Natural Hormone Replacement Alternatives -- Ann Louise Gittleman, MS -- 07/11/02

Last Editorial Review: 10/23/2003

WebMD Live Events Transcript

The opinions expressed in this transcript are those of the health professional and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician.

Have the headlines about HRT made you think twice about traditional drug therapy? Can your diet alone help relieve symptoms? Nutrition expert Ann Louise Gittleman, MS, CNS, joined us on July 11th, 2002 to discuss diet changes and nutritional supplements as substitutes for drug-based HRT.

Moderator: Hello, Ann Louise. Thanks for joining us on WebMD Live. The news about HRT that was released this week has caused concern among many women. Some are now looking for alternatives to drug therapy. How can we use diet to help ease the symptoms of menopause?

Gittleman: The good news is that both diet and the right supplements provide some of the safest and most effective hormone balancing remedies. One of my favorite and best-researched foods for menopausal symptoms is flaxseed. Flaxseeds offer a high content of essential fatty acids and large quantities of a natural hormone-balancing substance known as lignins. Lignins are very potent anti-cancer agents for cancers that are hormone sensitive, and extensive studies on both colon and breast cancer show that as little as 2 tablespoons per day is highly effective in reducing tumor growth. The best news of all: Lignins possess both anti-estrogen and estrogenic properties. With regard to menopausal symptoms, they are as effective as traditional HRT in lessening hot flashes and sweating. Grind up a couple of tablespoons a day and put it in your smoothie, yogurt, or cereal. You've then got one of the best sources for health, healing, and taking charge of your menopausal symptoms naturally.

Moderator: Flaxseed is great baked in bread.

Gittleman: It's so nutty and tasty. I even put it on popcorn. It can also be added to oatmeal for the kids and the family.

Moderator: Let's talk about soy. It is so often mentioned in relationship to menopause. What forms are helpful and how much?

Gittleman: We should talk about soy, yes. Good question. And here is the scoop on soy: I believe if we eat soy products, as they do in a typical Asian diet, then tempeh (fermented soy) as well as tofu is probably helpful. But the problem comes when we eat too much of a good thing. Because a study recently published in the November 2001 Journal of Nutrition found that if we eat high amounts of the isoflavones in soy (like daidzein), this could contribute to breast cancer. While a little of the isoflavone genistein is breast protective, larger amounts trigger estrogenic activity like breast tumor growth and multiplication of cancer cells. So if you are taking soy isoflavone supplements, make sure the amount -- which is very critical here -- is only 30-50 mg (milligrams).

Moderator: Is it better to get your soy in food rather than supplements?

Gittleman: Definitely. But make sure you are not allergic to soy (another challenge for many women). And if you are in the perimenopausal stage (35 years and over), then you are going to want to make sure you are adding more zinc to the diet because soy is high in copper, which can also trigger hormone imbalances. Many women who are copper-toxic exhibit the same symptoms as being estrogen dominant -- they retain fluid, gain weight around their tummy, become very irritable, have a short attention span, start to lose hair on the top of their heads, and exhibit signs of depression. So balance is the key and that goes for soy.

Member: Can you use flaxseed oil to scramble your eggs in? Do you lose any of its nutritional value when it is cooked?

Gittleman: Oh yes, indeed. You can only use flaxseed oil in no-cook recipes. So making a salad dressing with flaxseed oil, drizzling it on cooked veggies or brown rice, adding it to yogurt, or taking it straight like I do is fine. But you cannot cook with flaxseed oil because it's high in Omega 3s, essential fatty acids that are very sensitive to heat, air, and light. Flaxseeds on the other hand can be used in baking, up to 350 degrees, since they are not as high in the oil component, which easily becomes rancid. Both flaxseeds and flax oil should be stored in the refrigerator. An 8-ounce bottle of flaxseed oil should be used up within three weeks. The flaxseeds, if ground daily, last much longer, from six months to a year in most cases. Some individuals grind their flaxseeds daily and use them right away, while others, like me, buy them already milled in nitrogen-sealed containers.

Member: What about flax oil capsules? How do they compare? How many capsules replace, say, a teaspoon of the oil? Which way do you recommend?

Gittleman: I would like to get my oil straight in the liquid form, but for those who prefer to use capsules, you would need three capsules for each teaspoon of oil. And I also store my flaxseed oil capsules, which I use for traveling, in the fridge so they are away from heat, air, and light.

Member: What is the difference between golden and brown flaxseeds?

Gittleman: No difference whatsoever.

Member: What about evening primrose oil? I am 38 and premenopausal, but my doctor feels I'm in the beginnings of menopause. I take evening primrose oil to help with PMS and also I am on your Fat Flush plan, which works wonders for the PMS. Is it also helpful with menopausal symptoms?

