Super Nutrition for Menopause with Ann Louise Gittleman, M.S., C.N.S.

Last Editorial Review: 10/23/2003

Nutritionist Ann Louise Gittleman will discuss how to use proper nutrition as a substitute for hormone replacement therapy to protect the body from cancer, heart and hormonal problems from menopause.

WebMD Live Events Transcript

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Thank you for joining us, Ann. Please join us every Thursday at 1 p.m. EST here in the Senior Vitality Auditorium for our live weekly chat. Next week we will discuss Revitalizing Your Eyelids, with David Louis Wirta, M.D., B.C.

Welcome to WebMD Live. Today we are discussing Super Nutrition for Menopause with Ann Louise Gittleman.

If you would like to ask Ann a question, please type /ask followed by your question (e.g. "/ask How are you?")

Moderator: Ann, welcome to WebMD Live.

Gittleman: Thank you. Great to be with all of you today.

Moderator: What exactly is menopause?

Gittleman: Great question! Menopause really describes the end of your monthly period. And, in fact, it is a very natural transition that does not happen overnight. It occurs over a period of about ten to fifteen years, beginning at about 35 years of age in many cases. This time frame is characterized by a lowering of the production of two hormones by the ovaries. These are estrogen and progesterone. The average age of menopause, currently in North America, is approximately 51 years of age, according to the latest research. And, it seems to be a transition when women are "rewired" in many ways.

Moderator: How does a woman know she is going through menopause?

Gittleman: Oh, great question, indeed. Well, very often times, the first symptoms of menopause are not the traditional symptoms one would expect. There are quite a lot of unusual symptoms, in fact, that have been associated with menopause, like sleeping disruption, sleeping disorders, insomnia, mental sluggishness, a bit of short-term memory loss, spaciness. Some women report that they have what is called a "fuzzy brain". They even report symptoms like increased depression, anxiety and lack of focus of attention. So, there is a variety of symptoms that accompany menopause that might not seem to be hormonal at all.

Moderator: Does menopause happen suddenly?

Gittleman: Well, they come on very gradually. And, that's why you never associate these unusual symptoms and feelings and kind of lack of memory and spaciness. It comes on so slowly that you don't attribute it to menopause. Many women as early as 35 go through a stage we call peri-menopause, the years preceding menopause. And that's the time when most of these symptoms seem to surface. So, if you wake up one day and bingo you get some of these symptoms like you're missing your periods or having hot flashes, you would naturally associate these very classical symptoms with menopause. But, if they were the other symptoms of fuzzy brain, loss of memory and insomnia, then you might not recognize that these were menopausal and you would try to medicate them with drugs.

Moderator: At 35, would someone ever confuse that with pregnancy?

Gittleman: Well, certainly. But, if you weren't pregnant, of course, and started seeing a pattern of irregular periods, perhaps the cycle became shortened, or you went through several months and missed a period, then that is a sign of this peri-menopausal phase in which your hormones are starting to change and are giving rise to a host of symptoms that you might not even recognize.

Moderator: How long does that peri-menopausal phase last?

Gittleman: It lasts anywhere from ten to fifteen years. We used to call this the climacteric. But, we now recognize this as the peri-menopausal phase. I tell women that they're not going crazy. They've only entered the peri-menopause zone because there are some strange symptoms, as I've described, that start to manifest.

Moderator: If someone is in that phase, how do they know when they become actually menopausal?

Gittleman: Good question. One of the most definitive ways to diagnose the peri-menopause phase leading to menopause is to take a very simple blood test, known as the FSH, or Folicle Stimulating Hormone test. We know that the amount of this hormone will increase during peri-menopause. And so your doctor can tell you whether you've entered that peri-menopause zone by the results of this very simple test. What you can't tell from the test, however, is which hormones, whether it is estrogen or progesterone, that are currently fluctuating. That's where a salivary hormone test comes in very handy.

Moderator: What does it mean to someone taking those tests regarding either estrogen or progesterone?

