This in-depth article, written by Dr Plaskett, presents the topic of Nutrition & the Menopause. He describes the nature of the menopause & the physiological aspects including the adverse symptoms that a woman can experience during this change of life. There is strong focus on osteoporosis as this is the most definitive and measurable symptom of the menopause, however he also addresses additional physical, general & mental symptoms. The article covers the orthodox treatments of Hormone Replacement Therapy (HRT) and Dr Plaskett uses research to discuss why nutrition can be used as a Menopause Alternative Treatment..
In discussing this approach, Dr Plaskett shares evidence of essential food substances which have the potential to give significant physiological support to menopausal women, including phytoestrogens (which exert weak but definite oestrogenic effects in the human body); chromium (through its effect on insulin); calcium intake; micro-nutrients such as the vitamins, flavonoids & essential fatty acids necessary for a healthy organic matrix as well as the role of trace minerals which are serious candidates for supplementation in preventing or treating osteoporosis.
In relation to osteoporosis, the diet and lifestyle factors which positively and negatively influence the uptake of calcium into bones are covered, stressing the importance of taking steps to prevent osteoporosis and entering the menopause with well mineralised bones rather than trying to reverse its consequences afterwards.
Despite other symptoms of the menopause being more difficult to treat nutritionally, Dr Plaskett shares what can be done through diet and supplementation with the main nutrients (which have a direct and specific effect upon such symptoms) & other nutrients (which have an indirect, though no less beneficial action upon menopausal symptoms), so explaining why women of menopause age with good nutritional status and with less exposure to industrialised foods generally have an easier time at the menopause than those who do not.
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The Nature of the Menopause
The menopause is a very obvious key point in a woman’s life. A time when menstruation and ovulation cease, with the obvious concomitant that reproductive life is at an end, is bound to be an emotive watershed. For many a woman, (though not, of course all) her self-image during her reproductive years may owe much to her sexuality and her potential to conceive and to bear children. In society generally, notwithstanding a growing tendency, to share or even exchange roles with men, many women still view their worth and sexuality in terms of their childbearing and child-rearing potential. It is a connection that cannot be removed, only diluted slightly, by recent shifts towards liberalising society’s views about women, and by modern ideas about “the woman’s role” in society.
That this should be so, says nothing about the obstinacy or rigidity of male ideas, nor does it say anything about any failure of the feminist movement. This is about the woman’s image of herself – for there is usually no way that she can separate herself from the effects upon that image that arise from her child-bearing role, regardless of whether or not she actually bears children. Gay women and those who have otherwise successfully “broken the mould” may be excluded. However, this issue repeatedly recurs in patient consultations about the menopause and hormone replacement therapy. Hence, when this time of change is nigh, it is bound to be a major force in life. One woman of my acquaintance, upon hearing the results of a medical test that showed that she was menopausal, hurled furniture about with such fury and with such a force as to smash it to splinters. Unfortunately, unwillingness to accept the change when the time comes hurts only the woman concerned, for the change is inevitable. At the other end of the scale, women who are more willing to accept their own position are much more likely to accept the changes of the menopause, recognising them as a necessary part of life’s pattern. Indeed, most positively, such a woman may be able to look forward positively to the postmenopausal period. The ending of reproductive capacity also brings an end to any danger of unwanted pregnancy. Given favourable circumstances in life otherwise, she may be able to look forward to the postmenopausal period being both longer than the pre-menopausal, and also accompanied by much more freedom of personal decision-making and actions, including more freedom of choice in her occupation(s) and lifestyle.
Unfortunately, some women mistakenly feel that the coming of the menopause will mean reduced sexual feelings and less sexual activity and satisfaction, whereas that is not necessarily the case. Negative feelings about the change are needless. Perhaps the most normal and expected feelings are those connected with a “turning point” in life – a sense that what now follows will be rather different from what went before. The Japanese refer to this as having an awareness of “fu shi me”, showing that they recognise it as a definite mental outlook. Looked upon positively, that realisation can be entirely constructive, leading one to look to the future for the different things that it can now be expected to bring. Most importantly, when contacts around one promote negative feelings about the menopause, especially feelings which connect it with either reduced sexuality or the onset of old age, these need to be set aside, and not accepted – for it truly has nothing to do with either of them
The physiological aspects of the menopause
It arises from the cessation of ovulation, which occurs regularly each month throughout the premenopausal period by the maturation of “follicles”. At ovulation, a follicle bursts to release an ovum, or egg, which then passes down the fallopian tube to the womb, or uterus, where, if it becomes fertilised, it may embed and develop into a foetus. During this phase of a woman’s life, the active ovary produces the female sex hormones known as oestrogens, in a monthly cyclical manner.
These hormones are largely responsible for the development of the so-called “secondary sexual characteristics” in females, such as breast enlargement. The rises and falls in the oestrogens circulating in the blood are related to, and in many respects control, the events in the female monthly cycle. The other principal hormone involved in this cycle is progesterone, which is produced during the second half of the monthly cycle after ovulation has occurred. It plays an important part in preparing the conditions necessary for pregnancy. Its source is a body within the ovary called the corpus luteum (meaning yellow body), which develops from the follicle after it has burst.
These activities of the ovaries are in turn controlled by other hormones from the anterior pituitary gland, known collectively as “gonadotrophins”. In particular, these include the follicle stimulating hormone (FSH), which stimulates the follicles of the ovary to mature, and the luteinising hormone (LH), which promotes the growth and activity of the corpus luteum. These hormones are produced all through the pre- menopausal period and they are essential to normal female reproductive function. However, the levels of output of these hormones is in turn controlled by the circulating levels of oestrogens and progesterone. Therefore a balanced steady state is achieved through the premenopausal period. However, once the ovary stops producing normal quantities of oestrogens and progesterone the pituitary gland increases its output of FSH and LH as if in an attempt to promote further activity. In fact, at this stage the ovary is commonly regarded as being exhausted of eggs, which the ovaries contain only in limited numbers, about 400 in a young girl when menstruation begins. When the menopause starts, these have mostly gone. However, just a few may remain and one or two of these may be released intermittently, a factor that represents a certain risk of unplanned pregnancy in the period just before the menopause is completed. As these changes proceed, the FSH and LH levels in the blood rise, as already discussed. These hormone levels therefore become diagnostic of the menopausal condition, raised levels serving to confirm that the menopause is in progress. The high level of LH, and in particular short- term surges in LH release, has been connected with the generation of the “hot flushes” of the menopause.
The menses may stop suddenly, but more often there is a decreased flow each month until there is a final cessation, or the interval between periods may be lengthened until complete cessation occurs. Natural menopause occurs in 25% of women by age 47, in 50% by age 50, 75% by age 52 and 95% by age 55.
Adverse Symptoms of the Menopause
It is unfortunate that in societies with a “Western” lifestyle, and to a lesser extent elsewhere, the onset and continuation of the menopause are often accompanied by undesirable symptoms. This inevitably reinforces the negative view of the menopause. This however is not a fair and balanced view if one considers that by adjusting one’s lifestyle, these adverse symptoms may be largely overcome.
