Gestanin (Allyloestrenol)

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BEST NUTRITION FOR MENOPAUSE: CHOOSING AND USING OILS
Careful choice, storage and use of oils is essential as they can easily be damaged. If an oil becomes damaged, oxidation may take place. This leaves the oil open to attack by highly reactive chemical fragments called free radicals. It is these free radicals that have been linked to cancer, coronary heart disease, rheumatoid arthritis and premature ageing. Free radicals speed up the ageing process by destroying healthy cells as well as attacking collagen (‘cement’ that holds cells together) which is the primary organic constituent of bone, cartilage and connective tissue. As you get older there is a decrease in collagen, which can cause changes to your skin (wrinkles, prominent veins, slow wound healing, bruising easily), nails (brittleness), eyes (dryness, dark circles under the eyes), gums (bleeding, infection), hair (dullness, split ends, poor growth, hair loss) and mouth (bad breath, mouth ulcers). Restrict free radical formation by taking these measures:
- Choose cold-pressed unrefined vegetable oils or extra-virgin olive oil. Unfortunately most supermarket oils are manufactured and extracted with chemicals and heat so that the maximum amount of oil is obtained from each batch. This destroys the quality of the oil and the nutritional content. Anti-foaming agents may also have been added to the oils.
- Avoid hydrogenated vegetable oils which are listed in the ingredients of most margarines and also many fast foods, some crisps, biscuits and crackers. The process of hydrogenation changes the essential unsaturated fats contained in the food into trans fatty acids which have been linked to an increased rate of heart attack. It is for this reason that I would recommend using butter in moderation or unhydrogenated margarine (obtained from health food shops) rather than ordinary margarine. Although margarine is manufactured from polyunsaturated fats it is made into a solid form through hydrogenation. The process of hydrogenation makes terrifying reading:
1. Vegetable oil is mixed thoroughly with fine particles of nickel or copper.
2. It is heated to approximately 200 degrees centigrade and held at that temperature for six hours.
3. Meanwhile, hydrogen gas is pumped through the mixture at high pressure and the excited hydrogen atoms penetrate the vegetable oil molecules and chemically change them into ‘trans fats’ (trans fatty acids). These are new, complex substances that are not found in nature, except at low levels in some animal fats.
4. The mixture must be kept very hot – if it cools down the whole production line will get clogged.
5. The mixture is then cooled down to form tiny hard plastic-like beads, known as hydrogenated oil.
6. The beads of hydrogenated oil are mixed with liquid oil and heated up again to a high temperature. When this cools you have margarine.
Because these trans fats are not natural in such high levels and have a plastic-like quality your body has great difficulty in trying to eliminate or utilize them. Your body is then put under extra pressure simply to deal with a substance that you do not really need to eat.
– Do not fry polyunsaturated fats as they can become oxidized when heated. Use olive oil or butter for frying. Monounsaturated olive oil has less chance of creating free radicals and butter does not because it is saturated. Reduce temperature to minimize oxidation. Keep all fats to a minimum when frying; try to bake or grill instead.
– Do not store oil in clear bottles as light can cause damage.
*35/101/5*

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Other names: Mycelex-G

BEST NUTRITION FOR MENOPAUSE: SUPPLEMENTING ESSENTIAL FATTY ACIDS
As we cat fats, our bodies make them more and more complex. The omega 6 series, linolenic acid, is converted to gamma linolenic acid (GLA) which is found in evening primrose oil. The omega 3 series starting with alpha-linolenic acid is converted into eicospentaenoic acid (EPA) which is found in fish. There are a number of factors that can stop the conversion of linolenic acid into GLA. As these essential fatty acids are so vital at the time of menopause it is advisable to supplement them in your diet in the form where the conversion has already taken place – that is GLA and EPA – just in case your body is not converting them properly. You can get GLA from evening primrose, borage, blackcurrant or starflower. Whichever supplement you choose, do read the GLA content on the back of the container and aim for a supplement that gives you at least 150mg of GLA per day. With EPA aim for a supplement that will give you at least 300mg per day.
Recommendations for improving your intake of essential fat
Include:
? Cold-pressed, unrefined vegetable oils such as sesame, sunflower, safflower for salad
dressing. Store them in the fridge.
? Extra-virgin olive oil for cooking.
? Butter in moderation for spreading or cooking (organic preferably).
? Nuts (almonds, pecans, brazils, etc.) and seeds (sesame, sunflower, pumpkin, etc.).
? Nut butters – made without sugar or palm oil.
? Tahini (creamed sesame seeds) for sauces and dressings.
? Oily fish such as mackerel, sardines, etc.
? Unhydrogenated margarines.
Avoid:
? Commercially produced vegetable oils whose labels do not state that they have been cold-
pressed or are extra-virgin.
? Heating oils to high temperatures.
? Storing oils in the light, i.e., in glass bottles on a window sill.
? Roasting nuts as it destroys the oils.
? Palm oil as it is a saturated fat.
? Hydrogenated margarines, i.e. those made with polyunsaturated vegetable oils which have
been hydrogenated.
*36/101/5*