Gittleman: If you're taking the salivary hormone test, which is very hormone specific, then what you would be looking for is a ratio of 300:1 in favor of progesterone. Because progesterone, we have found through clinical research as well as clinical experience, is the hormone that starts to decrease during that peri-menopausal phase right before full-fledged menopause. And, it is the deficiency of progesterone, we believe, that is creating the very unusual symptoms that women are reporting all across the country.

Moderator: What are some of the health risks associated with menopause?

Gittleman: The traditional health risks associated with menopause are that your risk for heart disease and osteoporosis increase. And so, these are the traditional reasons that doctors suggest that you may want to consider some kind of hormone replacement therapy (HRT). The caveats here, however, are that women who may be at an increased risk for breast cancer should probably avoid synthetic hormone replacement therapy because extra estrogen fuels breast cancer. In addition, women who are at a higher risk for blood clots or have a history of liver problems or are at risk for cardiovascular disease may also consider avoiding the traditional hormone replacement therapy. So, in this day and age, HRT seems to be the umbrella treatment of choice that conventional medicine prescribes to avert the risk of osteoporosis, heart disease and also to eliminate hot flashes and mood swings. The problem with the conventional HRT is that is has side effects itself in terms of weight gain, depression, thinning of the hair, even rosacia has been reported. So, women stop it after two months on a prescription. That's why I opt for the naturals. The herbal and vitamin and mineral alternatives to conventional or synthetic hormone replacement therapy.

Moderator: What exactly is hormone replacement therapy?

Gittleman: Well, HRT, hormone replacement therapy, is a prescription from a doctor that usually includes Premarin, which is horse urine, and a synthetic progesterone. Most women have a prescription for about .625 mg of Premarin and a synthetic progesterone known most commonly Provera.

Moderator: What can women do to make up for some of the risks that come from hormone replacement therapy?

Gittleman: Many women, the baby boomer generation, have located and found some wonderful natural alternatives that seem to be just as effective without the side effects of weight gain, depression, hair thinning and nausea that seem to be very prevalent with the synthetics. The most common vitamins that are extremely successful include taking Vitamin E, anywhere from 400 IUs to 1200 IUs a day. And this acts as natural hormone therapy on a molecular level. Women report that Vitamin E helps to reduce and/or eliminate hot flashes as well as mood swings. Extra Vitamin C in the amount of 1000 mgs to 3000 mgs a day is also helpful in smoothing out the peaks and valleys of the hormonal shifts. And extra Magnesium, specifically in the amounts of 400-1000 mgs a day, is a godsend in providing relief in alleviating anxiety, panic attacks, irritability and insomnia. In fact, my readers keep a bottle of magnesium near their bedside when they awake in the middle of the night and pop a 400 mg magnesium pill so they can get back to sleep. Now, there are also some wonderful natural remedies in the herbal family that are very helpful. And, these include herbs like Wild Yam, Vitex, and Dong Quai. A combination of Flaxseed Oil and Evening Primrose Oil, known as the Essential Woman, has been found to be a great remedy for menopausal symptoms and helps to fight depression, fatigue, and clears up skin conditions. Many of my own clients use a tablespoon of this mixture in eight ounces of yogurt on a daily basis to protect their breasts and to fight off symptoms of depression, dry skin, and flaky scalp.

Moderator: Should younger women in their thirties who have not become menopausal yet be taking supplements before it happens?

Gittleman: Oh, I'm so glad you asked. Well, I'm going to tell you something. A lot of these herbal supplements, as well as the flaxseed oil and evening primrose oil, are absolutely outstanding for PMS. So, I would suggest that those very supplements that I've recommended, the extra Vitamin C, the magnesium, the Vitamin E, the herbs and oils, are outstanding for controlling PMS symptoms. So, yes, younger women would do very well to include these in a regimen. My younger readers in their mid-20s to early 30s use a supplement, topical progesterone cream, and they use this two weeks to ten days before their periods as a topical skin cream and they find that their PMS symptoms disappear. So you've got a whole arsenal of natural remedies from which to choose. I especially like the progesterone creams because they are transdermal. This means they can be easily absorbed into the system via the skin. And, there are several progesterone creams that are now on the market. So, it's important to choose one that contains USP Progesterone. These natural creams have been the best thing I have ever found for alleviating migraine headaches that are menstrually related as well as cramps. So, it's a wonderful natural adjunct for women from PMS to peri-menopause to menopause. Another guardian angel for our women out there.

estellepv_WebMD I have been on natural HRT for one year, and it has been perfect, but just recently I've started getting flashes again, not as frequent or as strong. Would a blood hormone level test while on HRT be helpful?