The best known of these negative symptoms is osteoporosis; a condition in which the bones lose a substantial proportion of the calcium phosphate mineral substance that hardens them. The result is a loss of strength in the bones and hence a tendency to fracture. A section across bone that has been affected in this way shows it to be porous – full of tiny holes. The condition may well be symptom-free until a fracture occurs. Whilst fractures may occur in anybody, given a severe enough blow, the characteristic of osteoporosis is the occurrence of fractures even with fairly light stress to the bones. An example of this was a woman who broke her ankle merely by pulling up sharply in her car. The pressure of applying the brakes rather harder than usual produced the fracture, which would never have happened to a person with normal bone structure. Diagnostic tests exist within orthodox medicine for measuring bone density, but unless there is reason to suspect some problem, these measurements are unlikely to be applied. Hence a fracture may be the first indication of trouble.
Osteoporosis is the most definitive and measurable symptom of the menopause. There are many others, however. Hot flushes, vaginal dryness, night sweats and palpitations are additional physical symptoms. Fatigue, insomnia, poor stamina, feelings of weakness, stress symptoms, night leg cramps, easy bruising and spontaneous nosebleeds are also prominent, but less specific, general symptoms. Mental symptoms include anxiety, irritability, mood swings, depression, excessive worrying and memory loss. Although these symptoms are often worse at the time of the menopause, they are obviously not specific to it and may occur at any time throughout life. It is clear that the prime triggering causes of these problems are related to the withdrawal of oestrogens and/or progesterone. In the case of the hot flushes, the excess of circulating LH has been implicated, but this too would be corrected by increasing the concentrations of circulating oestrogen and progesterone towards the premenopausal levels. Because the whole condition appears to be completely geared to the body’s availability of steroid hormones, it is not surprising that orthodox medicine came up with hormone replacement therapy (HRT) as a treatment.
Hormone Replacement Therapy
The contrast between orthodox and alternative medical solutions lies in some quite deep aspects of medical philosophy. In thyroid gland insufficiency orthodoxy administers thyroxine, a thyroid hormone. Alternative medicine methods seek instead to regenerate the body’s own production of thyroxine. In diabetes mellitus, orthodoxy quite straight-forwardly prescribes insulin; this represents once again a simple replacement of the missing hormone. Alternative medicine methods seek instead to regenerate the body’s own production of insulin from the pancreas. In the eyes of alternative practitioners, orthodoxy stands for direct intervention to provide whatever is shown to be missing, ignoring any effects which that might have upon the patient’s own glands. Obviously, such an approach is far better than no answer, since it saves lives once an emergency has been allowed to develop, but this approach is insensitive to the needs of the body to return to normal function. Instead, it traps the patient into a position of permanent dependence upon the prescribed hormone.
Therefore, the orthodox medical solution to adverse symptoms of the menopause is to prescribe oestrogens and progesterone. Such a prescription constitutes HRT. Depending upon circumstances, supplementary calcium and vitamin D may also be advised. One review by Heaney (1) concentrates upon such an orthodox viewpoint, it is a very simple and direct approach, lacking subtlety and ignoring the fact that women have undergone the menopause since our species first evolved. In another review given by Prentice (2), they come to the conclusion that the link between intakes of any dietary component and fracture risk to the individual is not sufficiently secure to make firm recommendations on their intake. They do however give the exception of calcium and vitamin D in this case.
Admittedly, the number of women reaching menopausal age was modest before the 20th Century, but have women always had a bad experience of it? Is HRT the only way out? Did the species evolve over aeons of time with a dependence upon a medical treatment that would only become available only in the 20th Century? Before attempting to answer these important questions, it is worth looking at HRT and assessing whether the benefits outweigh the dangers and disadvantages.
Drawbacks of Hormone Replacement Therapy
Some of the potential side effects are listed here for your information. One aspect of a particular form of treatment that we feel should be mentioned is regarding certain HRT drugs that are derived from the urine of pregnant mares (horses.)
From the website 'People for the ethical treatment of animals' www.peta.org : "According to an industry report, 26 ranches in remote areas of North Dakota and Canada house approximately 2,000 pregnant mares who produce urine for Premarin and Prempro. For most of their 11-month pregnancies, these horses are confined to stalls so small that they cannot turn around or take more than a single step in any direction. The animals must wear rubber urine-collection bags at all times, which causes chafing and lesions, and their drinking water is limited so that their urine will yield more concentrated estrogen. Once the foals are born, the horses are impregnated again, and this cycle continues for about 12 years. PMU ranchers are expected to follow the “Recommended Code of Practice for the Care and Handling of Horses in PMU Operations,” but following these guidelines is optional.
Some of the potential side effects of HRT are:
ABNORMAL VAGINAL BLEEDING
GALL BLADDER DISEASE (INCREASED RISK)
HEADACHES OR MIGRAINES
LOSS OF HAIR
LOSS OF SEXUAL DRIVE (LIBIDO)
THROMBOSIS (BLOOD CLOTS)
UTERINE AND BREAST CANCER (INCREASED RISK)
VOMITING OR NAUSEA
Not all sources of HRT drugs are from mares by any means, but clearly, this particular source is tainted by an element of animal cruelty.
Many women have found a better way, for them at least, by using a natural nutritional and herbal approach for the changes that accompany menopause.
Why Nutrition May Work Better
As to whether or not the human female evolved to suffer adverse symptoms at the menopause, can be addressed in a number of ways. In the first place, it seems rather unlikely to be so, since most natural systems evolve to work properly, at least when conditions are favourable. We cannot possibly know whether cave women suffered from the menopause, though it is clear that they often failed to live long enough to experience it. However, it is a lot easier to ask whether adverse menopause symptoms are the norm today, on a global basis rather than just looking at our own society. It has been reported that the incidence of hot flushes, the most common of the symptoms of the menopause, varies from 70-80% of menopausal women in Europe, 57% in Malaysia, but only 18% in China and 14% in Singapore. (3) (4)
Whilst it could be genetically based, such a wide global divergence strongly suggests differences in lifestyle. Substantial dietary differences exist between these populations, especially with regard to the consumption of soya products. Soya beans contain substances called phytoestrogens, which, although for the most part are not steroids like the normal human oestrogens, exert weak but definite oestrogenic effects in the human body. Obviously, such substances have the potential to give significant physiological support to menopausal women whose symptoms arise from relative oestrogen deficiency.
Foods that are high in phytoestrogens include certain fruits (apples, cherries, olives, plums, coconuts), legumes (soy beans, peanuts), tubers (carrots, yams), members of the nightshade family (eggplant, tomatoes, potatoes, peppers), grains (cereal grains and especially wheat germ, but not rye, buckwheat or white rice). Similar components are found in yeast. Fennel, anise, and liquorice all contain estrogenic compounds. However, concentrations and activities vary greatly and none appear to rival the soybean in effectiveness.
