Wisdom Wednesday: A Soy-based Diet Could Help Strengthen Bones

A new study has investigated the impact of dietary soy on bone strength in postmenopausal women. The authors conclude that eating more soy might in fact strengthen bones in women of all ages.

The reduction in bone density and strength that is common in postmenopausal women is of huge concern. As women age, osteoporosis, reduced activity levels, and weight gain act together to decrease bone health and negatively impact metabolism. Osteoporosis and bone weakness increases the risk of fractures, which then lead to even more inactivity and weight gain, exacerbating the issue further. As the population becomes – on average – older and heavier, bone health is an important area of medical science to study.

To investigate, researchers from the University of Missouri in Columbia utilized so-called low-capacity running rats, which have lower fitness levels.

The researchers surgically removed the ovaries of half of the rats to mimic menopause. The scientists fed half of the rats a soy-based diet and the remaining animals a corn-based diet. Both diets contained the same amount of calories. They weighed the rats every week for the duration of the 30-week trial.

Then, the team took blood samples, tested bone strength, and assessed body composition. The analysis showed that, although turnover markers were not significantly altered, the leg bones of soy-fed rats were stronger than the bones of the rats that were fed a corn-based diets.

Wisdom Wednesday: Dietary Intake and Age at Natural Menopause

Age at natural menopause is a matter of concern for women of reproductive age as both an early or late menopause may have implications for health outcomes.

Study participants were women aged 40-65 years who had experienced a natural menopause from the UK Women’s Cohort Study between baseline and the first follow-up. Natural menopause was defined as the permanent cessation of menstrual periods for at least 12 consecutive months. A food frequency questionnaire was used to estimate diet at baseline. Reproductive history of participants was also recorded. Regression modeling, adjusting for confounders, was used to assess associations between diet and age at natural menopause.

During the 4-year follow-up period, 914 women experienced a natural menopause. A high intake of oily fish and fresh legumes were associated with delayed onset of natural menopause by 3.3 years per portion/day and 0.9 years per portion/day respectively. Refined pasta and rice was associated with earlier menopause. A higher intake of vitamin B6 and zinc was also associated with later age at menopause. Stratification by age at baseline led to attenuated results.

Our results suggest that some food groups and specific nutrients are individually predictive of age at natural menopause.

My Take:
This is the abstract minus some of the statistical analysis. Several studies had shown an association between early onset of menopause and lower bone density, osteoporosis, depression and premature death. Other studies indicate an increased risk of cardiovascular and coronary diseases. However, late menopause has been associated with a higher risk for breast, ovarian and endometrial cancers.

Obviously, there are many other factors affecting the onset of menopause – genetic, environmental, hormonal and general health issues to list a few. But the link between diet is intriguing.

Wisdom Wednesday: Vitamin D Linked to Metabolic Syndrome in Postmenopausal Women

Postmenopausal women with vitamin D deficiency have greater risk for metabolic syndrome than those with sufficient levels, data from a cross-sectional cohort study suggest. Levels of 25-hydroxyvitamin-D below 20 ng/mL were also linked to a greater likelihood of high triglycerides and low high-density lipoprotein (HDL) cholesterol.

“These results suggest that the maintenance of adequate serum levels of 25(OH)D in postmenopausal women may reduce the risk of developing [metabolic syndrome], a condition that is known to be related to cardiovascular events and mortality in this group,” write Eneida Boteon Schmitt, MD, from Sao Paulo State University’s Botucatu Medical School in Brazil, and colleagues.

The study, published in the January 2018 issue of Maturitas, included 463 women, 45 to 75 years old, who had not menstruated for at least a year, were not taking vitamin D supplements, and had a diagnosis of cardiovascular disease. The researchers measured their total cholesterol, HDL levels, low-density lipoprotein (LDL) levels, triglycerides, glucose, insulin, and 25(OH)D levels.

Vitamin D deficiency was defined as serum 25(OH)D levels below 20ng/mL, whereas levels between 20 and 29 ng/mL were insufficient. Levels of at least 30 ng/mL were considered sufficient. Diagnosis of metabolic syndrome required presence of at least three of five criteria: a waist circumference greater that 88 cm, triglycerides at least 150mg/dL, HDL levels below 50 mg/dL, blood pressure at least 130/85, and glucose at least 100 mg/dL.