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BEST NUTRITION FOR MENOPAUSE: REDUCING FOODS AND DRINKS THAT ARE STIMULANTS
Stimulants in your diet (alcohol, sugar, smoking and caffeine in tea, coffee and chocolate) cause a fast rise in your blood sugar levels followed by a fast drop which contributes to the roller-coaster ride of blood sugar swings. They can actually increase hot flushes by causing the blood vessels to dilate. Just hot drinks themselves can worsen hot flushes. When we drink something hot on a summer’s day it has a cooling effect by dilating the blood vessels and allowing us to sweat more through the skin. Indeed you may have noticed the connection between a cup of tea or coffee and the start of a hot flush. The same is true for spicy foods such as curries, so keep these to a minimum during the menopause.
Recommendations for stabilizing your blood sugar levels
Include:
? Unrefined complex carbohydrates such as whole-wheat bread, whole-meal pasta,
potatoes, brown rice, millet, oats, rye.
? Eat fruits and drink diluted pure fruit juice.
? Always eat breakfast – oats are good.
? Eat small, frequent meals.
Avoid:
? Refined carbohydrates such as white flour in cakes, biscuits, pastries.
? Tea, coffee (also decaffeinated as it contains two other stimulants), alcohol.
? Sugar and foods containing sugar (chocolate, sweets and biscuits).
? Soft drinks and squashes.
? Convenience foods as they are likely to contain refined carbohydrates.
? Smoking.
*30/101/5*

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NUTRITION FOR MENOPAUSE: AVOIDING ADDICTIVE DRINKS
Alcohol, tea and coffee are called ‘social poisons’, socially acceptable drugs that have an anti-depressant or stimulant effect. Because they are socially acceptable we tend to forget their addictive properties. However, during the menopause it is especially important to look at the effects on your health and then ask yourself: is it worth it?
When we are younger, we are adaptable, flexible and able to eliminate toxins more easily. Eventually as we grow older and the effects accumulate, our bodies rebel seeming to say: ‘If you keep putting this rubbish in me, I will just get slower, sicker, and look and feel older than my years.’ As teenagers we could get away with it; as we grow older our bodies have less tolerance.
Coffee
Coffee contains three stimulants – caffeine, theobromine and theophylline. A cup of instant coffee contains around 66mg of caffeine. Filtered coffee contains even more.
The diuretic effect of caffeine may flush vital nutrients and trace elements out of the body. Added to this problem, the active ingredients in caffeine called methylxanthines have been linked to a benign breast disease known as fibrocystic disease. Many women experience breast discomfort in the week before a period that can become worse as they reach their forties and develop into mastalgia. The pain can be very intense and at over forty years of age can occur at any time of the month. By cutting out coffee, women have found relief from mastalgia. As these methlyxanthines are in caffeine, chocolate, cola drinks, cocoa and tea are also culprits. Although decaffeinated coffee docs not contain caffeine, it still contains theobromine and theophylline which can disturb normal sleep patterns. Also most decaffeinated coffee has often been decaffeinated by a chemical process.
Tea
Tea contains both caffeine (around 50mg per cup) and tannin. All the above effects of caffeine still apply. Tannin binds important minerals and prevents their absorption in the digestive tract. At this stage in your life, when you need to maximize your intake of such important minerals as calcium, zinc, iron, magnesium, etc., it is essential that you are not preventing them from being absorbed. Otherwise it could get to a stage where you are eating a nutritious diet, perhaps even taking vitamin and mineral supplements, and yet at the same time these vital nutrients are wasted because they are being excreted unabsorbed.
Alcohol
The consumption of alcohol in this country has been rising steadily, especially wine. Alcohol is full of calories. It is made by the action of yeast on sugar, so provides these calories in the form of a carbohydrate. One glass of wine provides us with 100 calories and a pint of beer around 200 calories.
As we have already seen, alcohol can contribute to a low blood sugar problem. It can also cause liver damage. Furthermore, it acts as an anti-nutrient: that is, it blocks the good effects of our food by depleting the body of vitamins and minerals, especially zinc. Alcohol interferes with your metabolism of essential fatty acids which are needed to produce prostaglandins, chemicals that help to control moods, immunity and vascular reactions such as hot flushes.
*31/101/5*

Femara (Letrozol)