The menopause is after all only a necessary physiological phase in human life. It is therefore possible to hypothesise that it was usually quite manageable without significant symptoms in Western countries so long as the diet of the population remained unaffected by industrialisation and modern farming practices. This would have generally ensured that people ate large amounts of unprocessed plant foods. Depending upon the choice of foods, this would tend to ensure a certain daily intake of phytoestrogens. The industrialisation of farming and food processing would certainly have greatly reduced this intake, for example, by stripping off the outer coat from grains – the phytoestrogen content of rice is an oil-soluble fraction within the bran, for instance. This is known as gamma oryzanol and can be obtained in isolated form. Clearly, the drop in circulating oestrogens and progesterone that occurs at the menopause, which is a drop to about one third of the premenopausal level, is potentially critical. The proposal made here is that this criticality was held at bay by the make up of human diets of unprocessed foods over the last two million years, but became exposed as soon as industrialised diets came about and removed a proportion of the phytoestrogen support.
There are, however, two other nutritional theories to add to the above. The first of these is that the status in other nutrients can have an effect upon the level of the body’s own oestrogen production. This appears to be true of the mineral chromium. One report by Evans et al (5) indicates that by ensuring adequate status of chromium in the body after the menopause, a woman can increase her internal production of the oestrogen dehydroepiandrosterone by some 20%. The Meeting Abstract, in which the references to the hormone insulin are of particular interest, reads:
“Osteoporosis results from the resorption of bone due in part to the absence or inaction of insulin and estrogens. Insulin resistance impairs bone calcium deposition and leads to hyperinsulinaemia that impairs the synthesis of DHEA. In post- menopausal women, DHEA is the only source of estrogens, inhibitors of osteoclast activity. Because chromium supplements reverse insulin resistance, we tested the effect of chromium picolinate (CrPic) supplements on factors which lead to osteoporosis. For a period of 60 days, 27 postmenopausal women, age 52-63, took two capsules per day that contained either a placebo or 200mcg Cr as CrPic. After a 3- month washout, the women were given the opposite supplement. During the period on CrPic, plasma insulin (2hr post-75g oral dextrose) decreased 37.6%, plasma glucose decreased 26% and DHEA increased 24%. During that period, the urinary hydroxyproline/creatinine ratio decreased by 23.5% and the urinary calcium/creatinine ratio decreased by 19%. The placebo had no effect on any of the parameters measured. When an 800mg/day calcium supplement was combined with CrPic supplements for 60 days, the urine hydroxyproline/creatinine ratio decreased by 47%. These results suggest that chromium, through its effect on insulin, may be effective in preventing osteoporosis.”
The reader is invited to read this quotation again later, after reading the section on osteoporosis, when the details of it will be more easily understood. However, referring specifically to the biochemical parameters measured in the above paper, the drop in plasma insulin may be taken to show that insulin is being used more effectively as a result of the chromium supplement. The decrease in plasma glucose also indicates the better use of insulin. The rise in DHEA level is important because DHEA affects the way we feel and it is a precursor of oestrogen. The urinary hydroxyproline/ creatinine ratio will be discussed below, but a reduction in this value indicates that less bone tissue is being broken down. The urinary calcium/creatinine ratio also diminishes when less bone is being broken down or when more bone mineral is being deposited. The results of the above study appear to indicate that bone metabolism is being very strongly supported by chromium supplementation and that a large proportion of the benefit is mediated through increase in the level of circulating oestrogen.
This has been given here as an example of the way in which micronutrient status may affect menopausal symptoms. In this case the micronutrient involved has no obvious connection with the production of oestrogens, but was nonetheless found to be quite closely connected.
The fact that oestrogen production in the body was found to be inhibited by “insulin resistance” is potentially very important and is apparently related to Western lifestyle factors. This phenomenon of “insulin resistance” is widespread, being associated with obesity, with Type II diabetes and with prediabetic conditions that arise from micronutrient imbalance and deficiency. Hence, the simultaneous prevalence in society of “insulin resistance”, obesity and of menopausal symptoms are quite likely to be jointly associated with factors in the Western lifestyle.
This may be a good example of the kind of way in which other nutrients may influence either the circulating oestrogen levels after the menopause or, perhaps, directly affect menopausal symptoms. New research on the trace minerals boron and strontium has shown that they have a major impact on bone integrity. They are mentioned here to further highlight the complexity of bone metabolism, and to draw sharp attention to the fact that substances other than oestrogen can have major effects on bone density.
Rosetta Reitz, in a book called “Menopause – A Positive Approach”, certainly believes from her work in the field that the quality of food and nutrients generally affect the severity of menopause symptoms. She wrote, “Among the women I interviewed I found that those who were concerned with the food they ate were experiencing their menopause with more ease.” Elsewhere she writes, “Altogether, have noticed that the women who take vitamins regularly have less problems.” The reader is invited to bear these observations in mind while studying the detailed sections that follow. Overall, there are both general and specific reasons for thinking that by avoiding nutritional imbalances and becomes freer from symptoms
Osteoporosis - the Nature of it and its Orthodox Treatment
As explained already, osteoporosis is the condition in which the bones loose mineral content and, as a result, become structurally weakened. It is a major health problem in all Western countries, and is a condition in which many dietary factors have been implicated. In the United States one third of the female population develop osteoporosis severe enough to cause a fracture at some point of their lifetime. At least 1.2 million fractures (primarily of the hips, vertebra or wrists) occur each year as a direct result of osteoporosis. The medical and social costs of this epidemic were estimated in 1990 to be $1.6 billion annually. In women, bone mass begins to decline at 35 years of age, and then accelerates for 8-10 years around the time of the menopause. Thereafter, bone loss continues at a slower rate.
In one study (6) made to determine the influence of diet on bone mass, the intake of 14 nutrients was measured in 159 white women, aged 23-75 years and bone mineral density (BMD) measured in the hip and in the spine and forearm and other sites. No significant correlation was found between current calcium intake and bone mass at any site. The participants in the study were Westerners, who were all likely to have more than adequate calcium intake, so this showed that variations in such intake were unimportant. Iron was a positive predictor of BMD in the femoral neck and alcohol intake a positive predictor of BMD in the proximal femur in premenopausal women. Iron, zinc and magnesium intake were positively correlated with forearm BMC in premenopausal women. Iron and magnesium were significant predictors of forearm BMD in premenopausal and postmenopausal women respectively. These results indicate that bone mass is influenced by dietary factors other than calcium. This particular study identified the following factors as affecting bone mineral density, but, as will be demonstrated, there are a good many more: nature of diet, alcohol drinking, body weight, caloric intake, magnesium intake and zinc intake. The fact that current calcium intake was shown in this study to be unrelated to the degree of mineralisation of the bones highlights the fact that overall the literature is by no means clear about whether this issue of calcium intake is important or whether the main influences upon bone health arise from other nutritional factors. Meanwhile, the medical orthodoxy continues to stress only calcium intake (with vitamin D to increase its absorption), while giving steroid hormones as HRT.
It should be noted that the bone density of premenopausal women is important because those women who enter the menopause period with well mineralised bones will fair best and be the more likely to avoid osteoporosis problems
Osteoporosis and the Effects of Calcium Intake
The orthodox stated daily requirements for adults usually range from 500mg to 1,000mg, a very commonly quoted figure being 800mg. In recent years, in the UK the value has been slightly reduced to 700mg per day as a “Reference Nutrient Intake” (RNI) for an adult.
