Feb
18
2017

Weight Gain In Menopause

Dr. Tasneem Bhatia, also known as Dr. Taz gave a lecture about weight gain in menopause. This was part of the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. The full title of the talk was “Hormone Balance and Weight Control in Menopausal Women”. Dr. Taz practices integrative medicine at CentreSpring MD, Atlanta. GA.

A few statistics about menopause

Weight gain in menopause is common. There are 50 million women who suffer from this in the US. Globally 300 million women have this problem. The average weight gain is between 5 and 50 pounds. There may be a small percentage of women where a genetic component comes in, and where all the females in the ancestry had a weight problem after menopause. But we do not know for certain what is genetic and what is due to hormone deficiency. It is only in the last few decades that doctors have determined how important hormone deficiencies are in menopause.

It has been determined that 10 million women who are over 40-years-old need treatment in long-term care facilities.

We will see below that when this knowledge is incorporated into a treatment schedule, the weight problem can normalize. In this case 2/3 of the cost of caring for postmenopausal women with obesity and diabetes can be reduced.

Pathophysiological changes in menopause

There are three intertwining aspects that drive weight gain in menopause. There is an altered metabolic rate, and less calories are burnt, which makes you gain weight when you eat the same amount of calories. Secondly there is a significant decline of three key hormones, estrogens, progesterone and thyroid hormones in menopause. Third, as the weight rises and the other mentioned hormones are missing, it is harder for the pancreas to keep up with insulin production and insulin resistance is developing. I will explain this further below.

1. Decreased energy expenditure

With the lack of the ovarian hormones there is a slowing of the resting metabolic rate. There is also decreased energy expenditure from reduced fat oxidation. Overall there is less need to consume the same amount of calories as before. But the hormonal changes trigger hunger and cravings.

2. Ovarian aging

With ovarian aging there is less estrogen production in the ovaries. This leads to less ovulation in the premenopausal period. A lack of ovulations creates a lack of progesterone production. When there are anovulatory cycles, there is no progesterone producing corpus luteum reducing progesterone production further. When estrogen and progesterone are missing, this is a stress on the thyroid gland that is trying to partially compensate for the lack of the ovarian hormones. Eventually though thyroid hormone production is reduced and hypothyroidism sets in. This is very hard on the adrenal glands that produce cortisol. For some time the adrenal glands can compensate for missing thyroid hormones with cortisol overproduction. But in time adrenal gland fatigue develops.

3. Insulin resistance

Insulin resistance can lead to diabetes, which becomes a real menace together with the metabolic changes of obesity.

Health risks of weight gain

Dr. Taz pointed out that there are very specific risks associated with the metabolic changes around menopause. There is an increased risk for heart attacks and strokes as LDL cholesterol and triglycerides are elevated and arteries get calcified from circulating calcium that was leaked out from the bones into the blood stream.

Osteoporosis is common in menopause; the brittle bones lead to an increased risk of fractures in the hips, wrists and vertebral bodies.

There is also increased risk of cancer in postmenopausal women, particularly breast cancer and colon cancer. The higher the weight, the more risky it is for these women to get one of these cancers.

Alzheimer’s disease and cognitive decline is also very common in menopause. This may be directly related to a lack of estrogen and progesterone, but may also have to do with overconsumption of sugar and starchy foods.

Hormone changes in menopause

Hormone changes in menopause can be complex. It is not only a lack of estrogens and progesterone that are the problem. All hormones work together. When there is weakness in one area (in the ovaries with menopause), those hormones that are acting in the same way or in opposition to ovarian hormones will be affected. In this way it is understandable that the thyroid gland can develop a weakness (hypothyroidism) or why the adrenal glands are over stimulated first, but will eventually suffer with adrenal fatigue in future. In a similar way the pancreas produces too much insulin, partially because weight gain stimulates this. Typically the physician finds the fasting insulin level elevated with menopausal obesity. But as insulin levels are too high, the body’s insulin receptors get lazy and do not respond fully to insulin anymore. This is called insulin resistance. In time insulin resistance can lead to diabetes.