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NUTRITION FOR MENOPAUSE: ADDITIVE DRINKS AND WITHDRAWAL SYMPTOMS
Thankfully, more and more people are now becoming aware of the health problems associated with these addictive drinks and are turning to alternatives. However, as with all drugs there can be withdrawal symptoms when you stop. These include: headaches, nausea, tiredness and depression. The withdrawal symptoms can be quite dramatic. Some hospitals have now discovered that certain post-operative symptoms are not caused by the effects of the anesthetic as previously thought, but by caffeine withdrawal. Before a general anesthetic patients are asked not to eat or drink for a number of hours and by the time they come around from the operation the withdrawal symptoms have already started.
To minimize these effects, cut down slowly, substituting some of your usual drinks for alternatives. I gave up coffee a few years ago and did not do it gradually. I had a migraine-like headache and the ‘shakes’ that lasted for about three days. Several patients of mine have experienced pains in their legs after giving up coffee, but they felt they could ‘see light at the end of the tunnel’ and persevered and have felt so much better since. As in the case of Sue, forty-five, who came to see me complaining of headaches and dizziness.
Sue was experiencing anxiety and panic attacks and said she felt muzzy and tired all the time. The panic attacks would come on suddenly and she would feel hot and start sweating. This would also be accompanied by palpitations. She sometimes woke in the night with them. Her mother had been fifty when she started the menopause, so Sue was obviously keen to get herself really well before this age.
Some years before Sue had begun to have very heavy periods, sometimes only a week apart. A fibroid the size of a coconut had been found, so a hysterectomy was recommended. Her left tube and ovary were also removed. She had been put on HRT (Premarin) but the headaches were so excruciating she had to stop. She was then switched to oestrogen patches and was on them when she came to see me. Sue was also keen to come off the medication she was taking for the panic attacks.
Her answers to my health questionnaire showed that Sue was drinking eight cups of coffee a day and four cups of tea. I suggested that we aim to cut these out completely, bringing her intake down gradually each day and substituting some herbal teas or grain coffees. Sue felt that her personality was such that if she knew something was not good for her she would rather get rid of it now, once and for all.
So she stopped both tea and coffee on the Monday. By Tuesday she had started to suffer terrible headaches and on Wednesday night began to have cramps. Sue persevered and within a week the headaches and cramps had gone. She said she was amazed at the extent of the withdrawal symptoms: she would never have believed it if she hadn’t gone through them. When she came back to see me she had checked with her doctor that her medication was fine to stop abruptly and so she came off the HRT and the medicine for her panic attacks.
Another patient who benefited enormously from giving up coffee and tea is Joy who was fifty-six when she first came to see me. She was still menstruating but over the last few months the pattern of her cycle had become very worrying. Her periods had become increasingly heavy and at one period Joy started to hemorrhage. She was put on HRT and the hemorrhaging stopped, but she said she felt so tired and depressed on the HRT.
Eventually Joy saw a gynecologist who suggested she had a hysterectomy because he had discovered a fibroid. Fibroids can cause excessive bleeding and may also delay the onset of the menopause. But once the menopause arrives, fibroids start to shrink because of the lack of female hormones and are not usually a problem any more. So Joy was in a catch-22 situation. Her fibroids were delaying the menopause, yet if she could get through the menopause it was unlikely she would need the hysterectomy as the fibroids would go. She told the gynecologist that she would like to try another approach so he delayed the hysterectomy for six months and in the meantime she came to see me.
I explained to Joy that coffee was a definite culprit in terms of excess bleeding and fibroids. She changed to herbal teas and grain coffee and found that the bleeding stopped. I also recommended some herbs to help balance her female hormones. By the time Joy had been to see me a couple of times, her heavy bleeding had become just regular periods, and she found she only bled excessively or between periods if she drank coffee or was under a lot of stress. She went back to the gynecologist three months after her first visit to me. He gave her an internal check and said that everything was fine; her womb was not enlarged and the fibroids were slightly smaller. As the bleeding was now under control she could postpone the hysterectomy indefinitely. Within a year she let me know that her periods had stopped completely and she was very grateful to have kept her body intact.
*32/101/5*

Femcare (Clotrimazole)

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NUTRITION FOR MENOPAUSE: REDUCE YOUR INTAKE OF DAIRY PRODUCTS AND RED MEAT
In the Western world we eat far more protein than we really need. Excess protein has been linked to kidney stones, gout and high blood pressure. A certain amount of protein is essential. Proteins are the building blocks in our food. They are necessary for the structural formation of our bones, skin, hair and muscle. However, it is important to monitor our intake of protein to ensure that we are not only getting the correct amount but also that it is coming from the healthiest sources.
Red meat which includes beef, pork and game should be omitted completely. Red meat worsens oestrogen deficiency. Because it is high in phosphates, it increases the loss of calcium from the bones, thereby increasing the risk of osteoporosis.
Poultry and eggs should be bought with care. Choose free-range, which have been produced without the use of growth promoters, antibiotics or hormones. It is hard enough to balance our own hormones without introducing extra ones given to animals. Ensure that all chicken is thoroughly cooked to kill off any bacteria.
Dairy products should be used sparingly as they contain casein, the protein in cheese, milk and cream which is not assimilated by many people. Casein is three hundred times higher in cows’ milk than human milk as it is important for the fast development of large bones in calves.
Cows’ milk is not designed for human consumption. The cow has a four-stomach digestive system where the casein is dealt with easily. But it cannot easily be absorbed by humans, so milk remains undigested in the gut and begins to putrefy and rot. This putrefaction in humans produces toxins and mucus. It clings as undigested matter to the lining of the intestines and prevents the absorption of vital nutrients into the body.
This digestive struggle takes a lot of energy to sort out. That means that the energy you would have to enjoy life and do the things you want is now being spent sorting out your digestion. The result is that you feel tired. How many times have you have felt sleepy after a meal? Your body is using much more energy than it should to digest the food. When you feel like that it may be worth looking at what you have eaten. Dairy produce (i.e. milk, butter and cheese) can also cause a runny nose, catarrh, a feeling that you need to clear your throat and a host of other unpleasant symptoms.
Clare had been suffering from shaking, anxiety, palpitations, sweating and insomnia. She found herself crying for no particular reason and felt she was becoming agoraphobic, not wanting to go out and socialize. She also had high blood pressure and was put on Bendrofluazide although this had not reduced her blood pressure at all. Her blood pressure was as high as 150/100. (A normal blood pressure is around 120/80 with individual variations.)
Clare told me that her grandfather had died of a heart attack, so she was very keen to find the cause of the high blood pressure and do something about it. Because her blood pressure had not been reduced by the medication I felt that something external must be to blame. I suggested that she cut out dairy foods (high saturated-fat content) and have her blood pressure monitored to see if there were any changes.
A month later she came back to report that the change had been remarkable. Her blood pressure was now down to 120/80. She had tried introducing dairy foods back into her diet and had immediately got a tight feeling in her chest and the return of her old symptoms including giddiness. I devised a programme of supplements for her to make sure she was getting all the necessary nutrients and she said she felt so much better and hadn’t fully appreciated how stressed she had been feeling in the past.
An added problem with dairy produce is what the farmers are giving their cows. They are now fed antibiotics to speed their growth, other growth promoters, and also hormones to increase the supply of milk per cow. The farmers making sheep?s’ and goats’ milk products seem to be more ecologically aware and are not interfering with nature to boost the milk yield artificially, so it is better to choose these dairy products.
Yoghurt is beneficial for your health when it contains the culture lactobacillus acidophilus which is a natural inhabitant of your gut. When yoghurts are heat treated they lose their original culture, so no benefit can be gained from eating them. They are also very acid forming. Fruit yoghurt can have very high sugar content, so it better to choose a natural bio yoghurt and add your own fruit.
*33/101/5*

