Effects of Menopause

Women with estrogen dominance as well as those who suffer from menopause problems whose diets are high in saturated fats, such as butter and dairy products (especially cheese and ice cream), often stimulate the growth of unhealthy, anaerobic bacteria in their intestinal tract. These bacteria chemically change the breakdown products of estrogen into forms that can be reabsorbed back into the body.

These bacteria split estrogen from the binding substances that inactivate it in your liver. This splitting process causes free estrogen to be reformed within your intestinal tract. As this free estrogen is reabsorbed into the circulation, it increases free estrogen levels within the blood.

To suppress the growth of these unhealthy bacteria, you should not only reduce your intake of saturated fat (which can lead to the problem in the first place), you need to increase your intake of probiotic-rich, fermented foods so you can recolonize your intestinal tract with healthy bacteria. These include yogurt (preferably goat- or coconut-based), kim chee, pickles, and sauerkraut.

While I ususally focus my blog on alleviating menopause symptoms like hot flashes and night sweats, today, I'd like to address new mammography guidelines that the U.S. Preventive Services Task Force proposed yesterday. Essentially, the recommendations now state that women between the ages of 40 to 49 should not get annual mammograms unless they are high-risk (i.e., strong family history and/or positive for the breast cancer genes BRCA-1 or -2) because the risks outweigh the benefits. The new guidelines also state that women over the age of 50 should get mammograms, but every two years instead of yearly. Finally, they state that self-breast exams are no longer necessary.

There are aspects of these new guidelines with which I agree, and others that, quite frankly, anger me.

First and foremost, I have been speaking out against mammograms for decades because I, too, believe that the risks outweigh the benefits. As I stated in my February 2008 issue of Women’s Wellness Today:

A routine mammogram’s sensitivity (how good it is at detecting suspicious tissue) varies. If a woman is still menstruating, her breast tissue is denser, which drops the sensitivity of routine mammograms to below 70 percent. That means that as many as 30 percent of existing breast cancers are missed, which is troubling because cancers in younger women tend to grow faster. After menopause, a mammogram’s sensitivity is better, but still not great. Routine mammograms are hamstrung by the fact that any tumor smaller than about four-tenths of an inch across is less likely to show up, so a tumor might be just small enough to escape detection, and then have lots of time to grow and spread before the next mammogram. On top of all this, human error in reading the films is also a very real possibility.

Here’s another problem with mammography. Five out of six “suspicious” routine mammograms turn out not to be cancer. Those five women are undoubtedly relieved, but they also got the scare of their lives, underwent more tests, maybe got biopsies, and possibly even had surgery they didn’t need.

The latest studies show that for every 2,000 women who get a routine mammogram, one life is prolonged. If that seems mediocre, you should know that protecting any individual woman against breast cancer was never the goal of routine mammograms—it’s well known that they miss too many cancers in the early, most treatable stage. As a routine screening tool, their purpose is simply to reduce the percentage of women who die from breast cancer.

For these exact reasons, I recommend a breast imaging test called thermography over mammography. In short, mammography looks at the structure of a woman’s breast tissue, while thermography looks at its behavior--which is a much more accurate indicator of potential future problems.

Keep Up with Those Self-Exams
The Task Force’s belief that self-exams are no longer important really frustrates me. I strongly believe that becoming familiar with your breasts, and how they look and feel, can help you determine if any scars, dents, lumps, or bumps are normal for you. Plus, you'll be more sensitive to any little changes that might indicate the need for further testing.

In a nutshell, I recommend that you look into getting breast thermography done, and I strongly encourage you to keep up with your breast self-exams. To learn more about thermography, visit the International Academy of Clinical Thermology or Infrared Sciences Corp.

• L-dopa is the natural precursor of the neurotransmitter dopamine--which is a powerful physical arouser. I recommend using an extract of the herb Mucuna pruriens—a concentrated natural L-dopa source. Try Herbal Herbal Powers Mucuna Pruriens. Take 300 mg per day in capsule form, standardized to 60 mg L-dopa.
• L-arginine is an amino acid shown to be effective in sending blood to the clitoris, which boosts physical sensitivity and arousal. Take 500 mg one to three times a day, or try a product called ArginMax for Women. 
• Maca is a root vegetable with aphrodisiac qualities. The traditional dose is between 2 to 10 grams, but start low and work up to the dose that gives you the desired effects. 