1. Lack of estrogen

A lack of estrogen in menopause is likely the single most important reason for weight gain in menopause.  As estrogen secretion declines, visceral obesity increases. There is also impaired insulin regulation. With obesity there is an additional risk of developing diabetes.

2. Progesterone

Progesterone is the other female hormone that is reduced with menopause. Bioidentical progesterone cream can prevent osteoporosis and hot flashes in menopause. Bioidentical progesterone replacement can also help a menopausal woman to sleep better. In menopause the production of progesterone goes down by 75% while estrogen production drops down by 35%.

3. Hypothyroidism

Hypothyroidism (with elevated TSH blood tests) is commonly found in menopausal women. This is known to be associated with weight gain. As a result it is important to check for hypothyroidism in menopausal women. It is important to check for micronutrients like iodine, selenium and iron and if they are low, supplementation may be necessary. Some women develop an inflammatory thyroiditis, called Hashimoto’s disease. This can be confirmed with a thyroid nuclear scan. The reason this is important to recognize is that after several years when it burns itself out, hypothyroidism develops often, which requires thyroid hormone replacement.

4. Cortisol response

The cortisol response to stress is suboptimal due to the decreased progesterone levels in menopause. Adequate amounts of progesterone are needed to synthesize cortisol. But in a group of menopausal women following a significant stressful event cortisol production was much higher than in non-stressed women.

5. Other hormones

Other hormones like leptins and melatonin are also contributing to weight gain in menopause. In rat experiments where ovariectomies (mimicking menopause) were performed, there was a clear relationship between low estrogen levels and weight gain; higher estradiol doses inhibited leptin expression resulting in weight normalization.

Leptin and melatonin are influencing insulin regulation. This can in time lead to diabetes in connection with weight gain. It is at this point when a woman’s body shape can turn from a healthier pear shape to an unhealthy apple shape. The extra visceral (abdominal) fat is very active metabolically and causes inflammation in the body. These changes can lead to high blood pressure, heart attacks, strokes and digestive dysfunction.

Treatment of weight gain in menopause: food, hormones and lifestyle

How do you treat a complex problem like weight gain in menopause? It is no surprise that this will require a number of treatment modalities in combination.

1. Diet

It is important to start on an anti-inflammatory diet like the Mediterranean diet. Any extra sugar should be cut out as surplus carbohydrates lead to fat deposits and higher blood lipids. Dr. Taz suggested a 1200-calorie diet. Reduce salt intake. Eat more food during the day until 4 PM, nothing to eat after 8 PM. Increase plant-based foods, lower or eliminate trans fats. Increase foods rich in probiotics (bifidobacteria) like kefir, yogurt and kombucha.

2. Exercise 

Do some exercise in a gym where you combine a treadmill for 30 minutes with 25 minutes of weight machines for strength training. Aim for doing this 5 times per week. But it would be more beneficial doing it every day. Have additional activity bursts on and off during the day. Exercise has been shown to increase HDL cholesterol, which protects from heart attacks and strokes.

3. Stress management

Supplements like adaptogens help the adrenal gland to better cope with stress. These are available through your health food store. Meditation, yoga, self-hypnosis will all help to refocus and protect you from stress. B-complex vitamins and vitamin C strengthen your immune system and give you more energy. Building and maintaining community is another factor in reducing stress.

4. Establishing healthy sleep

Many postmenopausal women have poor sleep habits, partially from hot flashes (due to estrogen deficiency), partially from melatonin deficiency and also from progesterone deficiency. In the next section I will describe how to normalize these hormones. But in addition you need to educate yourself to go to bed between 10 PM and 11 PM every night and to sleep 7 to 8 hours. If you go to bed later, you will disturb your diurnal hormone rhythm and this will interfere with a normal sleep pattern. There is an age-related reduction of melatonin production in the pineal gland. This is why many postmenopausal women are deficient in melatonin. You may need 3 mg of melatonin at bedtime. If you wake up in the middle of the night you could take another 3 mg of melatonin. You may experience a few nightmares as a side effect; otherwise melatonin is very well tolerated.