Folic Acid

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BEST NUTRITION FOR MENOPAUSE: ESSENTIAL FAT IN YOUR DIET
The important point about fat is that some fats are essential and good for you and some are definitely not. Unfortunately fat has got itself a bad name over the years. There have been low-fat diets and no-fat diets, both of which can be dangerous. As your body cannot make essential fats, the only source is from your diet. Total fat-free diets have resulted in joint stiffness, skin problems and vaginal dryness.
When considering fats, it is vital to appreciate the difference between those that can contribute to poor health and those that are necessary for good health. Basically, there are two types of fats – saturated and unsaturated.
Saturated fats come from animals (meat, cheese, eggs, etc.) and also from palm kernel oil. These are not essential for your health and in excess they can cause ill health. They are detrimental to health in two ways:
1. By increasing fat deposits – the more saturated a fat becomes, the harder it is for your body to use it and so the fat gets deposited and stored unhealthily in the body. Hence the connection between fat intake and hardening of the arteries. The more liquid the saturated fat is at body temperature, the more easily your body uses it and so there is less chance of it being deposited. The most easily used saturated fat is butter, followed by coconut oil, palm oil and then fat from beef, lamb and pork which is hard at body temperature.
2. By blocking the use of the essential fats – saturated fats interfere with your unsaturated fat metabolism.
Unsaturated fats are a group of fats which include those that are called essential fatty acids which, as their name implies, are essential for your health. These essential fats are a vital component of every human cell and your body needs them to insulate your nerve cells, keep your skin and arteries supple, balance your hormones and keep you warm. These essential fatty acids have been found to relieve benign breast disease, most especially fibrocystic disease, which is also linked with caffeine intake.
They are found in nuts, seeds, oily fish and vegetables. A handful of nuts or a salad dressing made with a good quality oil is sufficient for your needs each day. You should also try including in your diet oily fish such as mackerel or sardines.
Unsaturated fats fall into two main groups, monounsaturated and polyunsaturated:
1. Monounsaturated fats (olive oil is high in monosaturated fats) are so called because they have only one double bond (chemically speaking).
2. Polyunsaturated fats (sunflower oil is high in polyunsaturated fats) can have two or more double bonds.
Within this group there is a further split into omega 3 fatty acids (the most important of which is alpha-linolenic acid) and omega 6 fatty acids (the most important of which is linolenic acid).
? Omega 6 oils are found in unrefined safflower, corn, sesame and sunflower oils.
? Omega 3 oils are found in fish oils and linseed oil, with varying amounts in pumpkin seeds, walnuts and dark green vegetables. It is this type of essential fatty acid that is most lacking in our diet. It has been found to enhance immune function, increase metabolic rate and energy levels and soften the skin.
Your body makes beneficial prostaglandins (hormone-like regulating substances) from omega 3 oils. These prostaglandins are particularly useful at the time of menopause as they help lower blood pressure, decrease inflammation response and decrease sodium and water retention. They also help keep blood platelet stickiness down which helps to protect against heart attacks and strokes. A study in 1986 published in the Journal of the National Cancer Institute showed that linolenic acid killed human cancer cells in tissue culture without harming the normal cells.
*34/101/5*

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BEST NUTRITION FOR MENOPAUSE: WHAT AND WHEN YOU EAT OR DRINK
What you eat or drink
All the food you eat is broken down into glucose. When you eat any food in refined form (sugar, chocolate, white flour, sweets, biscuits, cakes), digestion is very fast and glucose enters the body rapidly. Any food or drink that causes a stimulant effect, such as tea, coffee, alcohol, chocolate, sugar or sweets, affects your blood sugar level and causes a sharp and fast rise in the blood glucose followed by a rapid drop. Smoking has the same effect.
At this low point, you feel tired and drained and need something like a bar of chocolate or cup of coffee (or both!) to give you a boost. This boost causes the blood sugar level to go up rapidly and the cycle is repeated. All of this causes an up and down, roller-coaster ride of blood sugar swings.
Over time, this constant over-stimulation exhausts the pancreas. Now, instead of too much insulin, it produces too little. Too much glucose stays in the blood, causing the symptoms of high blood sugar levels.
When you eat or drink
If there is a long gap since your last food (over three hours in women), your blood glucose will drop to quite a low level. You can then feel the need for a quick boost (cup of tea, biscuit). At the same time, the adrenal glands will make the liver produce more glucose. The combination of these two causes high levels of glucose in the blood which again calls on the pancreas to overproduce insulin in order to reduce the glucose levels. The roller-coaster ride starts all over again and the adrenal glands become more exhausted.
Effects of adrenaline
If blood sugar levels are repeatedly low and adrenaline is pumped into the body on a regular basis, this can take a toll on your health, especially during the menopause.
Adrenaline is the hormone most of us associate with stress. It is the hormone that is released for ‘fight or flight’ and its effect is very powerful. The heart speeds up and the arteries tighten to raise blood pressure. The liver immediately releases emergency stores of glucose – instant energy – into the bloodstream. Digestion stops because it is not necessary for survival and the clotting ability of the blood is increased in case of injury. This all means that we are prepared to run faster, fight back, react more quickly than normal.
Unfortunately when our blood sugar level drops during the day or night, adrenaline is released automatically and the body experiences all the above sensations except that there is no outside stress to respond to. When this happens repeatedly, we can see the effect on our health and the part it plays in heart disease (increased clotting of the blood, higher blood pressure) and extreme fluctuations of sugar levels caused by the release of sugar to give us energy.
Repeated stimulation of the adrenal glands can interfere with their proper functioning. During the menopause, it is crucial that your adrenal glands are working at their optimum and do not become exhausted because of the extra work they have to do. At this time of a woman’s life, the adrenal glands are required to produce oestrogen as the ovaries are producing less and less. The adrenal glands also produce a natural hormone, DHEA (dehydroepindrosterone), which has been linked to anti-ageing.
So clearly maintaining blood sugar levels is an important factor in good health at the time of the menopause. This can be achieved by careful consideration of not only what you eat and drink, but also when you eat and drink.
*27/101/5*