Reasons to Question the Orthodox View on Calcium Intake
There is ample evidence from studies reported around the world (some are mentioned here) that non- European peoples can live well and produce good strong (well calcified) bones on far lower daily intakes of calcium than those common in Europe and North America.
These published papers, often quoted in standard textbooks on orthodox nutrition, should have alerted nutritionists that there is something questionable about the RNIs for calcium normally accepted in orthodox circles in the West. But this message does not appear to have been received, for orthodox nutritionists go on advising 1,000mg of calcium or more per day and drinking plenty of milk to obtain it.
There would appear to be only two possible explanations for the very marked differences found between the calcium requirement of European and non-European peoples. The first would be that there is some genetic difference that renders the non-European peoples much more immune to calcium deficiency. No one appears to think, however, that that is the real explanation even though genetic differences do exist within populations, which predispose to better or worse bone density.
NICHOLLS,L. (7) Showed that growing children in Sri Lanka could maintain a positive calcium balance on intakes of about 200mg per day.
This general conclusion is confirmed by Murthy (8) in India and Hegsted (9). Which showed that Peruvians on different levels of calcium intake excreted less calcium than would have been expected from reports in the North American and European literature. Their subjects had become accustomed to diets low in calcium, but apparently they were also much better retainers of ingested calcium.
Also Walker (10) where the adult Bantu of South Africa, receiving no more than 300mg of calcium per day, have a normal plasma calcium concentration and, more important, normal amounts in their bones.
If not that, then there must be some influence or influences exerted upon European peoples which in theory could be either dietary or non-dietary which interfere in the normal management of calcium in the body, giving the European peoples the penalty of a higher calcium requirement. If that is the case then, surely, the Europeans should be capable of ridding themselves of these undesirable influences and avoiding this substantial dependence upon high calcium intake. Seen in this light, the work done in India, Sri Lanka, South Africa and Peru would reflect the more normal state of human calcium nutrition. On the other hand, the picture that occurs in the West generally, in which high calcium intakes are necessary to avoid calcium-related health problems appears to be a deviation from normality, brought about by factors in Western lifestyle. One might describe these factors as “errors” of the Western lifestyle. There are therefore grounds for asserting that the normal adult daily requirement for calcium is close to 300mg, so long as the anomalies of a Western lifestyle can be avoided.
Such a conclusion has potentially far-reaching implications. Many people in Europe and North America feel anxious about their calcium intake and cannot conceive how they could possibly reach their daily requirement if they did not consume milk and other dairy products (which are particularly high in calcium). Yet many parts of the world have an unsuitable climate for supporting dairy herds in any numbers, or simply the dairy cow has no part in the local culture, so that consumption of dairy products is very low or absent. Given that situation, are we to believe that humans were devised to be entirely dependent upon the dairy cow? The fact that people can thrive in parts of the world that are devoid of dairying, would indicate not. So does the knowledge that humans existed long before dairy herds existed at all.
It is ironic that milk, although it supplies much calcium, is actually one of the dietary factors, rather peculiar to Western culture, which increases one's calcium requirement. The reasons for this may be rather complex, but are likely to be determined by the effect of milk upon the sodium/potassium balance inside the cell. Dietary dependence upon milk is, indeed, a major factor responsible for the Western pattern of disease. If one eschews milk one dispenses with a high calcium source, but one has also taken the first step towards becoming less dependent upon a high calcium intake.
These considerations lead to the conclusion, then, that the idea of a fixed and absolute daily requirement figure is really nonsense. The daily requirement for calcium is clearly a variable factor, dependent upon the balance of other nutrients being received by the particular individual or population, and may well depend upon non- nutritional factors also.
Osteoporosis is, however, a ‘Western disease’, and hence can be presumed to have its roots in whatever adverse practices of the Western lifestyle are responsible for upsetting the normal pattern and balance of body calcium.
Loss of Bone Density in People with Substantial Calcium Intakes
So women over about 50 years are the most vulnerable group in our society. A woman who incurs a 40mg daily loss of calcium on a 500mg/day intake will most probably require about 650mg per day to reach a fairly safe calcium balance. So an intake at that level can be expected to be sufficient for the average older woman. However, there are always some individuals who are worse affected than the average; if a woman were to develop a daily calcium deficit of 80mg on 500mg/day then she would probably require as much as 800mg (which is actually above the orthodox RNI) to reach a safe position. Those who are responsible for evaluating RNIs have to take the most vulnerable groups into account. One should bear in mind also that some Western estimates of the daily calcium need are up to 1,000mg or even higher. Eventually, the levels of calcium intake required to overcome the calcium-wasting effects of the various adverse dietary and environmental factors in the Western lifestyle become impracticably large. The condition then also becomes associated with excessively high rates of urinary calcium loss, a raised level of cytosol calcium inside the cells of soft tissue, and a proneness to “dump” calcium out of solution as solid deposits in various part of the body soft tissues. Calcium, especially insoluble solid calcium deposits, are inappropriate in these places and may have pathological consequences. Ultimately, as the degree of exposure to the adverse dietary and environmental factors becomes still worse, we reach a point beyond which the addition of still further quantities of dietary calcium is altogether ineffective in depositing any extra calcium at all within the bones. At this point all of the extra calcium intake is wasted, either harmlessly, through urinary excretion, or possibly harmfully, through the laying down of calcium deposits in quite inappropriate parts of the body where it interferes with normal functioning. Also, flooding the cells with excess calcium may well have adverse influences upon cellular metabolism and control.
Obviously, this means that for anyone exposed to Western lifestyle concerned with the danger of loss of bone density, a choice exists. It is a choice between continuing to follow unmodified Western dietary patterns, and trying to balance it out with nothing but extra calcium intake, or, on the other hand, modifying lifestyle and diet, so to remove the adverse influences. The latter course will result in a return to a position in which a more modest intake of dietary calcium is sufficient for maintaining normal bone density. Clearly, the former option may necessitate the adoption of very high levels, indeed, of calcium intake, and may entrain the risk of calcium "dumping" problems which may lead towards arthritis and spondylitis, gallstones, renal stones and, perhaps, arterial atheroma. In the worst cases it may also be completely ineffective.
It is possible to summarise the conclusions from these observations as follows. The normal adult daily calcium requirement of humans is about 300mg per day, as is confirmed by studies on the actual calcium intakes of peoples living non-Western lifestyles. It was not found necessary in these studies to make any distinction between the most vulnerable group of premenopausal and postmenopausal women, and other members of the population. However, in Western society, due to the prevalence of factors un-favourable to good calcium balance, this value is generally advanced to 500mg. Moreover the more vulnerable group of women over the age of 50 may require, under the conditions of a Western lifestyle, a daily intake up to 800mg or even more. If they are prone to more severe metabolic disturbance, they may take gross intakes of several grams of calcium per day without solving the problem at all.
One might add that the same is also true of people of any age and either sex in Western countries if they have been suffering an individually high exposure to the various adverse dietary and lifestyle influences. Under these conditions calcium supplements of 1,000mg, 1,500mg or, in some cases, 3,000mg per day may be used on top of the 800mg per day which the Western diet already generally contains. These are bizarre levels.
