Nutrition, Supplementation and Lifestyle Considerations For Women 45 and Older
As women approach menopause a number of hormonal changes set the stage for the development of menopausal symptoms, and increased risk for heart disease, osteoporosis and breast cancer. Studies reveal that several important nutrition, supplementation and other lifestyle practices can help to combat menopausal symptoms, naturally, slow various aspects of aging, and help reduce risk of heart disease, osteoporosis and breast cancer during the peri-menopausal, menopausal and post-menopausal years. This article provides an overview of the important physiological changes that women face once 45 years and older, and the evidence-based lifestyle practices that have been shown to help maintain and improve quality of life and reduce risk of several common degenerative diseases.
Combating Peri-menopausal and Menopausal Symptoms Naturally
When a woman enters menopause estrogen levels drop by up to 90%, progesterone by up to 66% and testosterone by up to 50%. These hormonal changes accelerate the aging process of the skin and reproductive tissues, facilitate the loss of calcium from bone and trigger a constellation of menopausal symptoms (hot flashes, night sweats, mood changes, concentration ability, insomnia etc).
Clinical studies have shown that the estrogen-like substances found in black cohosh, soy isoflavones and gamma-oryzanol (found in rice bran oil) can significantly reduce menopausal symptoms, support skin health and integrity of the female reproductive tract and other tissues, help prevent loss of calcium from bone and improve feeling of well being. Since recent studies have shown that the use hormone replacement therapy has been shown to increase the risk of breast cancer, heart disease and stroke, providing women with safe and effective natural alternatives to hormone replacement therapy is information that is much appreciated and very timely.
Note that red clover, angelica species (dong quai) and licorice root can also reduce menopausal symptoms, but these herbal substances may increase risk of internal bleeding (bleeding disorder into the brain, under the skin etc) due to the presence of coumarins contained in these herbal substances. Licorice root may also elevate blood pressure. Thus, the safest combination of natural agents to support female well being during and after menopause, in my view, includes black cohosh, soy isoflavones and gamma-oryzanol
After menopause, women become less able to clear cholesterol from their blood stream, which greatly contributes to the fact that heart disease is the number one cause of death in postmenopausal women. During the pre-menopausal stage of life, high circulating estrogen levels increase the production of LDL-cholesterol receptors, which enable cells to extract LDL-cholesterol (low density lipoprotein-cholesterol, which is known to increase risk of heart attack and stroke) from the blood stream and use it for various purposes. The dramatic drop off in circulating estrogen levels in menopause reduces the ability of cells to produce LDL-cholesterol receptors. As a result there is a strong tendency for cholesterol to accumulate in the blood stream, stick to the walls of the arteries and cause narrowing of coronary blood vessels; leading to heart attack. As a high saturated fat diet is the main culprit in raising LDL-cholesterol levels, postmenopausal women should adjust their diet to lower their saturated fat intake in order to keep blood cholesterol levels below 5.2 mmol/L (200 mg per dL). This implies that the one should choose lower fat protein foods consisting of chicken, turkey, Cornish hen and fish, and that all milk and yogurt products consumed are non-fat or 1% varieties. No cheese above 3% milk fat should be consumed and that butter, ice cream, whipping cream, regular chocolate products, items containing coconut or palm oil, and deep fried products of all types, be avoided, or significantly reduced. Increasing soluble dietary fiber intake can also reduce blood cholesterol levels by dragging cholesterol out of the body, as well as bile acids, which can serve as precursors (building block) to the synthesis of cholesterol in the liver. Soluble fiber is found in most fruits and vegetables, oat bran, psyllium husk fiber, ground flaxseeds, and in beans and peas. Remaining physically fit and at or near one’s ideal weight are other important lifestyle factors in preventing cardiovascular disease in the postmenopausal years. Soy products and the herbal agent gamma-oryzanol have also been shown to reduce blood cholesterol levels, in addition to their role in helping to alleviate menopausal symptoms
The decline in estrogen levels that accompanies the menopausal years also permits calcium to leak out of bone into the blood stream, where it will eventually become filtered by the kidneys and exit the body in the urine. This of course, can lead to osteoporosis, which increases risk of fractures. Osteoporosis is reaching epidemic proportions in our society largely due to insufficient calcium intake and accumulation in bone, especially between ages 11 and 24, and loss of calcium from bone during the menopausal years. It should be noted that Canadian statistics indicate that complications from osteoporotic hip fractures (e.g., the development of pneumonia) result in more deaths each year than the combined mortality rate from breast and ovarian cancers. The lifestyle recipe to help prevent osteoporosis during the menopausal years is as follows:
- Ingest 1,500 mg per day of calcium. This can be through a combination of calcium from food and supplements. Note that a high potency multivitamin and mineral should provide 400-500 mg of calcium as a starting point.
- Supplement with 600 to 1,000 IU of Vitamin D. For general health reasons women should consider taking a high potency multiple vitamin and mineral throughout adult life that contains 400 IU of Vitamin D. Studies show that postmenopausal women ingesting an additional 200 to 400 IU of Vitamin D per day may reduce their risk of hip fractures by approximately 50%. As we age, our kidneys reduce their ability to convert 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D, which is twice as powerful a form of Vitamin D, than is 25-hydroxyvitamin D. However, studies indicate that by increasing blood levels of 25-hydroxyvitamin D, through the intake of Vitamin D supplements (600 – 1,000 IU per day), a postmenopausal women can compensate for the drop off in 1,25-hydroxyvitamin D synthesis, and thereby, significantly reduce her risk of osteoporotic fractures.
- Perform weight-bearing and/or resisted exercises 4 to 7 times per week. Weight bearing exercise such as walking or jogging, and weight training exercises, place increased stress on the spine and hips, which respond by holding their calcium in bone to help withstand the physical stresses acting on the bone structures. The ground breaking study performed at Tuft University by ME Nelson et al (JAMA,1994) showed that postmenopausal women can increase their bone density, without using hormone replacement therapy, by simply ingesting more calcium and performing a specific series of 5 weight training exercises, twice per week on a year round basis. The 5 gym-based exercise stations included: Hip Extension Machine, Back Extension Machine, Abdominal Flexion Machine, Knee Extension Machine and Lateral Pull-Down cable station.
It is well documented that women who are overweight during the postmenopausal years have approximately a three times greater risk of developing breast cancer. This is likely due to the fact that as fat mass increases there is a greater conversion of the hormone androstenedione to estrone within fat tissue. Higher circulating estrone hormone (one of three types of estrogens made by the female body) levels are associated with increased risk of breast cancer, as estrone is known to increase the cell division rate of breast cells. In turn, this leads to a greater chance of genetic mutations occurring, which may be cancerous. This is exactly the same mechanism through which hormone replacement therapy has been shown to increase breast cancer risk. Thus, postmenopausal women are well advised to attain and maintain an ideal body weight.
As women approach the menopausal years holistic health practitioners should provide these individuals with a consultation addressing the information contained in this article, as means to provide them with scientifically-based nutrition, supplementation and lifestyle advice aimed at helping women manage the peri-menopausal and menopausal period with natural alternatives to hormone replacement therapy, and build up there defenses against heart disease, osteoporosis and breast cancer, which account for a high percentage of morbidity and mortality during the post-menopausal years.