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BEST NUTRITION FOR MENOPAUSE: REGULAR INTAKE OF COMPLEX CARBOHYDRATES
Dr Katharina Dalton, a pioneer in the recognition and treatment of premenstrual syndrome (PMS), has found that one way the symptoms of PMS and the menopause can be relieved is by eating regularly. This stops the blood sugar level from dropping and adrenaline from being released. You are ideally looking for foods that give you a slow rise in blood sugar and keep the level up for about three hours. You can then eat again before it drops.
Complex carbohydrates are the best foods for this. They give a slow release of energy because it takes time for the digestive tract to break them down into the simplest substances that the body can use. Carbohydrates arc a large group of foods that include sugars and starches. They are an important source of energy and are all eventually broken down in the body into the simple sugar, glucose. It is the speed with which this happens that is the important factor. There are two types of carbohydrates: complex and simple.
To help maintain a steady blood sugar level, aim to eat complex carbohydrates regularly during the day. You do not necessarily need to eat more. Sometimes just a whole-wheat cracker can be enough between meals. If you find that the symptoms associated with low blood sugar level are greatest first thing in the morning or you wake during the night, heart pounding, and cannot get back to sleep, then it is very likely that your blood sugar level has dropped overnight and adrenaline has kicked into play. Eating a small, starchy snack one hour before going to bed (e.g. a cracker) and, if possible, one hour after getting up, will help to alleviate these symptoms.
Whenever possible, choose unrefined complex carbohydrates such as whole-wheat bread, brown rice and whole meal flour. When a carbohydrate is refined, the food is stripped of essential vitamins, minerals, trace elements and its valuable fibre content. It was originally thought that fibre’s role was only to speed up the passage of digested food to prevent constipation. It is now known that some forms of fibre can actually slow down the absorption of sugars and help to maintain our blood sugar balance. Without fibre, food acts more quickly on the blood sugar level and is harder to eliminate from the body.
Eating the right foods regularly, i.e. complex carbohydrates every three hours, can stop cravings and binges on foods which appear to offer a ‘kick start’ but only bring associated health problems.
Shelagh, thirty-nine, came to see me with terrible migraines which occurred around the time of her period – either the day before, on the day, or the day after. She got flashing lights, and tended to feel very sick with it. She craved sweet biscuits and kept a bag of them with her all the time so she could nibble when she felt the need. After the pain had gone she craved junk food. Shelagh said she had a ‘dreadful craving’ for chocolate.
I suggested that for the first two months she start to eat starchy foods every three hours, to keep her blood sugar levels steady. By keeping her blood sugar level in balance she would then stop any drastic drops in sugar levels and hence reduce the sugar cravings. After the first two months she came back saying she felt much better, had more energy and did not have her usual premenstrual agitation. She had not had any weekend headaches which had been a regular pattern before.
Shelagh said that her food cravings had almost gone. She occasionally felt she wanted something but there was now no compulsion. These changes were not due to willpower; her body just did not need those large amounts of sugar-rich food, so she had no cravings to eat it. She told me, ‘I’ve been eating every three hours and do feel better for it – no shakes and tension through lack of food! I had some of the migraine symptoms during my period but was not incapacitated as I usually am.’
I then suggested some food supplements to balance her deficiencies as suggested by the health questionnaire she had completed. She wrote the next month, ‘I actually got through this month with no migraine! Only the warning signs, so I’m very cheered.’ A couple of months later she dropped me a line to say, ‘I haven’t had a full migraine for two months although I’m still getting the aura symptoms. Thank you for all your help!’
If you experience binges and cravings, these may indicate a blood sugar imbalance as described above. They may also be symptoms of a food allergy, so this is worth checking. Ironically if we are allergic to or intolerant of a particular food, we tend to crave it and eat it more. Ask yourself the question, ‘Which foods or drinks would I find hard to give up?’ That will give you a clue to what to look out for.
*28/101/5*

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BEST NUTRITION FOR MENOPAUSE: AVOIDANCE OF REFINED FOODS, ESPECIALLY SUGAR
It is better to avoid the simple carbohydrates, where possible, except fruit. Although fruit contains fructose (fruit sugar) which is a simple sugar, the fibre content of the fruit is a complex carbohydrate which slows the digestion rate. So fructose is acceptable when taken in the whole fruit, like an apple, but not when used in the refined form of powdered white fructose. Pure fruit juice can also cause a rapid change in blood sugar level because it is not buffered by the fibre that is normally present. It is better to dilute fruit juice to make it less concentrated.
A can of cola may contain up to eight teaspoons of sugar, as may a pot of fruit yoghurt. Most of the convenience foods and drinks we buy are laden with sugar. Sugar is also in savoury foods such as tomato ketchup, baked beans and mayonnaise. Indeed, sugar is added to practically everything as it is an inexpensive bulking agent. Even some toothpastes contain sugar. As toothpaste is not a food, this does not have to be put on the ingredients list.
When sugar is in its natural form – the whole sugar cane – it is fine to eat. It has all the right amounts of fibre and is a whole-food. The problem starts when it is refined. The processing and refinement removes the fibre as well as the vitamins, minerals and trace elements. The same is true for white flour. In order to digest these refined foods your body has to use its own vitamins and minerals, so depleting your own stores.
You may be tempted to substitute sugar with artificial sweeteners: don’t. You are simply substituting a chemical which is alien to the body and has to be dealt with, giving it extra work to do. Nobody really knows what havoc these chemicals can cause when introduced to your body’s own delicately balanced biochemistry. If a food or drink is described as ‘low sugar’ or ‘diet’, it will usually contain a chemical sweetener. Artificial sweeteners are also found in some crisps, ice lollies, sauces, pot noodles and some medicines (check the label carefully). There is more information about artificial sweeteners in the section on reading labels.
*29/101/5*