When traveling, always keep your eye out for fresh, local fruits or vegetables. However, if you have menopause problems, you’ll want to avoid highly acidic fruits like oranges and grapefruit. Instead, stock up on high-enzyme foods like sprouts, carrots, celery, or papaya to snack on.

If you are eating in a restaurant, aim for salads, steamed vegetables, whole grains, legumes, fish, and poultry, especially if you suffer from hot flashes or night sweats. Be sure to order the less acidic, more alkaline fruits such as melons and papayas.

Conversely, if you have estrogen dominance, you should load up on spinach salads with vinegar- or lemon juice-based dressings, entrees with tomato sauce, spicy entrees, or healthy meat-based dishes.

If you are flying and your trip is an hour or more, try brown bagging it. That way, instead of raiding the frig or mini-bar, you can reach into your own store of energy-rich foods that you brought from home. These can include raw, fresh vegetables with a flavorful dressing or dip, whole-grain crackers with almond butter, and a piece of fruit. 

If you tend to eat out frequently, then you know that it is tough enough to make healthy choices, let alone having those choices reflect your particular hormonal makeup. To help you out, Dr. Lark and I created several tools in Hormone Revolution to make your food selections much easier when you are dining out.

Whether you tend to be overall acidic woman dealing with menopause problems or a more alkaline, woman with estrogen dominance or someone with low estrogen levels but excess yin, eating out can prove to be tricky since you are not the one preparing the food.

Traditionally, people have chosen mostly highly acidic dishes and entrées when eating in restaurants. Luckily, all-American, overly acidic fare such as the 16-ounce porterhouse steak, French fries, and rich, sugary deserts, and French cuisine with its heavy butter- and cream-based sauces have been replaced or supplemented in many restaurants by lighter, healthier, and less acidic, more alkaline dishes. This is true both in American restaurants and in those serving ethnic cuisines. The important thing is to know which dishes on the menu represent the less acidic, more alkaline options and to select a variety of these types of dishes when dining out.

International Cuisine

The following list can help you make healthy choices, particularly if you are working hard to balance your female hormones. In general, you will want to order salads, non-dairy soups, vegetable or bean appetizers and side dishes, and vegetarian or fish entrées. Remember, most restaurants are willing to make up vegetarian entrées and platters at your request, even if they are not on the menu.

• American cuisine: salad or salad bars, bean or vegetable soups, baked potatoes, rice, vegetable side dishes or platters, fish or shellfish entrées.
• Italian cuisine: escarole soup, bean or minestrone soup, white bean salad, Caesar salad, risotto, polenta (cornmeal) with a mushroom sauce, grilled eggplant entrée, fish or shellfish entrées.
• French cuisine: vegetable or seafood salads, nondairy soups, vegetable side dishes, stewed beans, fish or shellfish entrées.
• Indian cuisine: lentils, rice pilafs, cucumber salad, curried vegetable or shellfish dishes.
• Chinese cuisine: stir-fried vegetables, sizzling rice soup, tofu or bean curd dishes, steamed rice, shrimp and mixed vegetable entrées.
• Japanese cuisine: Japanese salads, miso soup, sticky rice, sushi, side dishes and soups made with vegetables and tofu.
• Mexican cuisine: mixed vegetable salads, tostada salad, bean and rice side dishes, bean or shrimp burritos, chicken or shrimp fajitas, bean or seafood tacos (skip the cheese and sour cream).

The month of October is National Celiac Disease Awareness Month. As you likely know, celiac (also known as sprue) is an intolerance to the protein (gluten) found in wheat, rye, and barley. Current statistics show that about one in every 100 people is affected with celiac disease.

Symptoms range from mild to severe bloating, gas, diarrhea, constipation, cramps, fatigue, aches, flu-like symptoms, and/or mood swings. Any of these sound familiar? They should…they are similar symptoms to conditions as varied as irritable bowel syndrome, chronic fatigue, Crohn’s disease, and even fibromyalgia. No wonder so many people are either misdiagnosed or never even seen.