Gittleman: Yes, indeed. I would strongly suggest that you get a test to see how your current prescription is working.

estellepv_WebMD I am on natural HRT tri est 1.9/progest 50 for 1 yr but now the flashes are back. I have started flashes again, not as severe or frequent, but mostly at night. Should I have hormone levels tested again? I added Lifetime Meno formula supplement, which is soy/blk cohosh, yam, dong quai, etc. but still flashing. Also 1000mg E daily.

Gittleman: I definitely would suggest you get a blood hormone check because it looks like your program would need to be adjusted, which is perfectly natural. That's number one. Number two, it seems to me, based on the herbal preparation that you are taking, the herbs are primarily estrogenic, like Dong Quai and Black Cohosh. You might want to specifically check your progesterone levels because you may be unknowingly suffering from too much estrogen even in the natural sources. Progesterone in the amounts of 200mgs in a micronized oral pill might be the way to go.

estellepv_WebMD How long should I anticipate staying on HRT? Is there a rule of thumb?

Gittleman: This is very individual. Very individual, indeed. If we're talking about synthetic or conventional HRT supplementation, then most women use it to relieve their immediate symptoms of hot flashes and vaginal dryness. They then proceed to a lower dosage to ward off possible osteoporosis or cardiovascular disease. So, again, this can be adjusted according to your symptoms and your individual case history. Of course, when it comes to osteoporosis, I'm a big believer in increasing magnesium supplementation in a ration of 2 to1 of calcium as well. To protect the heart, I would highly recommend a good cardiovascular exercise routine and additional coQ10, at least 100 mgs a day. Now, no matter what kind of HRT you are taking, be it synthetic or natural, it is very important to remember that the liver is ultimately the organ in the body which is responsible for processing all hormones. So, make sure that you take the stress off of your liver by lowering alcohol intake, OTC drug use and especially fried foods so your liver can be up to the task of metabolizing your hormones. Some extra Vitamin B6 would be great for the liver. Anywhere from 50 mgs to 200 mgs a day in a total B-Complex supplement.

Moderator: What's the difference between synthetic and natural HRT?

Gittleman: Synthetic hormone replacement therapy actually is drug-based. And the most common HRT in this country is from the urine of horses. That is where Premarin, pre-mar-in comes from, pregnant mares' urine. The natural hormone therapy matches your own molecular structure more identically. Natural hormone therapy matches your body's own molecular structure in a more identical fashion. Also, the natural hormone therapy has very little side effects, as opposed to the synthetic hormone replacement.

Moderator: What is your opinion of the recent studies that link breast cancer and hormone replacement therapy?

Gittleman: Well, there is definitely a link between adding extra estrogen to the system and increasing the risk of breast cancer. We know that breast cancer is fueled by estrogen. So, you want to reduce the amount of circulating estrogens in your system as much as possible. One of the ways to do this, is to make sure that you have enough natural progesterone in your body which acts as a counter-balance to excess estrogen or estrogen dominance. This is why the use of either topical progesterone or micronized progesterone is highly recommended.

Moderator: Does synthetic verses natural HRT influence our choice if we're at risk for breast cancer?