Gittleman: Yes, yes, yes. Evening primrose oil, which is a source of GLA, an essential fatty acid, is most helpful for getting rid of cramping, irritability, headaches, and water retention that are so common with PMS. But its benefits don't just stop with PMS. Many of my followers use evening primrose as a type of natural hormone replacement in menopause. It seems to quell hot flashes and triggers the production of serotonin, the feel good hormone in the brain. Skin conditions like eczema, psoriasis, and plain old dry skin are marvelously helped with evening primrose oil and other GLA-containing botanicals. It is one of the most potent inner and outer menopausal and skin care treatments that I know of. In my book, Before the Change, evening primrose, as well as flaxseed oil, are part of my "All-Star Perizappers," those combat-hardened warriors from the symptoms wars.

Moderator: What are they and what do they do to help with menopausal symptoms?

  • Our No. 1 Perizapper is flaxseed oil. It's very specific to help fight night sweats, as well as tissue dryness. But I also recommend the high-lignin oil because the lignins are such natural hormone modulators and they help to lessen the risk of osteoporosis and cardiovascular disease. Yay for high-lignin flaxseed oil, Perizapper No. 1!

  • Perizapper No. 2 is evening primrose oil, and can also act as a natural hormone replacement agent, especially good for getting rid of migraines, ladies!

  • Perizapper No. 3 is multivitamins and magnesium (my M&Ms!). I highly recommend the vitamin B complex (50 mg per day) with extra vitamin E (400-1200 IUs per day). Most important of all: magnesium. Magnesium is essential for smoothing mood swings and is your best friend for insomnia. If you wake up multiple times per night, keeping a bottle of 400 mg magnesium pills by your bed will help you go back to sleep. Women need equal amounts of magnesium and calcium. If you are stressed, you may need twice as much magnesium as calcium. I, personally, take 1000 mg of magnesium throughout the day and it does wonders for sleep and my mood.

  • Perizapper No. 4 is zinc. Zinc is a precursor for progesterone, the hormone balancer for excess estrogen, and it also keeps your immune system in tip-top shape. At least 25-50 mg per day is a must, particularly if you are vegetarian and eat soy products for their phytoestrogen properties.

  • Perizapper No. 5 is the use of natural progesterone cream. The natural progesterone cream is bio-identical to that made in our bodies. Many of us, as we reach perimenopause (I see this in saliva and blood tests), are frequently low in this vitally important hormone. Progesterone increases sex drive, helps with thyroid dysfunction, boosts adrenal production, aids in balancing blood sugar, and can also straighten out fuzzy thinking and fatigue.

  • Perizapper No. 6 is exercise. Be vigorously active for one-half hour, five days a week, and do bone-strengthening or resistance training.

  • Perizapper No. 7 is de-stressing stress. Take an inventory of how you respond to your many responsibilities in life and figure out ways -- via deep breathing, meditation, or journaling -- to vent frustrations.

  • Perizapper No. 8 is the adrenal refresher. You must remember that when you are under a lot of stress, it's vital to replace lost minerals and vitamins, particularly vitamin C and pantothenic acid, which will help your adrenal glands produce stress hormones like cortisol.

  • Perizapper No. 9 is natural phytoestrogen. Include foods in your daily diet that act as mild plant estrogens. Phytohormone-rich foods include yams, thyme, sage, fennel, apples, celery, and nuts -- they can help balance fluctuating hormone levels. My favorite is the high-lignin flaxseeds.

  • Last but not least is Perizapper No. 10, natural hormone therapy. And you can take natural hormones specially prepared for your biological needs as indicated by a salivary hormone test. You can call this number to get information on that salivary hormone test if you are interested in knowing which hormones are out of balance and what to do about them from a natural perspective: 1-800-888-4353. The results are sent to my office and I prepare an individualized letter based on your results, which will address your needs and recommend specific foods and vitamins. This test can check for estrogen, testosterone (the hormone of desire), progesterone, DHEA (the adrenal hormone), and cortisol (the stress hormone).

Member: In regard to all these supplements ... is there a multivitamin that has all these in the right balance?

Gittleman: Yes, it's called the Female Formula. And it is a formula that I myself made up for my own needs as well as those of my personal clients. The formula contains more magnesium than calcium and it also has the precursors like wild yam root for progesterone production. If you will call 1-800-888-4353, or visit you will see the exact formulation and how it will help you. When I am on the go and find it hard to take lots of different vitamins and minerals, I rely on this because it provides high amounts and therapeutic dosages of the B vitamins as well.

Member: Will progesterone cream relieve hot flashes and on what part of the body do you put it?