Just under a third (32.0%) of the women had sufficient vitamin D levels, and a similar proportion (32.6%) had insufficient levels. The remaining 35.4% were deficient. More than half (57.8%) of the women without sufficient vitamin D (below 30 ng/mL) had metabolic syndrome compared with 39.8% of the women with sufficient vitamin D levels.

Postmenopausal Women Should Still Steer Clear of HRT

Yet again, the nation’s leading authority on preventive medicine says postmenopausal women should avoid hormone replacement therapy (HRT).

The U.S. Preventive Services Task Force is standing by its original recommendation that women who have already gone through menopause should avoid using female hormones to guard against osteoporosis or diabetes, said task force chairman Dr. David Grossman, a senior investigator at the Kaiser Permanente Washington Health Research Institute in Seattle.

“Basically, the task force concluded there was no overall benefit from taking hormones to prevent chronic conditions,” Grossman said. “There are some benefits, but we believe those potential benefits are outweighed by the harms, making this essentially no net benefit overall.”

The advisory covers all formulations of hormone replacement therapy, the task force said. The therapy can consist of pills or patches containing either estrogen or an estrogen/progesterone mix.

However, women undergoing menopause can use hormone replacement therapy short-term to treat symptoms such as hot flashes and vaginal dryness, said Dr. Suzanne Fenske, an assistant professor of obstetrics, gynecology and reproductive science with the Icahn School of Medicine at Mount Sinai in New York City.

“Hormone replacement therapy does still have a benefit to women with menopause whose symptoms do not respond to other treatment options,” Fenske said. “It really should be used to manage menopausal symptoms, rather than being used for any sort of preventative medicine.”

The task force first recommended against hormone replacement therapy for postmenopausal women in 2012. It updates its recommendations every four years to make sure they reflect the latest medical evidence.

Obese Women May Have More Intense Hot Flashes

There’s another downside for women who carry a lot of excess weight: more intense hot flashes and night sweats during menopause, new research suggests.

“This study supports earlier studies that found that women who are heavier tend to have more hot flashes, particularly close to menopause,” said Dr. JoAnn Pinkerton, executive director of the North American Menopause Society.
The study involved nearly 750 Brazilian women between 45 and 60 years old.

The study authors said their findings support an idea that’s known as the thermoregulatory theory. This theory suggests that excess weight is linked to “vasomotor symptoms” – such as hot flashes and night sweats – because body fat acts as insulation, trapping heat in the body.

Obese women were also more likely to experience other symptoms more often, including joint pain, muscle pain and urinary issues, the study authors said.

The study was published online May 31 in the journal Menopause.

The researchers said their findings highlight the importance of a comprehensive approach to weight control among menopausal women.

Timing of Menopause May Affect Heart Failure Risk

Women who entered menopause early or who never gave birth might have an increased risk of heart failure, a new study suggests.

Researchers analyzed data from more than 28,000 postmenopausal women who did not have heart disease at the start of the study. During an average follow-up of about 13 years, just over 5% of the women were hospitalized for heart failure.
The study was published May 15 in the Journal of the American College of Cardiology.

“Our finding that a shorter total reproductive duration was associated with a modestly increased risk of heart failure might be due to the increased coronary heart disease risk that accompanies early menopause,” senior author Dr. Nisha Parikh said in a journal news release. Parikh is an assistant professor at the University of California, San Francisco School of Medicine.

“These findings warrant ongoing evaluation of the potential cardioprotective mechanisms of sex hormone exposure in women,” Parikh added.

Previous studies found that sex hormones present during a woman’s childbearing years may affect heart disease risk.

My Take:
Last fall I attended a seminar on “Hormones & Cardiometabolic Function” presented by Jack Monaco, MD. He cited extensive research that indicates that sex hormones serve as cardioprotective.

The sex hormones appear to reduce vascular inflammation in the intima of the vessel walls. This is how atherosclerosis begins. It is only after the intima becomes inflamed that LDL cholesterol binds to homocysteine and plaque forms against the inflamed intima.