5. Bioidentical hormone replacement

The complex hormone deficiencies described above are responsible for the many symptoms of menopausal women including weight gain. It is important to work with a knowledgeable health care provider who knows how to prescribe bioidentical hormones. Typically blood tests and possible saliva hormone tests are done before replacement. This establishes which hormones have to be replaced. Typically bioidentical progesterone is replaced first. Secondly, estrogen is added as Bi-Est cream, if blood levels indicate that it is low. If thyroid is required because of a high TSH level (meaning hypothyroidism) supplementation with Armour or a similar balanced T3/T4 combination is started. If fasting insulin levels are high, the doctor may want to start metformin as this is known to normalize insulin resistance. Blood tests have to be repeated from time to time to ensure adequate hormone levels.

6. Supplements

Every woman treated will likely require different supplements. But magnesium is one mineral that is often missing in the diet. 250 mg of magnesium twice a day will be enough for most women and men to balance internal metabolic reactions. Magnesium is a co-factor to many enzyme systems. Vitamin K2 (200 micrograms daily) and vitamin D3 (around 4000 to 5000 IU per day) in combination are important to prevent osteoporosis. Apart from these there are many options to take other supplements. Ask your healthcare provider what you should take.

Weight Gain In Menopause

Weight Gain In Menopause

Conclusion

This was a fast review of what Dr. Taz explained in a talk about weight gain in menopause. There are complex hormone changes that need to be addressed. A well-balanced diet like the Mediterranean diet needs to be followed. Stress management skills need to be learnt. A regular exercise routine needs to be followed. Healthy sleep patterns have to be reestablished. And missing hormones need to be replaced not in synthetic forms, which are toxic to the body, but in the bioidentical forms. Postmenopausal women will feel better when this comprehensive treatment program is in place; and in time they will feel normal again.

May
28
2016

Two Sides Of Medical Marijuana

The newest craze is to treat menstrual cramps with medical marihuana, but there are two sides of medical marijuana. What women with menstrual cramps may not know is that it is estrogen dominance that is the cause of their symptoms. As women get closer to menopause they ovulate less often, and there are anovulatory menstrual cycles. This leads to a relative loss of progesterone from the corpus luteum that will form less frequently in the small cavity where the cyst with the egg was. Nature designed women’s menstrual cycle with mostly estrogen production in the first half of the menstrual cycle and mostly progesterone production in the second half of her cycle.

Other causes of estrogen dominance

When a woman gains weight, estrogen can also be produced in the fatty tissue due to an enzyme called aromatase. Androgenic hormones, which are testosterone-like and produced in the adrenal glands, get metabolized into estrogen through aromatase. This upsets the balance between progesterone and estrogen. Normally that balance when measured with saliva hormone tests should be higher than 200 to 1. But when progesterone production from the ovaries is missing, or when estrogen production is in overdrive through aromatase, estrogen is dominant. The progesterone to estrogen ratio drops below 200 to 1. This is bad news as it has consequences. It can cause a number of symptoms: migraine headaches, painful menstrual periods, endometriosis, and fibrocystic disease of the breasts with breast pain; even cancer can develop in the cervix, the uterus and the ovaries. Estradiol, the main estrogen compound in women, stimulates cells to divide, when it is not balanced by progesterone. Progesterone does the opposite: it balances the effects of estrogen.

Two sides of medical marijuana: treating symptoms

Drug companies always look out for symptoms that they can treat with a patented drug. The link at the beginning of this blog pointed out that “there are some very sick patients in need” to justify treating them with marijuana. This may relieve their symptoms for as long as they take the chemical compound. But it does nothing for the hormone imbalance. With the next menstrual cycle the symptoms will recur, and the marijuana will be consumed intermittently for years to come. What is worse is that the women think that nothing bad can happen to them: they are just relieving their symptoms. But as pointed out, unbalanced estradiol can give them migraine headaches. It can cause painful menstrual periods with or without endometriosis. Breast pain can be caused from fibrocystic disease. The worst of all is that after decades of estrogen dominance cancer of the cervix, cancer of the uterus and cancer of the ovaries can be caused. This is when drug manufacturers have unwittingly victimized their customers.