There is therefore a degree to which the adverse influences we are speaking about can at least appear to be offset and compensated for by increased calcium intake. There does come a point however, as has been demonstrated above, beyond which that is no longer possible. We shall also be seeking to show that it is far better to avoid the adverse influences anyway than seek to circumvent them by using quantities of calcium so large as to cause other health complications.
One of the adverse influences has already been identified as milk consumption. Others are hinted at in this further quotation from Avioli:
"Modern diets, which are characteristically rich in animal proteins and phosphorus with low Ca/P ratios, may prove deleterious to bone because they may promote hypercalcuria (high calcium in the urine) and stimulate the release of parathyroid hormone with a resultant progressive decrease in bone mass."
So as well as high milk consumption, the following can also cause health problems:
● Diets high in animal protein
● Diets high in phosphorus
● excess release of parathyroid hormone.
It will also be possible to identify the other factors in the Western diet and lifestyle which interfere with correct calcium balance and metabolism, including magnesium deficiency, zinc deficiency, boron levels and aluminium toxicity.
The Crucial Need for Micronutrients, Magnesium and Silicon – Nutritional Treatment for Osteoporosis
To understand why there is a need for nutrients other than calcium to protect against osteoporosis calls for a clearer mental image of what exactly is happening in the bone. The popular orthodox medical view is to envisage the bone as if it were an inert substance into which calcium is deposited according to its immediate availability. However, the alternative view, and one to which many research biochemists might be expected to subscribe, is to picture the bone as a complete living tissue with all the usual nutritional requirements of living cells. If this living bone is to become vital, strong and in good health, all the nutritional requirements of its living tissues must be met. How can it be expected to deposit calcium to the full extent if its living cells are not in good order, having their metabolism adversely affected by nutritional deficiencies and imbalances? Clearly, if one accepts the general thesis already set out in this article that the overall supply of essential micronutrients affects the likelihood of a women experiencing adverse menopause symptoms, then this is consistent with the idea that the bone tissue itself should be properly nourished.
The principal substance of the bone does not just comprise mineral, or even the cells. There is a protein component of bone which has received surprisingly little attention despite the fact that osteoporosis has been shown to affect both the mineral and non-mineral components of bone. The organic matrix, forms about 30% of our bone mass. 95% is composed of collagen, with another protein called osteocalcin. The tensile strength of bone is directly influenced by the health of this organic matrix. This, together with the mineral density, is a major factor that determines whether our bones will shatter easily, as is seen in the bones of the elderly, with or without osteoporosis.
The non-mineral nutrients necessary for a healthy organic matrix are vitamin C, and the B vitamins B6, B12, and folic acid, which are often deficient in the elderly and have been implicated in the pathogenesis of osteoporosis. A deficiency of any or all has been shown to cause defective organic matrix, which then cannot be effectively mineralised. Whilst their greatest influence tends to be in older women, long after the menopause, there is some positive indication for the use of these vitamins for all who are at possible risk of osteoporosis. Taking 500mg of vitamin C per day plus a sufficiently strong vitamin B Complex capsule can fulfil this.
Research (11) has shown that vitamin K deficiency could lead to impaired mineralisation of bone due to decreased osteocalcin levels. Osteocalcin is one of the proteins in the organic matrix with a role in binding calcium to the matrix. The requirement for this vitamin can be explained biochemically. Osteocalcin contains a special unusual amino acid called gamma carboxyglutamic acid, whose presence is needed to make osteocalcin a really tight binder of calcium. Vitamin K is needed for the conversion of glutamic acid to its gamma carboxy derivative. Vitamin K is found in abundance in green leafy vegetables. Osteoporotic women have been found to have only 35% of the blood vitamin K levels that are normal in age-matched controls.
The importance of folic acid (one of the B vitamins) for bone health seems to be connected with its role in the metabolism of the amino acid homocysteine. Methionine, one of the essential amino acids present in food proteins, is converted in the body partly to homocysteine, which, although it is a normal product of metabolism, becomes toxic if it accumulates. The importance of this has been shown up as a result of finding some individuals with a genetic fault of the enzymes for the removal of homocysteine. In these people, homocysteine accumulates to high levels and they become subject to osteoporosis from an early age. Usually, premenopausal women are very efficient at removing homocysteine from their system but this ability is reduced at the menopause. Serum homocysteine levels were measured in female volunteers after they received a dose of methionine. The levels were substantially greater in postmenopausal than in premenopausal women, with no overlap between the two groups. Treating the women with folic acid partially prevented the methionine-induced rise in serum homocysteine. This happened even though none of the women were folic acid deficient according to orthodox measurements. Hence, the menopause appears to be associated with an increased requirement for folic acid, which, if it is not met, leads to increased homocysteine in the blood and thence to osteoporosis. The study quoted in this paragraph is that of Battstrom L.E. et al (12)
Folic Acid deficiency is quite common and typical American diets have been said to contain only half the recommended daily allowance. Folic acid status is further damaged by oral contraceptives, alcohol and smoking.
Several flavonoids have been claimed as showing remarkable abilities to stabilise collagen structures. These are the proanthocyanidins and anthocyanidins found in berries with deep red-blue juice. Since collagen is the major protein structure in bone, stabilisation of its integrity and structure with a high and regular intake of these berries is pleasant and, probably, advisable, though more research on this is needed. It will be noted below that some other slightly different flavonoids occur in oranges and lemons, and these are useful in connection with other menopausal symptoms. Grape seed may also be used as a source.
ESSENTIAL FATTY ACIDS
Omega 3 fatty acids are both nutritionally essential yet rather scarce in the UK and US diet except among those who consume a fair amount of fatty fish, like mackerel, herrings and salmon. Fish oils provide these acids, mainly as eicosopentaenoic acid (EPA) and docosahexanoic acid (DHA); they are recommended to be taken in the dosage of 3 grams of the pure acids per day. They are essential for many processes within the body and this has been shown to include the maintenance of strong bones. In the case of non-fish eaters, flaxseed or flaxseed oil may be used.
The Role Of Trace Minerals
This can be best understood by consulting a detailed review of the literature, such as that by Wallach S. & Chausmer A.B (13), which discusses most of the minerals which are serious candidates for supplementation in preventing or treating osteoporosis. It will now be useful to look more closely and individually at these same minerals.
The non-metallic trace mineral boron has been recently shown to have a positive effect on calcium and active oestrogen levels in postmenopausal women. Supplementing the diet with 3 mg of boron daily reduced urinary calcium excretion by 44% and dramatically increased the levels of the most biologically active oestrogen, oestradiol. This position of boron in this role is unusual because it is not recognised as an element essential to human nutrition. The work by Neilson, F.H. (14) illustrates this.
The biochemical role of boron has been described as “oestrogen-like”. If it brings about an actual increase in the body’s production of oestrogen, this is understandable. The way it functions is not quite clear, but it has been suggested that it is required for the interconversion of different types of steroid hormone. Whatever the mechanism, intake of extra boron has been found to result in the formation of low concentrations of a form of oestrogen having high activity. It is thought that this obviates the dangers which accompany the administration of much higher doses of oral oestrogen that have to be used in HRT.
The same type of biochemical change, which is required for the interconversion of the above steroids, is also required for the formation of the active form of vitamin D, the vitamin needed for the absorption of calcium. Some studies show that shortage of boron may lead to poor Vitamin D status. Hence, boron deficiency may be having a marked effect upon calcium absorption.