This research has created a boon for hormone replacement therapy (HRT). However, the introduction of exogenous sex hormones has significant side effects. Even bioidentical hormones down regulate cell hormone receptor sites after just two months of treatment. This requires more and more hormone to obtain the same response.

The Bottom Line:
Despite the cardiovascular protection afforded by endogenous hormones, exogenous hormone therapy has severe side effects and should be limited to short term therapy up to two months. The key is to stimulate endogenous hormone production from the adrenal glands in menopause and andropause. More on this topic in my next blog.

Source: May 15, 2017 National Institutes of Health

Menopause Hastens Aging

Menopause, and the insomnia that often goes along with it, can speed aging in women, two new studies suggest.

“For decades, scientists have disagreed over whether menopause causes aging or aging causes menopause,” said Steve Horvath, senior author of both papers. “It’s like the chicken or the egg: which came first? Our study is the first to demonstrate that menopause makes you age faster,” said Horvath, a professor of human genetics and biostatistics at the David Geffen School of Medicine at the University of California, Los Angeles.

He and his colleagues said they found that menopause boosts cellular aging by an average of 6%. “that doesn’t sound like much, but it adds up over a woman’s life span,” Horvath added in a UCLA news release.

For example, a woman who began early menopause at age 42 would be a full year older biologically at age 50 than a woman that same age who began menopause at age 50.

Insomnia, which often accompanies menopause, can also lead to faster biological aging, according to the second study. “Not getting restorative sleep may do more than just affect our functioning the next day; it might also influence the rate at which our biological clock ticks,” said Judith Carroll. She is an assistant professor of psychiatry at UCLA’s Semel Institute for Neuroscience and Human Behavior, and first author of the sleep study.

“In the women we studied, those reporting symptoms such as restless sleep, waking repeatedly at night, having difficulty falling asleep and waking too early in the morning tended to be older biologically than women of similar chronological age who reported no symptoms,” she said.

Migraines May Worsen as Menopause Approaches

“Changes in female hormones such as estrogen and progesterone that occur during perimenopause might trigger increased headaches during this time,” said study co-author Dr. Richard Lipton. He is director of the Montefiore Headache Center and vice chair of neurology at Albert Einstein College of Medicine in New York City.

The new research included more than 3,600 women who suffered migraines before and during menopause. The risk of high-frequency migraines (10 or more a month) rose 60% during the transitional time into menopause marked by irregular menstrual cycles (perimenopause).

The risk of migraine was highest during the later stage of perimenopause, when women have low levels of estrogen, the study found.

“Women have been telling doctors that their migraine headaches worsen around menopause, and now we have proof they were right,” study author Dr. Vincent Martin, co-director of the Headache and Facial Pain Program at the University of Cincinnati Neuroscience Institute, said in a news release.

There is help for women who have migraines and are approaching menopause, said study co-author Dr. Jelena Pavlovic, an attending physician in neurology at the Montefiore Headache Center and an assistant professor in the neurology department at Albert Einstein College of Medicine.

“Physicians can prescribe hormonal therapies that level out these changes that occur during the perimenopause and menopause time periods. If the patient is in early perimenopause, you can give birth control pills that level things out. If they are in late perimenopause and they start skipping periods, they can be put on estrogen patches,” Pavlovic said.

But hormones may not always be the culprit. Although the number of migraines rose 76% during menopause, some headaches may be the result of medication overuse, which is common in this age group, according to Martin.

“Women, as they get older, develop lots of aches and pains, joints and back pain, and it is possible their overuse of pain medications for headache and other conditions might actually drive an increase in headaches for the menopause group,” he said.

During Menopause, ‘Good’ Cholesterol May Lose Protective Effect on Heart

HDL cholesterol is commonly called the “good” cholesterol, but new research suggests that it could be harmful to women going through menopause.

The new study finds that rather than helping to inhibit the formation of dangerous plaque in the arteries, HDL cholesterol may increase its buildup during menopause. This process is known as hardening of the arteries, or atherosclerosis, and can lead to heart trouble.

“This was surprising,” said lead researcher Samar El Khoudary, an assistant professor of epidemiology at the University of Pittsburgh.

“We know that the good cholesterol is supposed to protect women,” she said. And, before menopause, good cholesterol does help protect against heart disease, El Khoudary said.

