Naturopathic Newsletter June 2009: MENOPAUSE Part II

MENOPAUSE: PART II

June 2009

Saturday August 22nd from 10am-4pm is the 2nd annual Initiative: Community Wellness Day. The event will be held on the main street in Ste-Anne-de-Bellevue in front of the clinic/city hall. We look forward to seeing you there where you can learn how to increase the well-being of yourselves, your families and your communities.

Starting Wednesday September 23rd at 7pm, I will be giving a 4 week lecture series on Naturopathic Nutrition at John Abbott College, as part of their Continuing Education Program. For more information adn to register, pls contact the college.

Please note that as of July 15th, the naturopathic consultation fees will be as follows:

$130+tx for 1.5 hour initial consultations, and

$85+tx for 1 hour follow-up consultations.

I am also available for consultation in Cornwall, Ontario, on Fridays. As a licensed profession in Ontario, I am able to provide my patients with a greater level of care, including blood tests, complete physical exams, and PAP tests. For more information, please visit the clinic's website: 

www.millenniumhealthcenter.com

The May 2009 newsletter: Menopause: Part I reviewed the definitions, statistics and hormonal changes involved with menopause, along with some information regarding both synthetic and bio-identical hormone replacement therapy (HRT). As stated in the closing section of the May newsletter, 

Although my office phone has been ringing with inquiries about BHRT, I educate women that BHRT is the last route of recommendation. There are NUMEROUS interventions that can be applied with overwhelming success before the options of BHRT needs to be entertained. As a Naturopathic Doctor, it is my pledge to use therapies that are the least invasive to produce the greatest outcome; less is often more.

Before considering BHRT, I will educate my patients on the following interventions:

1. diet

2. nutritional supplements, such as certain vitamins and minerals

3. botanical medicine, the use of medicinal plants

This month's newsletter discusses some of these non-invasive interventions that most women can apply to their daily lives.

 

It is no surprise that the standard North American diet with its refined carbs, animal fats, low fruits and veggies, sugar and caffeine is conducive to aggravating menopausal symptoms. The explanation is simple:

Specific molecules, called prostaglandins, stimulate an area in the brain that controls temperature. These molecules are responsible for increasing the number and intensity of hot flashes and other menopausal symptoms.

Prostaglandins are increased by red meat, dairy, sugar, peanuts, and shellfish.

Prostaglandins are inhibited by antioxidants found in fruit and vegetables.

Other foods and beverages that aggravate hot flashes include: coffee, chocolate, alcohol, hot drinks, foods containing histamine (cheese and red wine), and spicy foods.

Healthier food choices to decrease menopausal symptoms include:

Minimizing dairy products. Bear in mind that epidemiological studies show us that the societies which consume the most dairy products have the highest rates of osteoporosis. Please see September 2008 newsletter for information about bone health.

Focus on non-animal sources of protein, such as legumes (lentils, chickpeas, adzuki beans, tempeh, etc ...), nuts, nut butters, and fish (yes, I know it's an animal!).

Eliminate white carbs, minimize wheat sources, and focus on alternative grains for your cereals, breads, pasta, rice, cookies, cakes, crackers, etc ... The alternative grains include: corn, buckwheat, brown/red/black/wild rice, quinoa, millet, kamut, spelt, etc...

Replace coffee with green tea or herbal tea.

Minimize alcohol, whether it be wine or beer or liquor.

Incorporate phytoestrogens in your diet! Phytoestrogens are naturally occurring substances found in plants that have estrogen like properties and thus can replenish the decline in this hormone. The 2 main classes of phytoestrogens:  

-    isoflavones (mainly from soy)

-    lignans (from seeds and grains, legumes)

A review of 11 clinical trials showed that soy significantly decrease the number and intensity of hot flashes (Menopause  2006; 13: 831-839).

Soy has an effect on vaginal dryness, heart health, bone health, mental function and the prevention of breast and uterine cancer.

I recommend patients chose the following forms of soy to incorporate into their diet: miso, tempeh, and soy nuts. For more information on the controversy of soy, please see October 2008 newsletter.

Ground flax seeds are the highest source of lignans.

Lignans are modified in the gut to form estrogen-like compounds and absorbed into the circulation where they have weak estrogenic activity.

Lignans also have anti-tumor and anti-oxidant effects (cancer prevention).

To discuss matters further regarding phytoestrogens and estrogen-dependent conditions, such as breast cancer, please feel free to bring up any concerns at our next appointment. In short, current research shows that these are healthy foods to consume without concern for aggravating such conditions, and with the possibility of acting favorably.

Vitamin B6 plays a critical role in the manufacture of serotonin. An insufficiency of this vitamin may contribute to insomnia, depression, and irritability. Since these are typical menopausal symptoms, this supplement may be a helpful addition to your protocol. I recommend dosing between 50-200mg, depending on  the individual.

Evening primrose oil has been used to alleviate vasomotor symptoms, such as hot flashes, as well as breast pain, known as mastalgia. I recommend dosing between 1500-3000mg, depending on the individual.

Studies dating back to the 1940s indicate the effectiveness of vitamin E in alleviating hot flashes. Vitamin E can also be beneficial for the atrophic vaginal changes that result in vaginal dryness. I recommend dosing between 400-800IU, depending on  the individual.

 

My first "go to" remedy for menopausal symptoms is black cohosh (Cimicifuga racemosa). Let's start this discussion by setting the record straight. This plant is NOT phytoestrogenic, and therefore does NOT stimulate estrogen receptors. It is therefore NOT a concern for triggering or aggravating estrogen-dependent conditions, such as estrogen receptor positive breast cancer. 

Over 90 published scientific papers and presentations show the efficacy and safety of this plant. In my practice, I find it to be about 75% effective in addressing menopausal symptoms such as hot flashes, night sweats, insomnia, and mood changes. Many women come to office and say that they have "already tried it", but it didn't work for them. We often find that this is not the case when they are given the correct concentrated doses, as well as optimal quality of the plant.

Trials comparing black cohosh to estrogen therapy showed they were equally effective in reducing menopausal symptoms.

- Over a 12 week period showed vaginal mucosal stimulation similar to conjugated estrogens

- Over a 12 week period showed improvement in depression and anxiety similar to diazepam

(Zen Gyn, 1988;110:611-618)

In cases where the black cohosh isn't enough to provide sufficient relief, then the next step is to use this plant in combination with other plants, such as sage, yarrow, dong quai, etc ...

A formula comprised of: black cohosh, dong quai, milk thistle, red clover, ginseng, and chaste-tree berry yielded the following results:

-    73% decrease in hot flashes, with complete elimination in 47% of women

-    69% decrease in night sweats 

(Gynecological Endocrinology 2007; 23:117-22)

As previous stated in both this and May's newsletter, there are numerous effective options for addressing menopausal symptoms before needing to even consider either bio-identical or synthetic hormone replacement therapy. See your local ND to find out about the protocol that best suits your needs.