While celiac disease represents the extreme end of a gluten disorder, women with even a mild to moderate case of wheat or gluten intolerance (like me) can put their health at risk if they keep wheat on the menu. Some of the conditions that can be trigger by even a slight wheat intolerance include digestive inflammation, chronic fatigue, mood disorders, estrogen level imbalances, false fat-related weight issues, and migraine headaches.

In the case of digestive inflammation, wheat and other food allergies or intolerances can cause bloating and fluid retention in the abdomen. In addition to swelling and bloat (the “false fat”), wheat intolerance can cause intestinal gas and bowel changes.

Additionally, allergens such as wheat stress your adrenals, thereby triggering the release of anti-inflammatory hormones. Over time, these repeated allergic reactions can weaken your adrenals, greatly increasing your susceptibility to stress of all types and can lead to fatigue and low energy. Plus, recent studies indicate that an astounding 80 to 93 percent of women suffering from migraines also suffer from food allergies that trigger their headaches, and wheat is one of the most common allergens that triggers these incredibly painful headaches.

Finally, wheat can wreak havoc on your hormones. For women suffering from menopause problems, wheat can trigger mood shifts, due in part to your growing inability to produce enough enzymes that are needed to digest wheat properly and easily.  And for women like me who tend toward estrogen dominance, wheat can throw your estrogen levels even more out-of-whack, due in part to the high carb content, as well as the inflammation factor.

Clearly, wheat is one ingredient to keep off your plate. On Friday, I’ll give you a few tips and brands that make going wheat-free an easy and delicious choice for your health.

As we reach a certain age, it seems that more and more of our friends are being diagnosed with breast cancer. This can be disheartening and frightening. While we know women who are estrogen dominant or those who have eleveated estrogen levels are at greater risk for breast cancer, women in premenopause or even those experiencing menopause symptoms can be diagnosed with this awful disease.

However, cancer is not an inevitable part of growing older! Arming yourself with the right information on how you can prevent breast cancer from happening in the first place can help lessen your fears and improve your overall health. And a key piece of that information is an amazing nutrient that has been shown to significantly lower your risk of breast cancer: DIM.

DIM and Breast Cancer

DIM (diindolylmethane) is a compound found in Brassica vegetables such as broccoli, bok choy, cauliflower, cabbage, and Brussels sprouts. When you eat these vegetables, the chewing process releases plant enzymes, which in turn create a phytochemical known as indole-3-carbinol (I3C). DIM is formed directly from I3C in the acidic environment of the stomach. Best of all, DIM has also been found to be highly stable, requires no conversion, and promotes beneficial estrogen metabolism.

When we talk about estrogen or estrogen levels, we are actually referring to three different compounds: estradiol, estrone, and estriol. During estrogen metabolism, estradiol (the most potent of the three) is converted into estrone. Estrone then becomes either 2-hydroxyestrone (a “good” estrone metabolite) or 16-alpha-hydroxyestrone (a “bad” estrogen metabolite). The good metabolite (2-hydroxyestrone) is then converted into 2-methoxyestrone and 2-methoxyestrodial. These two estrogen metabolites have been shown to inhibit the growth of malignant tumors. Conversely, 16-alpha-hydroxyestrone has been strongly associated with cancer growth.

This is where DIM comes in. Research has shown that when DIM is ingested, it not only encourages its own metabolism, but that of estrogen. While it is not an estrogen or even an estrogen-mimic, its metabolic pathway exactly coincides with the metabolic pathway of estrogen. When these pathways intersect, DIM favorably adjusts the estrogen metabolic pathways by simultaneously increasing the good estrogen metabolites and decreasing the bad estrogen metabolites.

After many studies confirmed that the 2-hydroxyestrone to 16-alpha-hydroxyestrone ratio was a good predictor of breast cancer risk, researchers set out to determine if consumption of Brassica vegetables could influence this ratio. In 2000, American researchers took urine samples from 34 healthy postmenopausal women. They then added 10 grams of broccoli a day to the women’s diets. After taking another urine sample, researchers found that this dietary change significantly increased the 2-hydroxyestrone to 16-alpha-hydroxyestrone ratio.