Gittleman: Synthetic is much more potent than the natural so you'd be exposed to a much more potent dose, most definitely. And the other area we need to be aware of is that we have lots of estrogen in our food products. Cattle today are receiving a lot more hormones than ever before. And, in the feed lots they're putting these hormone implants in the cattle so that the cattle get bulkier at a much faster rate. Let's not forget that, since 1988, the European union has absolutely banned beef imports from USA animals raised with hormones. So, I believe that we've got to make a big deal out of getting extra estrogen out of our food supply. Our food supply is one of the most potent sources of breast cancer increasing toxins. That's really a big deal. This is huge. And then, to add injury to insult, there are many pesticides and industrial chemicals as well as solvents, like nail polish remover and nail polish, that many of us use on a daily basis which have estrogen-like effects. So, we are swimming in a sea of estrogen. No wonder breast cancer is an epidemic. I believe much of it is from the environment so we have to control our intake as much as possible. So, please read my books. (laughs) I have a book called, The Living Beauty De-Tox Program which details and itemizes all the surprising sources of cancer-causing estrogen lurking not only in your food, but in your plastics and cosmetic and household cleansing products. But, the good news is, you can cleanse it out of your system and reduce the amounts, thereby helping your body to protect itself against disease.

stickerG_WebMD How can we control our estrogen intake?

Gittleman: I would say, eat organic whenever possible. When you eat out, do not eat beef unless you know it is organically raised. That's number one. And then, number two, if you're taking a birth control pill, make sure it is the lowest dose possible. Because that's another source of adding estrogen to your system. And then, number three, don't reheat foods in plastic. The plastic has estrogen-like effects and can migrate into your food when you microwave. Number four, when you buy cosmetics, get those that don't contain mineral oil or lots of petrochemicals. Try to get natural brands in your health food store. And then, number five, consider the use of a topical progesterone cream that balances the ratio of estrogen to progesterone in favor of progesterone.

Moderator: Are there tests you can take to find out what your levels are?

Gittleman: Yes. One of the most accurate tests is a salivary hormone test. I do this on my readers, my patients and on myself. I do it once to twice a year, depending upon the severity of symptoms. 1-800-888-4353 is a number that you can call and have up to six hormones tested. But, the ones that are really crucial, that are most important is having your estrogen and progesterone tested. That way we have your levels of each hormone, we know your ratio which is crucial, of estrogen to progesterone and we know, according to your age and stage of life, what the norm should be. It's never too late or too early to have this test. It can be life saving, I assure you. That's 1-800-888-4353

stickerG_WebMD I finally convinced my mother to go off synthetic HRT. What can she expect to have happen now? She's taking the natural therapy.

Gittleman: Well, that depends upon how much she was taking and for how long. What I usually recommend is that you don't go off of your synthetics all at once. What is helpful according to the physicians that I consult with is halving the dose of estrogen and adding natural progesterone cream to the protocol. So, in essence, if the doctor were giving her .625 mgs of Premarin, you would take half that dose, which is about .3 mgs of Premarin and use 1/4 teaspoon of natural progesterone cream to balance this out. I would also tell your mom to take one to two tablespoons a day of the Essential Woman oil. Let her take one tablespoon in yogurt in the morning and use another one at night as a salad dressing. This is the same program I have used for my own mother, so I know it can be successful

Moderator: Why did you write, Super Nutrition for Menopause?

Gittleman: Well, I wrote this book because I believe that there must be dietary ways of controlling menopausal symptoms. And so, it was the first natural menopausal approach out there. And we have a wonderful exercise program, a menopause diet called the Prime Time Diet and the best recipes I have ever come up with. So, even if you're not in menopause you'll love the recipes. They're really wonderful! (laughs) On a more serious note, it also gives women options. I tell them symptoms from hot flashes to vaginal dryness and weight gain and tell them what the natural approach should be, so they can take control over their life, feel empowered and know they can sail through this natural experience and manage it quite safely and simply.

Moderator: What do you mean by Super Nutrition?

Gittleman: I give a super program for supplements. So, we go above and beyond just the dietary program. And, I give an itemized listing of the best supplements for women that are fully in the menopausal phase. I also give them a super exercise program that anybody can use, no matter what age or stage of life she may be in. See, I truly believe, and let's not forget, that exercise is one of the best preparations for menopause because it helps keep your weight down, it handles stress and it reduces the risk of bone thinning and heart disease. Plus, it's free!

Moderator: What kind of exercise do you recommend to your patients?