Proper treatment of menstrual cramps

1) Premenopausal women: The proper treatment for estrogen dominance because of a lack of progesterone in premenstrual women is to replace the progesterone deficit by bioidentical progesterone cream. Naturopathic physicians and anti-aging physicians understand this and treat it this way. Many practicing physicians including specialists, however, use anti-inflammatories and pain medications to treat this. Replacing the missing progesterone is causal treatment. Treating pain is symptomatic treatment. Treating the cause treats the medical problem properly; symptomatic treatment treats the drug company to a profit at the expense of the patient’s health.

2) Women with obesity: As explained already, estrogen dominance can also be produced from estrogen conversion of androgenic adrenal gland hormones due to aromatase in fatty tissue. The key here is to concentrate on watching the diet and exercising regularly. Even 10 to 20 pounds of weight loss can have significant effects on lowering estrogen production. The treating naturopath or anti-aging physician should measure progesterone and estrogen levels in a saliva hormone test. The progesterone to estrogen ratio should be calculated. If progesterone is missing, this can be added by giving a bioidentical progesterone cream or by taking oral micronized progesterone capsules at bedtime. As mentioned above, this is a causal therapy, and will in time not only cure the painful periods, but will prevent all of the other negative conditions mentioned. And most of all, there are no negative side effects, because the body knows the bioidentical hormones.

Two sides of medical marijuana: side effects of marijuana

Marijuana has real side effects. j can cause high blood pressure, dry mouth, headaches, dizziness, hallucinations, depression and sexual problems. It is unsafe with pregnancy, as it has been shown to be associated with childhood leukemia. Marijuana can cause rapid heartbeats and increases the risk of having a heart attack. Regular use of marijuana is associated with lung cancer and emphysema. There is an association of marijuana use and seizures: in some patients it makes seizures worse, in others it makes them better. But marijuana is a central nervous system suppressant. So it is imperative that you stop marijuana two weeks before any surgical procedure, as the anesthetic and other medicines given during surgery will also depress the nervous system.

Why the difference between hormones and marijuana?

You may ask yourself why there would be such a difference in the side effect profile of hormones versus marijuana? Hormones are natural messenger molecules in the body. They are designed by our genes to communicate between our brain, the hormone glands, and cells in organs with certain hormone receptors. This design helps to ensure optimal balance of our metabolic processes.

In contrast, marijuana is affecting cannabinoid receptors in the brain. There are several subtypes that are defined at this point. But these were only detected because researchers were curious what marijuana was doing. This research is in flux. We do not know enough about the long term side effects of marijuana. We do know that marijuana has central nervous depressive effects, because it is binding to these receptors. This makes these receptors not available for the normal brain function. One of these effects may even be that it would block pain perception for a period of time. But nobody knows how safe this is in the long term.

Another possible effect, which makes it to the media a lot, is a possible anti-cancer effect. Before you get your hopes up, read this thorough review of all the cancer research with cannabinoids. I am afraid that at this point there is no clear evidence to support that cannabinoids help fight cancer persistently. There are occasional cures reported, but this is not a persistent pattern.

Safety of synthetic hormones versus bioidentical hormones

You may have heard of the Women’s Health Initiative (WHI) that was abruptly ended in 2002. They used synthetic estrogens (derived from horses) and synthetic progestins (bad copies of progesterone). There results were breast cancer, uterine cancer, heart attacks and strokes that developed in patients who took these synthetic hormones. Originally the investigators wanted to show that HRT (hormone replacement therapy) would prevent heart attacks and strokes. It was supposed to also show that osteoporosis would be diminished. But the opposite was true! The synthetic hormones blocked the natural receptors, so the woman’s own hormones could not reach their target cells. Had the investigators used bioidentical hormones, the natural receptors would have been stimulated, and all of the research objectives would have been reached. The WHI was a huge debacle, which showed that drug sponsored research can lead to disasters. The only problem now is that women are scared, as they do not understand what hormones do. The bioidentical hormones, when balanced properly, are harmless. Synthetic hormones from drug manufacturers are interfering with the body’s hormone receptors causing all kinds of serious side effects including cancer. Bioidentical hormones don’t do that.