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HEALTH DURING MENOPAUSE: EATING NATURALLY
Sally came to see me when she was forty-one because she was determined to do all she could to prevent the symptoms of the menopause. She wanted to get herself as well as possible, to learn what to eat and drink and what to avoid. She also wanted to know what supplements, if any, would be good to take. She was looking for good general advice on how she could prepare for the menopause. Sally had a few minor symptoms such as headaches behind the eyes and low back pain. Her GP had been suggesting she take HRT because although she was still having regular periods they were very heavy. She had been feeling some heat at night but none during the day.
At first I recommended that she try to cut back on tea, coffee and sugary foods. She soon noticed the benefits. Her energy levels increased and she was sleeping better because she was not feeling hot at night. Sally was so enthused by the results that she asked what else she could do. I advised her that she should start to check the labels on foods in order to eliminate added sugar, preservatives, additives, etc., and to buy brands free of these ‘additions’ where possible. She also increased her intake of fresh fruit and vegetables and cut down on the amount of processed and convenience foods she was eating.
When we reviewed all the changes that she had made, Sally was surprised at how easy it had been to adapt to her new eating pattern. She says that if she had been faced with such an upheaval in one go, she might have found it overwhelming. It was because she took it gradually, progressing from one step to the next in her own time as she felt the benefits, that she was encouraged to keep it up.
We all have very different eating patterns depending on personal preferences and our lifestyles. However, there are certain steps which every woman can take to try to improve her health during the menopause:
- Stabilize blood sugar levels by reducing your input of refined foods and those foods and drinks that have a stimulant effect; cat regular amounts of complex carbohydrates and fresh fruit.
- Avoid tea, coffee and alcohol – addictive drinks – which contribute to the blood sugar level problem and also deprive the body of vital nutrients and trace elements.
- Reduce your intake of dairy products and red meat which can adversely affect your health during the menopause.
- Ensure your diet contains sufficient essential fatty acids and a minimum of non-essential fats.
- Check that you are eating enough fibre from natural sources.
- Reduce your intake of sodium.
*25/101/5*

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NUTRITION FOR MENOPAUSE: STABILIZING BLOOD SUGAR LEVELS
Maintaining a steady blood sugar level can make a big difference to how you feel emotionally and physically before, during and after the menopause. A healthy blood sugar balance will enable the female hormones you have circulating to be fully utilized which will help you to avoid many of the unpleasant symptoms you might otherwise experience.
Nutrition is the key to stabilizing your level of blood sugar (glucose).
Glucose is the only form in which food can be absorbed by the body and turned into energy. After a meal, glucose from the breakdown of food (digestion) is absorbed through the wall of the intestine into the bloodstream. At this point, there is a high level of glucose in the blood, so the body produces insulin from the pancreas in an attempt to lower the level. Any extra glucose that is not used for energy is changed into glycogen and stored in the liver and muscles. The glucose level in the blood then reduces to normal.
Your body works in a similar way to the thermostat on your central heating system to balance the blood sugar level.
- When in balance your body maintains its own optimum blood glucose levels.
- When the glucose level rises too high, insulin is produced to lower it. If the blood sugar level remains too high, this causes the symptoms of hyperglycemia – high blood sugar level. The extreme form of hyperglycemia is diabetes. With this condition, insulin is supplied from outside the body by injection to bring the level down.
- When the glucose level falls too low, then the hormone adrenaline is released from the adrenal glands and glucagon is produced from the pancreas. Glucagon works in the opposite way to insulin and increases blood glucose by encouraging the liver to turn some of its glycogen stores into glucose.
If the blood glucose level stays low for a period of time, this can cause symptoms of hypoglycemia – low blood sugar level. These symptoms, which include irritability, aggressive outbursts, palpitations, forgetfulness, lack of sex drive and excess sweating, have a marked similarity to those associated with hormone imbalance experienced during pre-menstrual syndrome and the menopause.
During a normal day, the amount by which your blood sugar level rises and falls depends on two main factors:
- what you have had to eat or drink
- when you last ate or drank.
*26/101/5*

