possible errors in the cardiovascular risk algorithms of many clinical guidelines. If our findings are generalizable, clinical and public health recommendations regarding the ‘dangers’ of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless even beneficial.” (bold emphasis mine).

WOW.

Still not convinced? In another eight-year study of about 26,000 men and women in Isehara, Kanagawa Prefecture in Japan, the death rate rose for women with LDL cholesterol (used for making all-critical female/steroidal hormones) LESS THAN 120/mg/dL!

“Cholesterol is an essential component for the creation of cell membranes and hormones. It’s not recommended to lower LDL figures by means of dietary intake and medication,” stated Hamazaki.

“When women reach menopause, their cholesterol figures rise sharply, the do not affect the arteriosclerosis process or development of heart diseases. At the very least, cholesterol criteria is not necessary for women,” -Hiroyuki Tanaka, director of Niko Clinic in Takeo, Saga Prefecture.

This study, along with other studies, leads one to the conclusion that optimal LDL levels are within the 120-160 mg/dl range.

A separate study of 16,850 patients nationwide that suffered cerebral stroke showed the death rate of people with higher cholesterol who died from a cerebral stroke was lower, and their symptoms more slight. (World Rev Nutr Diet. 2011;102:124-36. Epub 2011 Aug 5. ”New Cholesterol Guidelines for Longevity” (2010). Okuyama H, Hamazaki T, Ogushi Y; Committee on Cholesterol Guidelines for Longevity, the Japan Society for Lipid Nutrition.)

And then there’s this little gem:

“In women and elderly, there was no appreciable difference in coronary heart disease rate for any level of cholesterol. In fact, for women of all ages and the elderly, higher cholesterol is associated with a longer lifespan.” Circulation. 86, 1026-1029, 1992

And what about the famous 30-year long Framingham heart study? The researchers concluded: “In people with a falling cholesterol level (over the first 14 years of the study), for each 1% mg/dl drop in cholesterol there was an 11 percent increase in allcause mortality over the next 18 years. “ JAMA 1987;257:2176-2180

In other words—simply put—less is anything but more when it comes to cholesterol. –ESPECIALLY if you are a woman.

OH—and on a related note, a recent study in the Archives of Internal Medicine looking at the impact of statin (cholesterol-lowering) medications found something quite disturbing. Researchers found that the use of statins increase a postmenopausal woman’s risk of developing diabetes by 48-71% !!! In this study, researchers used WHI data through 2005 and included 153,840 women without diabetes and with an average age of 63.2 years. At the beginning of the study 7.04 percent of the women reported taking a statin.  After three years there were 10,242 new cases of diabetes in this group—which amounted to a 71% increased risk.  Once a number of other variables such as ethnicity, age and body mass index was taken into account the association still didn’t go any lower than 48%. And it didn’t matter which statin women were even taking. The results were consistent for all statins on the market. In the study’s accompanying editorial, author Dr. Kirsten Johansen from the University of California, San Francisco said that the increased risk of diabetes in women without heart disease has “important implications for the balance of risk and benefit of statins in the setting of primary prevention in which previous meta-analyses show no benefit on all-cause mortality.” Culver AL, Ockene IS, Balasubramanian R, et al.  “Statin use and risk of diabetes mellitus in postmenopausal women in the Women’s Health Initiative.” (Arch Intern Med 2012 Jan 23;172(2):144-52. doi: 10.1001/archinternmed.2011.625. Epub 2012 Jan 9).

Another study published in The Lancet found that statins increased the risk of diabetes by 9 percent (Abramson J, Wright JM. Are lipid-lowering guidelines evidence-based? Lancet. 2007 Jan 20;369(9557):168-9).

Seems to me its past time we invited the supposed “sacred cow” of supposedly “health-promoting” statin drugs to the next Paleo BBQ…as the main course.

Still worried about high cholesterol? Really?? I’d be a lot ore worried about not having enough.

IN SUMMARY

In short, the struggle with menopausal symptoms may not be the natural response toward this phase of a woman’s life that Nature intended, but Nature can still provide useful answers to these problems.

By supplying your body with whole, clean and unadulterated nutrient dense foods while eliminating those foods and substances that do not support our human genetic makeup and Primal physiological design a great deal can be accomplished toward supporting optimal health— at any stage of life!

By Nora Gedgaudas

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