Boron is most readily available from vegetables, fruits and nuts. Therefore, boron intake may well be yet another case of a micronutrient whose daily human intake is being compromised today by industrialised food patterns and unwise food choices.
This trace mineral, a relative of calcium, is known mostly because of its radioactive form. In its non-radioactive form, it is non-toxic, accumulates in bone, occurs naturally in food and has a beneficial effect on bone health. Strontium has been shown to improve signs and symptoms of osteoporosis significantly. In one study of strontium supplementation (15), 85% of the subjects experienced a marked eduction in bone pain and 75% displayed increased bone density on X-rays.
Magnesium is a fundamentally important macro mineral of the body and is required as a co-factor for the activities of hundreds of different enzymes, especially those involved in generating and using cell energy and maintaining the integrity of the intracellular environment. Therefore no type of human cell can be in health if it is suffering from relative deficiency of magnesium. Bone cells are no exception and, furthermore, magnesium is a co-factor for the enzyme alkaline phosphatase, a particularly important enzyme in bone. The conversion of vitamin D to its active form also requires magnesium. Osteoporotic women have low whole body content of magnesium and low bone concentrations of the element. Low dietary magnesium is extremely common in both the UK and the US and several studies have shown that it is quite critical for bone health.
Magnesium deficiency in osteoporotic patients has been studied by Driessens F.C.M. et al (16) They used magnesium lactate and estimated the dose that would be required in osteoporotic patients to establish normal intracellular magnesium concentration. The required dose was between 660mg and 1,050mg per day, elemental. This then is a treatment dose. It is so far above the UK RNI for magnesium of 270- 300mg/day that osteoporotic patients, unless specifically directed, will rarely receive such an amount either by diet or by supplements. It is possible to obtain such an amount of magnesium through diet, but it has to be a very special one. This explains, perhaps, why a few other studies, which used only low intakes of supplementary magnesium, produced only modest changes in the osteoporotic condition. However, all such studies are affected by the fact that only single nutrients are being used. It is not known for sure, but it seems inherently likely that these nutrients will usually be relatively more effective against osteoporosis at a given intake when used together than when used singly. Therefore, the therapeutic amount of magnesium for osteoporosis may not be so high if other minerals are given at the same time.
ZINC AND MANGANESE
Zinc and manganese are necessary for bone formation and mineralisation and this has been reconfirmed many times in work on small, developing, young animals. Like magnesium, zinc is a cofactor for some 200 enzymes within the living cells, and so is fundamental to healthy and balanced metabolism. It also increases vitamin D activity and promotes immune functions. When supplementing with zinc and manganese at higher doses and for long periods of time, it is necessary to also ingest copper, since high dose zinc reduces copper absorption and may produce copper deficiency. Several studies have also been undertaken in human subjects, both osteoporotic and otherwise. In particular, Strause, L. (17) reported a two-year study in non-osteoporotic late menopausal women fed a supplement containing Ca (Calcium), Mn (Manganese), Zn (Zinc), and Cu (Copper). These women gained 1.3% in bone mineral density. In contrast, a group that was only calcium supplemented lost 1.6% in bone mineral density. So much for the current widespread notion that calcium supplements alone are good for osteoporosis. Zinc supplement intakes generally advocated within alternative nutrition circles are from 10 to 25mg per day and for manganese from 5 to 15mg per day (elemental).
The strong case for using chromium supplements in osteoporosis has been made already. 200-400 mcg per day can be used. The GTF form (Glucose Tolerance Factor form) should be used and this distinction is important.
Copper is thought to be involved in bone, both through its effects upon the production of bone matrix and upon bone mineralisation. The effect upon matrix formation occurs because copper is needed for the action of an enzyme called “lysyloxidase”. This enzyme is needed to give the correct properties to the main structural protein of the bone matrix, collagen. In particular it forms cross-linkages between the fibres of protein – such an important aspect of bone strength. The adverse effects of copper deficiency on mineralisation is thought to be through the impact of cellular deficiency within the cells which form new bone, called the osteoblasts.
Apart from the work of Strause, mentioned above, there is a shortage of human work on copper in osteoporosis. One of the most relevant pieces of animal work on copper is that by Yee, C.D. et al (18) They worked with rats deficient in oestrogen and suffering from bone loss, feeding them diets that were either copper deficient or copper enriched. The bone loss was found to be rather more severe when the diets were copper deficient. However, replacing the dietary copper afterwards did not necessarily alleviate the extra bone loss induced by the copper deficiency. This is in accord with many other studies on osteoporosis, which often show that once bone loss has occurred, inducing the reminer- alisation by reversal of the process is much more difficult. This puts quite a premium on to maintaining good intakes of the nutritional minerals throughout life, and specifically both pre and post menopause.
The non-metallic bulk mineral silicon is often available herbally in the form of plant extracts, such as from “horsetail”. However, one must depend upon foods and supplements for one’s main intake. Silicon aids calcium absorption into bone. Like copper it probably influences both matrix formation and mineralisation. The appropriate dosage level has not been determined as yet. A study has been made by Eisinger, J (19) in which they showed that silicon had a significant effect upon the density of the femur bone of the upper leg. They used 50mg injections of an organic form of silicon, twice weekly for 4 months. Rather more has been done in animal work. For example, Hott, M et al, “Short Term Effects of Organic Silicon on Trabecular Bone in Mature Ovariectomised Rats”, found that 1.0mg/day of the organic silicon compound, silanol, increased the formation of new bone, mineralisation and the number of bone-forming osteoblasts by 30%. These are rather strong indications that silicon is a significant supporting mineral for the maintenance of strong bones and, therefore, for prevention and/or treatment of osteoporosis.
Fluoride has often been shown to help increase bone density. Black tea has 1 to 4 mg fluoride per cup. Fluoride supplementation is currently available only by prescription; excessive ingestion can harm bones and is toxic. Therefore the question of including it in nutritional supplements does not arise. In any case, some studies suggest that fluoride addition, which may be helpful in some cases, or in some parts of the body, may be unhelpful in others, so its use, even at modest levels, would probably not be wise.
This is a toxic metal which has been reported to aggravate the tendency towards osteoporosis, perhaps by stimulating the parathyroid glands to produce extra hormone, favouring bone resorption and loss. The main sources of unwanted extra aluminium intake are (a) use of aluminium cookware, and (b) antacid preparations obtained, usually on medical prescription, for indigestion, containing aluminium hydroxide.
The Benefits to be expected from Nutrients in Combination – a Supplement Formula is needed – not Single Nutrients
Whilst some of the studies on nutrients and osteoporosis that have been cited above have employed combinations of a few different ones, the majority are single nutrient studies. This is the way with the majority of scientific studies because the scientific method is usually being employed in an analytical and reductionist way. In the same way, in toxicology toxins are usually tested singly rather than in multiple combination to draw conclusions about their toxicity. The fact that we more often encounter both toxins and nutrients in complex combinations is not taken into account.
