A Natural Solution

December 2003

A Natural Solution

By Angela M. Miraglio, R.D. Contributing Editor

For many women, menopause - the "change of life" - represents a time of physical and emotional discomfort caused by altered and erratic levels of normal female hormones. Common symptoms include hot flashes, insomnia, mood swings, depression, memory lapses and menstrual irregularities.

Over time, these symptoms diminish. However, during the acute phase, many women need help coping. Additionally, menopause is associated with the beginning of longer-term health issues, such as osteoporosis, cardiovascular disease and cancer.

Initially, traditional hormone replacement therapy (HRT) seemed to address both the acute and long-term concerns. Yet recent research from the Women's Health Initiative indicates that the risks of heart disease and cancer do not outweigh the benefits, and calls into question the common practice of pharmaceutical HRT for treating menopause and preventing diseases associated with aging. Many women are now turning to natural and alternative methods for dealing with this biological stage of a woman's life cycle.

Dealing with Mother NatureWhile some practitioners debate the need for all women to replace what Mother Nature takes away, they do recognize the need to treat acute symptoms. Based on current knowledge of the risk and benefits of HRT, the American College of Obstetricians and Gynecologists, Washington, D.C., recommends HRT for the shortest time necessary in the smallest effective dose when required. For those women who do not want traditional HRT, alternative therapies involve the use of one or more botanicals, vitamin or mineral supplements, avoidance of alcohol and caffeine, exercise and weight management.

Individualized treatment plans for using botanicals are based on a woman's symptoms and goals. The first question Stacie Geller, Ph.D, M.P.A., professor, Department of Obstetrics and Gynecology in the College of Medicine, University of Illinois-Chicago (UIC), and director, UIC National Center of Excellence in Women's Health, asks patients seeking advice is, "Why do you want botanicals? Is it for short-term relief or long-term replacement?" And Leslie Beck, an R.D. in private practice at The Medcan Clinic, Toronto, and author of "The Ultimate Nutrition Guide for Menopause," begins each patient consultation with a menopause rating scale.

According to these experts, the botanical answer for treating hot flashes and mood swings is black cohosh (Cimicifuga racemosa). "Black cohosh is my first choice only because it has the most studies," says Geller. "I recommend the German brand (RemiFemin®), again only because we know the most about it."

Beck agrees, and says it is important for women to understand how black cohosh works. "We need to educate women that getting a good quality product is important and that it takes 4 weeks for it to kick in." She adds that the more-common mistakes women make include not buying a quality, standardized product, taking an inadequate dose or not waiting long enough for results.

Black cohosh, a perennial plant native to eastern North America, has a long history of use by women. American Indians called it "squaw root" and used it for menstrual problems and childbirth. In Germany, women have used it for menopausal symptoms since the early 1940s. Available as a supplement derived from the plant's root, Geller says, "There is no way to take it through food." To date, its mechanism of action is unknown and research on estrogenic activity so far has yielded contradictory results. Potentially active compounds under study include fukinolic acid, triterpene glycosides, resins, and caffeic and isoferulic acids.

Commercial preparations of the extract are standardized to 26-deoxyactein content and usually contain 1 mg of total triterpene saponins in each 20-mg dose. Short-term studies have shown only a few side effects and no serious adverse reactions or drug interactions. According to the governmental regulatory agency German Commission E, a dose of 40 mg per day for 6 months is safe, but Beck says that longer studies demonstrating its safety for more than 6 months have recently been reported.

A number of other herbs also are recommended to treat various symptoms. But in many cases, support is based on common usage and inadequate scientific studies. Beck says it is important to use treatments that are supported by evidence-based research. In her practice, she recommends valerian for insomnia, kava kava for anxiety and gingko biloba for reducing the effects of aging on brain cells. She also advocates a good diet with adequate vitamin B12 for insomnia, choline for memory, and soy foods for isoflavones that help with hot flashes and provide longer-term protection against cardiovascular disease.

Bring on the PHYToestrogensAt first glance, it appears that Mother Nature provided a natural replacement for endogenous estrogen in the form of phytoestrogens - plant sterols that exhibit weak estrogenic activity when ingested. A variety of plants provide phytoestrogens in the form of isoflavones, lignans and coumestans. However, the most common phytoestrogen sources for women seeking natural solutions to menopause and aging are soy, flaxseed and red clover.

Observational studies of populations who regularly consume soy and flaxseed support the theory that phytoestrogen consumption helps alleviate some menopause symptoms. But clinical studies to date have yielded contradictory and inconclusive results on their effectiveness to deal with acute problems, such as hot flashes. It appears that the real value of phytoestrogens may be in prevention of longer-term health issues such as cardiovascular disease, osteoporosis and cancer.

Among the phytoestrogens, soy probably has the most extensive data on its potential health benefits. Soy's role in reducing coronary heart disease is well-recognized. Clinical studies demonstrated a relationship between soy protein consumption and lower serum total and LDL cholesterol. Other research indicates that soy-isoflavone consumption may increase bone density and provide protection against osteoporosis. Some research suggests soy may increase the risk for breast cancer, but other studies indicate that soy, when consumed before puberty, may actually reduce the risk of breast cancer in adulthood.

"Soy through food appears to be more effective (than supplements)," Geller says.

To help increase soy consumption, Beck suggests that the industry needs to develop tasty, convenient products so women can get soybeans and tofu with less processing and sodium.

The answers on botanicals' efficacy as natural HRT are still a few years away, according to Geller, who is lead investigator on a Phase II clinical trial on black cohosh and red clover. But, she says, "We have known for years, and now know again, that exercise and a healthy diet are important."

In general, both Geller and Beck recommend a low-fat diet with adequate calcium and vitamin D, exercise, and maintenance of a reasonable weight as key to women's health in middle age and beyond.

Sharon Palmer is a registered dietitian with a 16-year career in health-care, food and nutrition management. She now focuses her interest on the world of journalism as a freelance writer and editor, cookbook contributor and culinary instructor.

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