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Other names: Serophene

BEST NUTRITION FOR THE MENOPAUSE
The best kept secret of good health during the menopause is to eat as naturally as possible. Good nutrition means not only eating the ‘right’ foods but also avoiding the ‘bad’ ones. So where do you begin? Let’s start by exploding a myth. There are no such things as ‘health’ or ‘healthy foods’. This is just marketing hype. There are foods that are not good for you and there are foods that are natural. Natural foods are those that your body can digest easily and use to maximum benefit. Those are the foods that your body needs in order to be able to respond naturally to the different stages of your life.
In computer jargon there is a saying, GIGO, which stands for Garbage In, Garbage Out. In other words, you only get out as good as you put in. If you put poor-quality petrol in a high-performance car like a Rolls-Royce or Porsche, it may run for a while but eventually it will become less productive and less efficient. It will probably start to run down until the engine deteriorates so much it can no longer work. It is exactly the same with the human body. You need top-grade ‘fuel’ to function properly. Survival is your body’s top priority and it will use whatever nourishment you give it to try to keep healthy. However, you can either make this job much harder by providing poor-quality food and drink which will eventually lead to bad health, or much easier by providing a quality diet which will keep you feeling healthy, fit and well.
Good nutrition is essential during the menopause so that your body can adjust itself automatically and keep your hormones in balance, thus avoiding or preventing disease. (Disease means not being at ease or being out of balance). If you can keep your body in balance and allow your own hormones to work to the optimum during these menopausal years, and naturally maintain oestrogen from the adrenals and fat deposits, then you have a much better chance of reducing the symptoms of the menopause to the minimum or even avoiding them altogether.
The outlined eating plan is an enjoyable, pleasurable and healthy way of eating. It is not a diet that you follow for a short while and then abandon for your former unhealthy eating patterns. It is easy to follow on a daily basis, full of variety and very tasty. I know this because I cat this way myself.
There may be occasions when it is not possible to follow the guidelines, perhaps when you are being entertained by others, but so long as your foundation of eating is good, these one-offs will not make much difference. Above all, food is to be enjoyed. Eating is a time for sharing and socializing. Remember: this is not a strict diet but a plan for making improvements in your eating patterns to enhance your health and well-being.
Some changes are fairly easy to make – such as choosing free-range eggs or drinking diluted fruit juice instead of squash. Others may be harder – such as giving up coffee, tea and sugary snacks. Don’t be put off because you think altering your eating habits sounds too difficult. Try taking it one step at a time. You’ll be pleasantly surprised at how well you can adapt to changes if you make them gradually. Once you start to feel the benefits, you’ll know that it was all worthwhile.
*24/101/5*

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Other names: Emulgel, Voltaren Xr, Voltarol

CORONARY BYPASS SURGERY: DOUBT AND INSECURITY
While you are in hospital, doctors and other team members will explain to you what has happened. They will discuss coronary heart disease and its causes with you and you will learn about the processes of mobilization and physiotherapy. However, when you are in hospital recovering from a big operation, it may be difficult to take in all this information. Your mind is probably on other things. You may be anxious and insecure about your recovery, about possible disability, about the operation failing or heart problems recurring, about what the future may or may not hold. We all know that death associated with surgery is always a possibility, no matter how remote. Even if you have been told that only one patient in 100 dies, you may worry that you could be that one.
The possibility of unsuccessful surgery
We know that the operation may occasionally fail. This may be because the grafts or the coronary arteries themselves are unsuitable for the operation to be successful. Your surgeon can only find this out once the chest is opened and the vessels are inspected. It is also reasonable to think that something may go wrong during the operation. A patient could suffer from a heart attack while undergoing surgery but this is very rare. In some cases, the operation is successful in relieving angina but leaves you partly disabled by shortness of breath or some other problem.
Although these chances are small, it is not unreasonable to think about the possibility that you may not be able to work in future, or support yourself or your family, or lead a normal life. Indeed, it would be a strange person who does not have such thoughts. These thoughts may linger and concern you for some time after the operation, until your recovery is complete.
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‘NATURAL’ PROGESTERONE AS A ‘NATURAL’ ALTERNATIVE TO HRT
It is true that researches appear to demonstrate that progesterone cream has improved bone density among his patients who could not take oestrogen therapy. But his admirable desire to help those women who could not take HRT leaves a fundamental question mark over the results of his surveys since it means there is no ‘control’ group not taking progesterone whose results could be compared. The Natural Osteoporosis Society (NOS) marks its concern by stating that there has been ‘little validated scientific research into the effects of progesterone alone on bone density or fracture risk.’ NOS medical advisers do not recommend the use of ‘natural progesterone’ creams to prevent osteoporosis (or to counteract the effect of oestrogen in HRT products). Their recommendations for healthy bones include a well-balanced diet, regular exercise, no smoking and a minimal intake of alcohol. Dr Lee, the Californian physician, also made recommendations on exercise, diet and nutrient supplements as part of the treatment. It could well be that these factors, rather than the progesterone itself, were responsible for the improvement in his patients.
This is very important. My main fear is that the media hype about progesterone and the desire for easy solutions to a myriad of complaints are obscuring the real issues. Are we merely falling into the same trap that we did in the fifties and sixties when oestrogen was hailed as the wonder cure for menopausal women? First we try one hormone, and then another. First it was oestrogen. Now it’s progesterone. Both, I believe, are short-sighted short-term solutions which may have long-term negative effects. Surely the aim is to get our bodies back in balance naturally – and to allow our bodies to do this by themselves. By adding in any kind of direct hormone we are never addressing the fundamental cause of problems. If you stop the cream, you are back to square one: your body will not have become any healthier in the process.
There is the possibility too that supplying something from an outside source merely encourages the body to produce less of its own. This is known to happen when people are given the thyroid hormone thyroxin. Our bodies are extremely clever. Why produce something yourself when it is being supplied from the outside and somebody else can do the work! And can it be sensible for women to take progesterone supplements after the menopause when the body’s own production of the hormone stops quite naturally? Its fans talk of progesterone as the ‘missing’ hormone. But after a certain stage of our lives it’s not supposed to be there anyway.
‘Natural’ progesterone is being touted as a ‘natural’ alternative to HRT. But there is nothing natural or alternative about it. The theory behind it is the same as the theory behind HRT – that menopausal women are suffering from a hormone deficiency disorder, a modern complaint that has arisen because we are now living way beyond our reproductive years. That is how the medical establishment, when pressed, explains and justifies the case for hormone supplementation.
*23/101/5*