Nonetheless, the results of some of these single nutrient studies are impressive for their ability to influence the course of bone metabolism in either animals or humans, as has been shown for boron, magnesium, silicon, strontium, chromium, copper and Omega 3 essential fatty acids. Zinc and manganese have been studied rather more in limited combination with others, but such work is backed up by other studies which show that osteoporotic women show various signs of zinc and/or manganese deficiency compared to non- osteoporotic women of the same age.
Where appropriate, guidance has been given on the supplementary levels of intake likely to be needed to have a significant impact upon the course of osteoporosis. This is an estimate of the supplementary intake likely to be needed if just that single nutrient is used. One should bear in mind that for the most part we simply do not have information about how these levels would be changed if the relevant nutrients were used in combination. Most particularly, that would apply to any formula that might be designed which would combine together all the different individual nutrients that have been shown to help prevent osteoporosis, or to favourably influence its course once started. There are good biochemical reasons to expect that in such a combination the individual nutrients would be effective at lower intakes. It was shown in one study, already quoted above, that for full effectiveness magnesium needed to be given as a supplement at two and a half or three and a half times the officially recommended RDI in the UK. We can reasonably expect that this requirement will come down when magnesium is used in full combination with the others, though there is a lack of any rigorous proof to that effect.
One should always bear in mind that it is far easier to prevent osteoporosis than to reverse its consequences. This stresses the importance of using supplements and/or a diet far superior to the current British or American diet, before the menopause, rather than trying to pick up the pieces afterwards. Obviously, if you have osteoporosis already, then the advice just given reminds one of the Irishman who said “If I wanted to get to Dublin I wouldn’t be starting from here”! Sincere apologies to Irish readers. Nonetheless, if osteoporosis has developed, it is still very worthwhile following the supplementations suggested by all the experimental work and attempting to reverse the bone loss by these means. For example, one of the studies quoted above, using only calcium, zinc, manganese and copper as supplements succeeded in reversing the bone loss trend and bringing about a 1.3% gain in bone mineral density within the limited period of the study. That was only a very limited combination.
Incidentally, it appears from the literature that even oestrogen administration in HRT does not generally reverse the osteoporotic process. The progesterone hormone is rather more effective at doing that. As to whether calcium supplements should be used along with such a formula, the answer is not entirely clear. Older people, both female and male, in their 70s and beyond, have more difficulty in absorbing calcium and perhaps they should use a calcium supplement. This author’s view is, however, that the quite bizarre gram quantities often used in orthodox medicine should simply not be used at all. For menopausal and postmenopausal women below the age of 70 it seems likely that a little supplementary calcium may benefit some but not others. Certainly, the value of calcium supplements diminishes rapidly as attention is given to the negative lifestyle factors that contribute to the Western nations’ prevalence of calcium wasting. The more one uses anti-osteoporotic nutrients other than calcium, the nearer one can expect to get to the situation of those people, men and women, in non-Western countries, who produce bones much stronger than European or North American bones on about 300mg of calcium intake per day. Nor is there any need at all to fear calcium deficiency from an entirely non-milk, non-dairy diet if it is properly constructed from whole unprocessed foods with plenty of green vegetables.
Diet and Lifestyle Factors in Osteoporosis
Factors which positively influence the uptake of calcium into bones, are:
● Plenty of fresh unprocessed vegetables and, to a lesser extent, fruit in the diet.
● Limited intake of or no junk food
● Good gastric acid levels – use Betaine-HCl Pepsin if extra acid is needed.
Factors which negatively influence the uptake of calcium into bones, are:
● Certain drugs, including the contraceptive pill
● Chronic diarrhoea
● Over consumption of alcohol, coffee, or salt
● Poor diets and/or frequent dieting
● Low gastric acid levels
● High consumption of processed food and food empty of micronutrients, such as white bread and separated fats.
● High protein diets, such as those containing too much meat, eggs and dairy produce.
● High sugar diets
● High milk and dairy intake
Organically grown fruit and vegetables are the main sources of boron, while animal proteins are a poor source of this mineral. Many Australian soils are deficient in boron and in that country supplementation may be required, even in the presence of an otherwise adequate intake of vegetables. Vegetables are also the main source of silicon. Organically grown vegetables are always the preferred dietary source of most of the nutritional minerals mentioned, though, as explained, supplementation is usually needed for vulnerable people or for osteoporosis sufferers.
Biochemical Tests for Osteoporosis
When one is dealing with a clinical phenomenon such as bone loss, it certainly helps to be able to measure it. One may directly measure bone density in a human subject by physical tests known as photon or X-ray absorptiometry. Such techniques are certainly useful for finding out whether a person has already lost any measurable proportion of their bone density. However, they tell nothing about their current rate of loss and cannot even tell whether the person is still losing bone or has moved into a period of renewed bone mineral deposition. Understanding the current dynamics of the situation is obviously very important. A person might have fairly normal levels of bone mineral even though a phase of very fast bone loss might have just begun. That is because the bone stores of mineral are so large relative to any likely rate of change. It naturally takes quite a period of loss to noticeably alter the size of these stores. The ability to measure, or at least to obtain an indication of changes in bone mineral is also important when trying to determine the effectiveness of any treatment. The treatment given might be hormone replacement therapy and/or calcium supplements. Or it might be a wide range of nutrients as suggested here. Only by measuring rate of change can one tell whether the measures taken are working. If the treatment is alternative, consisting of giving a range of minerals and vitamins and, perhaps, a high phytoestrogen diet, we would still like to know how well it is working.
The biochemical tests are possible because when bone breaks down, the products of bone breakdown appear in the blood or urine at higher concentrations than would be normal for them. These include bone mineral substance that is being lost. This is represented chiefly by calcium and phosphorus, though it has also been found that urinary zinc excretion is significantly higher in women with postmenopausal osteoporosis than in non-osteoporotic women of the same age range. There usually seems to be breakdown of bone matrix components at the same time as bone mineral loss. The biochemical markers which appear in body fluids as a result include the protein “osteocalcin”, which is the principal binder of calcium into the matrix, the enzyme “alkaline phosphatase” and various degradation products derived from the major structural protein, collagen. These are likely to include the special amino acid most characteristic of collagen, namely “hydroxyproline”. Another breakdown product in this same category is one derived from a second special amino acid of collagen, “hydroxylysine”. Hydroxylysine is especially important in collagen for its ability to form the cross-links between one protein chain and another, thereby increasing structural strength. Hence, when collagen breakdown occurs, the substance one finds circulating in the blood as a result is not the unaltered amino acid itself, but the special product that comes from the cross- linkages when the collagen is degraded. The cross-links are called “3-hydroxypyridinium cross-links” and the breakdown product appearing in biological fluids is called “pyridinoline”. This can be measured by biochemical analysis and, together with the other parameters, gives a good index of rate of bone breakdown. If previously high levels of these various biochemical markers are reduced by a therapy, such as a combination of nutritional minerals, this is a sign that bone loss is being reduced or halted by the steps taken.
Analysing for the products of collagen breakdown is not quite specific to bone, however. Arthritic conditions also involve collagen breakdown, as does the spread of cancer secondaries through the tissues. Collagen from these different sites varies in composition and that may, perhaps, be distinguished in the analysis. However, bone also releases osteocalcin, alkaline phosphatase enzyme, calcium and phosphate, which are not released from other collagen containing tissues. Those combinations are distinctive.