Two Sides Of Medical Marijuana

Two Sides Of Medical Marijuana

Conclusion

Those who like to push the sale of marijuana will minimize the side effects of marijuana. They will also push testimonials of women who have been helped with regard to painful periods.

You will rarely hear about women who had their hormones analyzed and had been replaced with bioidentical hormones to normalize their estrogen dominance. The latter approach is a safe approach with no side effects, because you are using natural hormones that stimulate your body’s hormone receptors. Synthetic hormones or marijuana are foreign substances to the body, partially blocking cell receptors, which blocks normal cell function. But nobody knows exactly what these chemicals do other than produce a myriad of side effects. Are you really willing to put your health at risk? After reading this, the answer should be clear.

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Apr
09
2016

Treating Lack Of Sexual Arousal

A few years back lack of sexual arousal was not discussed that much. But since Viagra has been such a success in males, the search was on for a similar drug for females who have a lack of sexual arousal. The new drug, the “Viagra equivalent for women” is flibanserin under the trade name Addyi.

The news about this new drug has been noted in the media.

How flibanserin works

How does flibanserin work? It stimulates 5-HT1A receptors in the frontal brain to produce more serotonin and dopamine. Due to these substances a premenopausal woman with a lack of desire for sex becomes more arousable. It may sound reasonable at first, but when you look at the many other effects that a stimulation of 5-HT1A receptors can produce, I find it surprising that the FDA gave approval to this drug.

Flibanserin can cause opening up of skin veins leading to hypothermia and fainting due to a lowering of blood pressure. It has some pain relieving properties. Flibanserin can also interfere with learning and inhibit some aspects of memory. Some positives are decrease in aggression, increase in sociability and decreased impulsivity.

Here are a few points that need to be discussed regarding this new drug.

Treating a symptom rather than the cause

Premenopausal women have a lack of progesterone, as their ovaries do not ovulate as regularly as they did in the past. When the last ovulation has occurred, the woman’s periods stop for good. She is said to have entered menopause. There is a profound lowering of estrogen and progesterone levels, which also leads to a lowering of the testosterone blood level. In women the percentage of testosterone is minute compared to men, but testosterone is essential for normal libido. About 5 years before a woman gets into menopause testosterone levels and progesterone levels may already be getting reduced. It is this low testosterone level, which is the cause of the lack of sexual arousal. So, why are we suddenly treating these symptoms with a poorly understood drug? Why are we not treating the cause? The causes for a lack of sexual arousal are premenopausal hormone changes: mostly lowered progesterone and including lowered testosterone levels as well.

Alternative treatment of lack of sexual arousal

Dr. Lee has written several books that became famous. He treated hormone deficiencies in people with replacement of bioidentical hormones, which resulted in feeling renewed energy and losing the symptoms for which the patients were seen. With regard to premenopausal symptoms Dr. Lee wrote the following in one of his books.

It is interesting that these premenopausal women were all helped with progesterone cream, and their sexual arousal returned as well as a tiny amount of bioidentical progesterone is metabolized into testosterone, which is known to increase libido in women.

It is clear that Dr. Lee would have done what any anti-aging physician today would do: measure hormone levels and add back the hormones that are missing. In the case of premenopausal women it is mostly progesterone that is missing.

What is better: using a chemical or using a natural hormone?

We need to come to terms with the question: is a chemical like Viagra better for a male to get an erection or natural testosterone?