Gittleman: The latest information about progesterone cream is that it should be applied to the throat area. And I would only use about a one-quarter teaspoon per day (20 mg), the amount your body can process at one time. Using the topical cream bypasses the liver so it will be absorbed even if your liver is tired and overtaxed. Many women report that the progesterone cream alone will diminish and/or eliminate hot flashes completely. There are others of us, however, who need small amounts of phytoestrogens in the form of high-lignin flaxseeds to do the trick. This is very individual. In the earlier stages of menopause, progesterone cream may do the trick all by itself, but as we get in our prime-time years, small amounts of estrogen are often needed for those who are 48+. That is why taking the salivary hormone test can be so very helpful. You will know the state of your hormones. And it changes from year to year, might I add.

Member: Are there any side effects from natural progesterone cream?

Gittleman: Not generally. Sometimes the use of the cream will upregulate [increase the activity of] the estrogen and sometimes there can be breakthrough bleeding, but that usually balances itself within a cycle or two. There is some indication that the cream is also breast protective.

Member: Does black current seed oil have the same effect on menopausal symptoms as the evening primrose oil?

Gittleman: Yes. Black currant seed oil is another source of the hormone-balancing essential fatty acids. I like it even better, to be honest with you, because it contains some of the heart-smart Omega 3s as well. The research indicates that if circulatory problems are a challenge, black currant seed oil is a good natural remedy. As many of my readers of Fat Flush Plan know, black currant seed oil is the recommended essential fatty acid and is part of the Fat Flush Kit lineup of formulas.

Member: When taking a natural progesterone cream to help with PMS and premenopause symptoms, how often should you have a test (like a saliva test)?

Gittleman: I would suggest that a test should be taken, specifically if there are major deficiencies, every three months so you can make adjustments as your body is changing and shifting.

Member: Let's talk about your "Changing Diet."

Gittleman: Whole foods are front and center in terms of providing slow-acting carbohydrates, phytohormone-rich fruits and vegetables, protective fats, and quality proteins that will help balance your body's hormones. I am a big believer in unprocessed carbohydrates, in moderation, such as sprouted-grain breads, brown rice, and tons and tons of fresh and steamed veggies that are rainbow colored from orange and yellow to green, blue, and purple. The higher the pigment, the richer the nutrients.

For those who do not tolerate milk and dairy, I believe you can find outstanding nondairy calcium sources like broccoli, kale, bok choy, and sea veggies (seaweeds) like nori (the covering around sushi).

In my plan you should not be afraid of fats. They are your friends. Even avocados and flaxseed oil. These balance blood sugar, assist in energy, and provide raw material for hormones. Bring in the almonds!

Member: I'd like to ask you about your suggestion to rid foods of pesticides by using a Clorox rinse. What is the research behind that? And I tried it, with less that the teaspoon per gallon, and thought that there was an aftertaste in the peaches and apricots. Suggestions?

Gittleman: There should be no aftertaste at all. I use one teaspoon to a gallon of water these days. With regard to the research, there are no clinical, double-blind, randomized trials for supporting the usage of a Clorox bath to detoxify foods from pesticides, herbicides, fungus, parasites, and viruses. Having said that, my own mentors (one of whom lived to 106 years!) were the originators of this process. And my understanding is that it is the inert ingredients in the original brand of Clorox, which has the ability to remove toxins from foods. Members of our armed services have used the Clorox soak for decades overseas to protect against the perils of night soil (fertilizer using human manure). You need to follow the instructions in my books because there are a Clorox soak and plain-water soak detailed therein.

Foods last two weeks longer in the refrigerator and the metallic-like tastes and aftertastes are removed with this process. If you could only see what rises to the surface when you Clorox chicken, you would become a true believer. For years I did not eat out when I learned about the benefits of Cloroxing food. When I Clorox my food, it sanctifies my kitchen.

Moderator: What are your thoughts on meat? How does eating meat affect women's hormone health?

Gittleman: I think it's best to get grass-fed meat (please check my Fat Flush Plan book for great resources) or organic meat where the cattle are not force-fed hormones that become secondhand hormones in your body. The same goes for dairy products. And please note that grass-fed beef and lamb have higher amounts of CLA (conjugated linoleic acid), which is helpful for burning body fat, maintaining lean muscle mass, and is a potent antioxidant that's protective for breasts.

So eating well will help you to balance your hormones, stay lean and mean, and protect overall health. It's as simple as that, if we all learn to be proactive and take charge of our bodies. The bottom line is that nobody cares more about you than you.

Moderator: We are out of time. Our thanks to Ann Louise Gittleman, ND, MS, and thank you, members, for joining us today. For more information, please read Super Nutrition for Menopause and Before the Change: Taking Charge of Your Menopause, both by Ann Louise Gittleman, ND, MS. You can get those books, as well her current best-seller, The Fat Flush Plan at booksellers, or by calling 800-888-4353. You can also visit Ann Louise Gittleman's website at

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