This serves to give the reader an idea of what can be achieved by biochemical monitoring. Such measurements are not routinely available to women who may be concerned about their bone density. Without them it is very hard to know just how you are doing in this respect. Perhaps more biochemical monitoring might become available in the future.
Nutritional Treatment of the Other Symptoms of the Menopause
When one comes to study symptoms of the menopause other than osteoporosis there is much less experimental data available. One reason for that it is that many of the symptoms are very non-specific. They may well be more common at the menopause, but they are symptoms anyone could get at any time, such as depression, irritability, mood swings etc. Because they are not specific menopausal symptoms, little work seems to have been done on them within the context of the menopause. Much more specific symptoms are hot flushes, vaginal dryness, night sweats and palpitations. Hot flushes (“flashes” in the US) and night sweats are connected as both relate to temperature control. Without question, these are more difficult to treat nutritionally than is osteoporosis, probably because they seem to be very specifically connected with the hormonal readjustments of the menopause itself. They are more easily controlled by hormone replacement therapy than anything else, if one is prepared to accept the disadvantages that go with that treatment. If one rejects hormone replacement therapy for whatever reason, then the situation places a heavy premium upon somehow getting sources of phytoestrogens, which, as described already, seem to be able to significantly support the woman’s oestrogen status. This could be done, at least in part, through diet, i.e. by eating those foods already listed above, that have significant phytoestrogen content. The alternative to that is to use concentrates of the actual phytoestrogens derived from the foods that contained them.
The principle behind the use of phytoestrogen concentrates is partly that of convenience. Eating a diet largely composed of brown rice may be partly effective but highly inconvenient. The same would be true of a diet composed largely of soya beans. Indeed, such heavily imbalanced diets may be inadvisable for other reasons in the longer run. If the fraction of the food solids, which contains the phytoestrogen, is concentrated into a small volume, it can then be taken in much the same way as an ordinary food supplement. This could be done with gamma oryzanol, the phytoestrogen concentrate from rice, or with genistein, a phytoestrogen from soya bean.
The effectiveness of gamma oryzanol has been demonstrated by Ishihara, M (20) this study showed that according to an index of menopausal symptoms, 85% of cases were successfully treated by use of 100mg of the product three times daily. There are several other such studies.
A study was done on a selection of less specifically menopausal symptoms by Horoschak A. (21) (Epistaxis means nosebleeds). Success rates of 75 to 100% were noted with intakes of 400mg/day each of hesperidin and ascorbic acid (vitamin C). Hesperidin, a bioflavonoid, comes from oranges and lemons and has also been referred to as “citrin” and as vitamin P. It has also been shown to eliminate or reduce hot flushes, 87% of patients responding to the treatment. Clinically, some workers have noted the same response from moderate to high doses of vitamin C. It is speculated that this may be due to the vitamin C increasing the bioavailability of oestrogens in the body, but further research is needed.
Numerous studies have demonstrated that Vitamin E reduces the severity of hot flushes and other symptoms associated with menopause. In the clinical trials, doses ranged from 10- 100 mg daily. (100 IU = 67 mg). Around 100-200 IU can be recommended to ensure the intake is sufficient, provided that this is not contraindicated by high blood pressure, malignancy or use of the drug Warfarin. Indeed, anyone who is taking a medical drug should seek advice before using any of the supplementations suggested herein.
No studies appear to have related chromium to any of the non-osteoporosis menopausal symptoms. However, the evidence already cited above showing that chromium enhanced oestrogen production in postmenopausal women, should, logically, indicate that benefits can be expected from chromium in any condition that is critically dependent upon oestrogen levels.
One additional dietary consideration seems to emerge in relation to the non-osteoporotic symptoms, and that is avoidance of sugar. This is a pretty good dietary guideline anyway, since too much sugar in the intestines inhibits mineral absorption, especially that of magnesium, and because sugar encourages wrong bowel bacterial flora, tends towards diabetes and other chronic diseases and is known to combine with cell proteins to produce damaged “glycosylated” proteins. Rosetta Reitz, who is referred to above, is convinced (p161) that “Women who do not eat man-refined sugar seem to have fewer and milder flashes”. This is an interesting observation rather than a study, but it suggests yet another way in which an industrialised diet could contribute to abnormal and unnatural problems with the menopause – which is a natural change in woman’s life.
General Status in Critical Nutrients
There is reason to refer once again here to the book by Rosetta R. Her two quotes are repeated here:
“Among the women I interviewed I found those who were concerned with the food they ate were experiencing menopause with more ease.”
“Altogether, I have noticed that the women who take vitamins regularly have less problems”.
One should take these points very seriously into account when considering the nonosteoporotic symptoms of the menopause. Vitamins C and E plus the various forms of phytoestrogens seem to be the main nutrients having a direct and specific effect upon such symptoms. However, it may well be that several other nutrients apart from chromium have an indirect, though no less beneficial action upon menopausal symptoms. It seems much more likely that this is so than that it is not. This would explain why women of menopause age, having good nutritional status in micronutrients, generally have an easier time at the menopause than those who do not. It would also tend to explain why populations with less exposure to industrialised foods show far fewer of their women experiencing adverse menopausal symptoms.
Overall, there are both general and specific reasons for thinking that by avoiding nutritional imbalances and deficiencies, the menopause becomes less problematic and more free from symptoms.
A Word about Herbs
Many Herbs are advocated for menopausal symptoms, the non-porotic ones. There is general dearth of scientific studies to lend any support to these claims, although there are a great array of candidates. Dong Quai, Black Cohosh, Mexican Yam and Licorice root are prime contenders, but are all unproven. There are a great many more as almost every culture around the world has its own particular alleged herbal remedies for the menopause. This does not mean that these herbs are all useless, but rather that at present the buyer is not buying a reliable and proven product. For anyone wishing to know about these claims and allegations, Biomedical Information Services Ltd issues a fact-sheet listing these herbs and the specific types of claims made for them. Several of these herbs are alleged to be effective on account of their phytoestrogen content.
To make sense of this one should of course consider what weight of the herb is recommended as a treatment dose and what is the identity and concentration of phytoestrogens contained in it.
Usually, such information is not offered. Given the very low dose of a herbal remedy compared to food intake, the situation suggests that foods should be better sources of phytoestrogens than herbs, unless herbs showing a specially high content of active phytoestrogens can be found and demonstrated. A particular confusion seems to surround the Mexican yam, Dioscorea. This plant was long used as the principal source of steroids for manufacture of the contraceptive pill. It has therefore become associated in people’s minds as a provider of oestrogens. This is a mistake because the plant itself does not appear to be a source of active oestrogen or progesterone. What it contains is a substance called diosgenin, which is a precursor of oestrogens and progesterone. However, it needs to be converted into these hormones by industrial chemistry, so that to suggest that the yam itself is an effective source of oestrogen or progesterone seems to be inaccurate. The psychological associations of this yam and its former use by the pharmaceutical industry may have been played upon.
There may be little harm in experimenting with most of these herbs, so long as one understands that the claims made about them seem, at this time, to be largely insecure.
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