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Other names: Nor-qd, Ortho Micronor

ALTERNATIVES TO HRT: PROGESTERONE AND MENOPAUSAL SYMPTOMS
You may have heard that progesterone can help menopausal symptoms and protect you from osteoporosis. The same question that is asked about HRT would have to be asked in progesterone’s case as well: when do you stop taking it? According to Dr John Lee, the Californian physician, the answer is, ‘Do it until you are ninety-six and then we will reconsider. You will not be the same at seventy as you are at fifty-six, so how do you know how much to use? Are you oestrogen dominant or are your hormones doing what they are supposed to at that age anyway? Yes, you can have your hormones tested and know what the profile is, but if you then continued to use progesterone cream for years, you would need to keep having tests to know whether you were overdosing or not. It’s all a bit hit and miss.
The cream is rubbed into the skin so it can be absorbed directly into the bloodstream. A team of researchers in Belgium found that the cream tended to accumulate in the skin instead of being fully absorbed into the bloodstream. Dr. John Lee advises applying the cream on a rotational basis to different parts of the body. You can imagine that if you use the cream for forty years, from the menopause to age ninety-six as he suggests, you will have used all the possible sites available and it is unknown what the side effects of the hormone accumulation in the fat cells will be. Dr Lee also believes that during the initial stages of using the cream it temporarily sensitizes the body to oestrogen. It is oestrogen sensitivity that has been linked to breast and endometrial cancers, fibroids and endometriosis. So by using progesterone cream are you increasing the risks of disease? And progesterone has some well known side effects. In the British National Formulary (BNF), which many doctors have in their surgeries, progesterone is listed separately from progestogens. And according to the BNF the side effects of progesterone include acne, urticaria, fluid retention, weight changes, gastrointestinal disturbances, changes in libido, breast discomfort and menstrual irregularities. Claims have been put forward that progesterone can protect against breast cancer, although there are arguments that higher levels of progesterone may be a risk factor for breast cancer. In animal studies cancer of the ovary, uterus and breast were all linked to increased progesterone.
Even Dr Lee admits that women taking ‘natural’ progesterone may experience exaggerated pre-menstrual or menopausal symptoms at the beginning. There are possibilities of breakthrough bleeding (bleeding that occurs at times in the cycle other than during a period) and other cycle irregularities as well. Linda, who is forty-seven, came to see me after using a progesterone cream over a period of two months. She had been recommended to use it even though she had had no menopausal symptoms and was still getting regular periods. She then started to get breakthrough bleeding halfway through the month. She was obviously concerned about this but was told that it was ‘normal’ and her body would adjust. The bleeding continued, so she decided to stop using the cream. At this point, she was overwhelmed by hot flushes and tiredness which she had not had before. Linda was getting hot all over, and waking up during the night; then she would feel really cold. She had lost her sex drive and felt ‘very fed up’. By this time she had not had a period for six weeks which was very unusual for her. Obviously she was worried. I recommended a good nutritional programme tailored to her needs and herbs to redress the imbalance. By the time she returned in a month, the hot flushes had gone, her energy was back and her periods had returned. I felt that the progesterone had had a pronounced effect on her hormone levels and it was only by taking a more gentle, natural approach that her body was able to balance itself.
*22/101/5*

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Other names: Abilify

ALTERNATIVES TO HRT: ?NATURAL? PROGESTERONE AND OESTROGEN
You need to be aware that progesterone creams contain a powerful pharmaceutical hormone that is made in a laboratory. Because the US FDA (Food and Drug Administration) won’t allow the manufacturers of the creams to make medical claims, they are sold as cosmetics, not as hormone replacements. It is because these creams contain a pharmaceutical agent that the UK’s Medicines Control Agency will only let them be sold under prescription, and rightly so. My main concern is that women are being duped into thinking they are buying a natural herbal remedy containing wild yam. They are not: they are buying hormone replacement – just a different hormone (progesterone instead of the usual HRT combination of a form of oestrogen plus progestogen). And they may not be buying anything truly to do with wild yam, which has a very respectable reputation as a herbal treatment for menstrual and menopausal problems. Although for centuries, herbalists have indeed used wild yam in a tincture form, the effect of the herb in its pure state is very different from that of the synthesized progesterone. This wild yam is taken orally and has traditionally been used as an anti-spasmodic and anti-inflammatory herb. As is the case with so many effective herbs it is not known precisely how it acts on the body. Since the essence of herbal medicine is that all the ingredients help towards the overall therapeutic effect, diosgenin alone cannot be responsible for the wild yam’s beneficial qualities. Herbs work because they contain a host of substances – active substances, balancing substances and substances that cope with any side effects of the active substances. They are holistic and truly ‘natural’. But the ‘natural’ progesterone that is being hyped is no more ‘natural’ than a number of the plant-based oestrogen preparations that form the basis of some HRT products.
These oestrogens are ‘natural’ in the same sense that plant-based progesterone is classed as ‘natural’. The oestrogens too are synthesized in the laboratory from soya beans and yams. They still have side effects, however. We need to be clear that these hormones, oestrogen and progesterone, which are synthesized in a laboratory from plants, are not natural to us. They may be chemically identical to what our bodies produce but they are powerful drugs, hence the need to put them on prescription. Plant-based progesterone is termed ‘natural’ because it has the same molecular structure as the progesterone molecule found in humans. This idea of different substances being chemically identical can be very misleading. For example, coal, diamond and graphite (the ‘lead’ in your pencil) are all chemically identical and yet they have very different properties and functions. They have the same molecular structure, but you wouldn’t expect to produce much heat by putting diamonds on the fire.
*21/101/5*