Gittleman: I recommend a daily walk out in the sunshine because I believe that we really need sun coming through the lens of the eye to help balance hormones on a total body level. So, at least 20-30 minutes, perhaps first thing in the morning, or at 4-5 PM at night for some good cardio exercise. And then, I have become a real advocate of resistance training. There have been some very, I'd say, impressive studies in the Journal of the American Medical Association and the New England Journal of Medicine to suggest for those prime time women who are in the menopausal stage, that at least twice a week, maybe 20-45 minutes of some resistance training, of weight training or training on special machines, does an enormous amount to increase bone density and it increases confidence, self-assurance and puts back a real vitality and zest into women's lives. So, cardio and weight lifting. And I'm doing that myself. Twice a week I now go, and I've got a trainer who helps me do it because I'm not naturally an exercise person. I'm naturally a diet and nutrition person. But I have a trainer who helps me exercise twice a week and the results are astounding!

stickerG_WebMD I'm a woman in my 20s, not on the birth control pill and recently quit smoking. Do you recommend anything specific in my diet? Or any kind of particular exercise?

Gittleman: What I would suggest, because you've just stopped smoking, is that we increase dietary antioxidants so that we can rebuild the system from the toxins created by the nicotine. I specifically would have you include extra beta-carotene or Vitamin A in your supplement regimen. I would like to see you do 25,000 IUs of Vitamin A a day, 1000-3000 mgs of extra Vitamin C. And, a newer antioxidant known as lipoic acid that will really help to clean up your body in no time at all. That would be 100-300 mgs a day.

estellepv_WebMD regarding my question #40, I have a tube of Emerita progest topical cream. Is this sufficient to combat estrogen dominance?

Gittleman: It's a wonderful start, but also include progesterone building minerals in your diet that will also help this challenge. I suggest at least 50mgs of zinc, as well as 50-200 mgs of B6 that are the precursors of progesterone in your system. So, that would be a really excellent plan. The progesterone, the added zinc and B6 and I think you're doing yourself a real dietary service.

stickerG_WebMD As a vegetarian, should I be taking any particular supplements?

Gittleman: Yes. Please include more zinc into your diet. I would like to see you include at least 45-50 mgs of zinc and please consider a free-form amino acid supplement that you can get at your health food store. And take that between meals. I often find that vegetarians, upon testing, are deficient in L-Carnitine and Methionine. And, of course, do not forget Vitamin B-12. I like the sublingual, 1000 mcgs to 2000 mcgs per day.

Moderator: How is weight gain associated with menopause?

Gittleman: Weight gain is usually a symptom of estrogen dominance.  Or, it can also be symptomatic of a slow down in the thyroid gland production, so that your system becomes more sluggish and you're not burning your calories as efficiently. Again, this is where the natural progesterone cream, and my favorite if I may plug this is one called, Progesta-Key, comes in very handy. Now, for women that are at the menopausal stage of life, you need to watch your carbohydrates very carefully because we also find that excessive amounts of carbohydrates produce insulin which triggers more fat in the system. And more fat is connected to elevated levels of circulating estrogens. So, again, pick up Living Beauty because it's got a diet that will help in all of those regards.

stickerG_WebMD This is a great chat. I am going to buy your book for my mother. What a great resource! Thanks.

Gittleman: Thank you so much. We'll continue this into a "part two" program. I'm personally very gratified that we had so many younger women. I wish I knew then what I know now so you are way ahead of the game. I congratulate you!

Moderator: Any last thoughts from today's chat?

Gittleman: I would say that I believe that you can say goodbye to hormone havoc and sail through your PMS, your peri-menopause and your menopause simply by understanding and then controlling their symptoms. So, it's my hope that you will all be empowered to choose natural options to take care of yourself and that you will continue to feel great through every phase of your life.

Moderator: Thank you for joining us, Ann. Please join us every Thursday at 1 p.m. EST here in the Senior Vitality Auditorium for our live weekly chat. Next week we will discuss Revitalizing Your Eyelids, with David Louis Wirta, M.D., B.C.

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