Viagra and others of that type are drugs that are a foreign substance to the body. There are a significant number of side effects with this medication such as headaches and clotting problems that limit the use for certain patients. Bioidentical testosterone replacement therapy, which can stimulate libido significantly, can often eliminate the need for Viagra type drugs. In the past, with the use of synthetic testosterone, hepatic toxicity and with long-term use the risk of liver cancer existed. Dr. Morgentaler has shown that prostate cancer is not a risk with long-term use of bioidentical testosterone. Also, with synthetic testosterone blood could get thickened (secondary polycythemia), which could cause a stroke. Patients on synthetic testosterone need to be monitored for these side effects accordingly, but not on bioidentical testosterone.

If a male with erectile dysfunction is found to have a low testosterone blood level, this is the cause of erectile dysfunction and therefore treatment consists of bioidentical testosterone replacement therapy, NOT a drug like Viagra. Testosterone is well tolerated with no side effects. Instead the man experiences a profound feeling of wellbeing.

The same reasoning is true for a premenopausal woman with a lack of sexual arousal. If she is deficient in progesterone hormone, she needs bioidentical progesterone cream, not a new drug called flibanserin with a myriad of side effects.

Evidence of efficiency of flibanserin in treating sexual arousal

Evidence based medicine scrutinizes research papers to calculate the numbers of patients to be treated before there is one positive therapeutic effect. A good medical treatment is one where there are only 50 or less patients needed to treat before one therapeutic success occurs.

The observation from the studies on flibanserin was that satisfying sexual events rose from 2.8 to 4.5 times a month. However, women receiving placebo reported also an increase of satisfying sexual events from 2.7 to 3.7 times a month. There was only a difference of 0.8 times per month that a satisfying sexual event occurred compared to the placebo! If the average American couple has sex 2 to 3 times per week (2.5 times per week), this translates to 10 times per month. We just heard that 0.8 times of these 10 times per months a satisfying sexual event occurred on flibanserin. Flibanserin is taken as one tablet at bedtime.

Compared to the placebo group, it would take 12.5 episodes of sex to generate one event of success (satisfying sexual event), which can be attributed to taking flibanserin daily. The NNT (number needed to treat) is 12.5. However, if the number of days of taking tablets is used, it would take 37.5 days of taking flibanserin to create one satisfying sexual event, so the NNT=37.5. Nevertheless, both numbers would still be acceptable as a moderately effective medicine, as they are below 50.

But I think that we have to be much more cautious in this case as the side effects are considerable and an alternative with no side effects and much more effect exists (bioidentical progesterone replacement).

Consumer education needed

Should the patient trust a physician’s prescription? Should the patient put up with side effects like nausea, tiredness, and difficulty falling asleep or staying asleep, a dry mouth, constipation or excessive sleepiness? Should the patient insist to be educated about bioidentical hormone replacement therapy?

From an evidence-based medicine view bioidentical hormone replacement with a number needed to treat (NNT) of 2 to 5 has a much higher efficiency than flibanserin. In other words, many women would experience the satisfying sexual event a lot more commonly, namely after having had sex 2 to 5 times instead of 12.5 times. This is what you expect when a similar hormone environment is provided like in the time when the woman was younger. It is the responsibility of the physician to explain to the premenopausal woman that bioidentical progesterone replacement is a much safer treatment option with no side-effects as progesterone as a hormone from the ovaries has been part of the woman’s  menstrual cycle all along. It is also important for the woman to educate herself about bioidentical hormone replacement and ask questions. Some physicians are of the old conservative school and may refuse this type of approach. In this case it is time to seek out a naturopathic physician.

Treating Lack Of Sexual Arousal

Treating Lack Of Sexual Arousal

Conclusion

Nobody would suggest to treat depression associated with hypothyroidism with antidepressants. Instead the physician treats hypothyroidism with thyroid hormones and the depression disappears.

Similarly, lack of arousal, a symptom associated with premenopausal syndrome is due to progesterone deficiency and should be treated with bioidentical progesterone cream. It does not make sense to treat symptomatically with flibanserin and risk all of the side effects mentioned. It makes more sense to treat the cause (low progesterone) rather than the symptoms. See a naturopath or a physician who understands natural hormone therapy to get the best results.