A similar study conducted in 2001 looked at the dietary habits of postmenopausal Swedish women aged 50 to 74. When asked how often, on average, they consumed a wide variety of foods, including 19 different commonly eaten fruits and vegetables, researchers found that those women who ate 1 to 2 servings of Brassica foods a day had a 20 to 40 percent lower risk of breast cancer than those women who ate virtually none.

What’s a Girl to Do?

Clearly, we all need to eat more Brassica vegetables. Aim for at least two servings a day to help keep estrogen levels of estrogen metabolites in the right balance. You can also augment your diet with a good, high-quality DIM supplement. Dr. Lark suggests taking 30 mg of DIM a day.

Fall is my favorite time of the year. Not only does it mean snuggly sweaters and football, but it is also the time to pull out those soup and stew recipes. As you look through your favorites, keep your hormone type in mind.

If you have low estrogen levels and are experiencing menopause symptoms, you will want to lean toward recipes that are light on the spice and acid and high in vegetables, gluten-free grains, legumes, and seafood/fish.

If you have high estrogen levels and/or are estrogen dominant, then you’ll want to lean toward a diet rich in fruits and vegetables, poultry, fish, eggs, and more acidic condiments like vinegar and lemon juice. You will want to steer away from a grain-heavy diet.

In some cases, you’ll find that perfect recipe that pleases both estrogen profile. And here is just such a one for you!

Butternut Squash Soup
Serves 6

Butternut squash is rich in beta-carotene and vitamin C. Beta-carotene helps balance the estrogen excess in women with estrogen dominance, while vitamin C has many menopausal benefits, including the ability to fight heart disease by preventing the oxidation of LDL cholesterol.

Plus, the onions in the recipe provide the antioxidant power of quercetin. And with an antiseptic boost from sage, this soup is sure to keep your immune system strong during the cold winter months.

1 cup red onion, chopped
2 teaspoon olive oil
1 teaspoon ground sage
½ teaspoon sea salt
½ teaspoon cayenne pepper
3 cups vegetable broth
1 large butternut squash, peeled, seeded, and cubed
2 tablespoons soy or rice parmesan cheese (optional)

1. In a soup pot, sauté onion in olive oil over medium heat until soft
2. Add sage, salt, pepper, broth, and squash. Bring to a boil. 
3. Reduce heat and simmer for 25-30 minutes, or until squash is soft. 
4. Ladle ¾ of the soup in to a blender or food processor and purée. 
5. Pour back into pot and reheat for 5 minutes. 
6. Stir in parmesan cheese (if desired) and serve.

• Genistein is a phytoestrogen that provides significant help for menopause hot flashes, night sweats, and other menopause symptoms. If your hot flashes occur four or more times per day, taking geinstein in divided doses should help. 
• Hops is best known as a flavoring agent in beer, but it also contains a potent phytoestrogen known as 8-prenylnaringenin (8-PN). Studies show that 8-PN brings significant relief from hot flashes and other menopause symptoms within just six weeks of taking 100 mcg per day.
• Kudzu is a prolific vine that contains the phytoestrogen puerarin. It has been used extensively in Traditional Chinese Medicine to relieve menopause symptoms.

Today, I read an article in the Los Angeles Times about a new study published in the Journal of Women's Health that stated that gabapentin (a drug originally used to treat seizures and psychiatric disorders) is useful in helping women who have menopause hot flashes get better sleep. You can see the abstract here: http://www.liebertonline.com/doi/abs/10.1089/jwh.2008.1257.

Poor quality sleep is one of the most common effects of menopause, thanks to sleep-disturbing night sweats. However, I can't support the use of a medication such as gabapentin to help women with insomnia, especially when there are safer, more natural ways to promote better sleep. Side effects of gabapentin include drowsiness, headache, uncontrollable shaking, vision problems, anxiety, memory problems, nausea/vomiting, and strange or unusual thoughts--just to name a few!!