But during menopause, HDL cholesterol seems to add to the plaque buildup. She explained. “This was independent of other factors such as body weight and levels of bad cholesterol,” El Khoudary said.

It’s not clear why good cholesterol may turn bad, she said. “There are many biological changes that happen to women during the menopausal transition,” she said.

Among these changes is the addition of fat to the abdomen and around the heart. “This could put women in a state of chronic inflammation that could change the good cholesterol,” El Khoudary suggested.

Hot Flashes, It Seems Like, Forever

Menopause-related hot flashes and night sweats aren’t a short-term problem. More than half of women experience these unpleasant change-of-life symptoms for seven years or more, a new study finds.

“Women should not be surprised if their hot flashes last a number of years,” said lead researcher Nancy Avis, a professor of social sciences and health policy at Wake Forest School of Medicine in Winston-Salem, N.C.

Four out of five women experience hot flashes and night sweats in the years before their periods cease, leaving some with almost 12 years of unpleasant symptoms, the study found. And women who could pinpoint their final period reported symptoms persisted for an average 4.5 years afterward.

The findings, published February 16 in JAMA Internal Medicine, suggest a need for “more research on safe and effective ways to relieve these symptoms,” Avis said. Menopausal symptoms affect quality of live, disrupt sleep and result in worse physical health, she and her colleagues noted.

Menopause – which is confirmed when a women’s periods have ceased for 12 consecutive months – occurs most often between ages 45 and 55, according to the North American Menopause Society. The symptoms women experience are related to lower levels of estrogen and other hormone. Common among these symptoms are hot flashes.

One option – hormone replacement therapy – is avoided by many women because it has been linked to an increased risk of breast cancer, Avis said. “Also, women who have had breast cancer cannot take hormone replacement therapy,” she noted.

Last week, researchers reported in The Lancet that taking hormone replacement therapy for even less than five years after menopause increased a women’s risk of ovarian cancer by about 40%.

Wisdom Wednesday: Female Health Concerns

I attended a seminar last weekend in Miami and thought I would share some of the high points. My chiropractic license requires 40 hours of continuing education every two years. However, my nutritional diplomat requires 12 hours each year. Some of the hours can overlap, but for the most part I take different classes for each requirement. The nutrition classes are by far the more interesting.

The class composition is always quite eclectic when nutrition is the topic. We had MDs, DOs, acupuncture physicians, naturopathic physicians, registered dieticians, a few chiropractors, and some of the staff from the UM School of Medicine. The instructor, Michelle J. Pouliot, ND practices naturopathic medicine in Connecticut. She specializes in women’s issues and over 80% of her practice is comprised of adult females.

The seminar focus was on PMS, perimenopause, menopause, osteoporosis and female sexual issues.

On the surface all these health issues appear to be hormonal and to a great extent they are. Dr. Pouliot frequently uses botanical herbs like Chaste Tree, Black Cohosh, White Peony, and Wild Yam to treat her patients. She is even more enthusiastic about Chaste Tree than I am. However, she also provided great information about the neurological aspects of female health concerns.

Wisdom Wednesday: Chaste Tree

This herb has been used for over 2500 years as a tonic for female hormonal issues. During the middle ages, the monks would chew the leaves to reduce their libido and “keep their thoughts on higher things.” The tree originates from the Mediterranean region but grows well in all sub-tropical climates.

I began using this herb about fifteen years ago. Like most nutritionists, I used it to treat PMS, irregular menstrual cycles, painful menstruation, etc. The herb was thought to have a direct effect on the ovaries so it was not used on men or postmenopausal women.

Within a couple of years, we began to use it to treat postmenopausal women, but only if they still had a least one ovary. It was very effective for hot flashes and mood swings.

Chaste Tree (or Monk’s Pepper) also had an antidotal use as a sleep aid. In addition, the full dose was given first thing in the morning rather than throughout the day like most supplements. The rationale for use and the application had been lost over the centuries.

New research on Chaste Tree was published ten years ago. The study focused on the traditional use as a sleep aid. They discovered that Chaste Tree does not directly influence the ovaries at all. Rather, it stimulates the pineal gland to make more melatonin. Clinically, melatonin production increases by 95% within two weeks.