If you are experiencing menopause problems such as night sweats or hot flashes that are disturbing your sleep, I encourage you to try any one of these safe, effective, natural therapies:

If you are have healthy estrogen levels or are in early menopause or premenopause, then you should quickly make lycopene your close and personal friend. A fascinating study from the International Journal of Cancer found that high carotene intake, especially a diet high in lycopene, significantly reduced the risk of ovarian cancer in premenopausal women. Investigators suggested that consumption of fruits, vegetables, and food items high in carotene and lycopene, particularly raw carrots and tomato sauce, may reduce the risk of ovarian cancer.

To reap these benefits, aim for 10 servings of cooked tomatoes or tomato products every week. Just be sure to mix the tomatoes in an oil base, such as olive oil, to enhance lycopene absorption.

If you do not want to eat this much tomato-based food, or you simply dislike their taste, then lycopene supplements are a good alternative. Dr. Lark recommends taking 5–10 mg per day. Lycopene is available in most health food stores.

Unfortunately, lycopene does not confer the same protection against ovarian cancer in postmenopausal women that it does in younger women. Luckily, foods high in alpha-carotene and alpha-carotene supplements have been found to significantly reduce the risk of the disease in postmenopausal women.

And, animal studies have shown alpha-carotene is 10 times more effective than beta-carotene in suppressing lung, liver, and skin cancer, while other research has found that the nutrient is 38 percent stronger in antioxidant activity than beta-carotene.

Foods highest in alpha-carotene are carrots, corn, squash, watermelons, green peppers, potatoes, apples, peaches, and leafy green vegetables. If you prefer a supplement, Dr. Lark suggests taking 25,000 IU of mixed carotenoids that contain a blend of both alpha- and beta-carotene.

When it comes to ovarian cancer prevention, there are definitely categories of foods that you should avoid, namely caffeine, dairy products, and red meat. In the case of caffeine, several studies have shown a connection between regular caffeine intake and cancers of the reproductive system. For example, in one study from the September 2000 issue of the International Journal of Cancer, researchers compared the coffee intake of 549 women who had been newly diagnosed with ovarian cancer with that of 516 women without the disease. They found that the consumption of coffee, and caffeine in general, was linked to an increased risk of ovarian cancer in women in early menopause or premenopause.

Similarly, dairy products and red meat can also increase your risk for ovarian cancer. According to a 2003 study, also from the International Journal of Cancer, women who consumed more dairy products and red and white meat were at increased risk for ovarian cancer. Most likely, it is the saturated fats found in these two food groups that put women at high risk for the disease, as they elevate estrogen levels. And, as I wrote about earlier, elevated estrogen levels can lead to or contribute to one of the biggest risk factors for ovarian cancer—estrogen dominance.

In addition to avoiding certain foods, there are others you should strive to eat more often. These include cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, etc.). In a study from the International Journal of Cancer, researchers looked at the frequency with which 609 ovarian cancer survivors in three Australian states ate certain foods and took certain supplements. They found a "survival advantage" in those women who consumed more vegetables in general, especially cruciferous vegetables. They also observed a significant advantage among those women in the upper third of vitamin E intake.

A second study found that vitamin E is not alone in its cancer-fighting benefits. In a 2001 study from Nutrition of Cancer, researchers asked 168 women with ovarian cancer and more than 200 cancer-free women to record their intake of specific foods and supplements. They found that women who took in more than 363 mg of vitamin C a day had a 40 percent lower risk for developing ovarian cancer, while women whose daily intake of vitamin E exceeded 75 mg had a 33 percent decreased risk for the disease.

A 2002 study from the same journal confirmed this conclusion. Researchers found that supplementing with vitamins C and E did indeed appear to significantly decrease the risk of ovarian cancer by about 50 percent.

The bottom line? To help avoid ovarian cancer, avoid caffeine, red meat, and dairy products. You can also increase your consumption of foods high in vitamins C and E, as well as cruciferous vegetables. These include: wheat germ oil, sunflower seeds, almonds and almond butter, and flaxseed and flaxseed oil (all high in vitamin E). For those high in vitamin C, aim for any fruit, tomatoes, red bell peppers, broccoli, cauliflower, spinach, celery, and avocado. Finally, your cruciferous veggies include broccoli, cauliflower, Brussels sprouts, kale, collard greens, bok choy, watercress, radish, and mustard seed.