MARCH 1998

CyberHealth Index

Contents

1. HRT lessens voice virilization after menopause
2. Men’s voices and “andropause”
3. Estrogens, androgens and hair: readers’ experiences
4. Phytoestrogens decrease DHT production
5. T cream: a reader’s experience
6. T cream may not work well if you’re hypoestrogenic and/or hypothyroid
7. Networking works! 7 Brazilian MDs found
8. Bloated no more: how to eliminate abdominal distention
9. Care of the Soul: The rejuvenating effect of having a goal; More on kindness

HRT and voice pitch and volume

The pitch of the female voice generally drops with age. This becomes particularly noticeable after menopause, when untreated women become androgen-dominant and even treated women typically don’t come up to the levels of estrogens they used to have premenopausally. This is part of the overall VIRILIZATION that can be seen when women become estrogen-deficient. Specifically, this is the “virilization of the voice.”

In other words, it’s not that there is suddenly a lot more testosterone and other androgens; it’s that the RATIO of androgens to estrogens increases dramatically. Also, because the levels of sex-hormone-binding globulin typically decrease after menopause (estradiol increases SHBG), there may actually be more free, or bioactive testosterone available. (As an aside, I can’t help but note that Dr. Lee’s use of the term “estrogen dominance” has created a lot of confusion. Women are supposed to be estrogen-dominant just as men are supposed to be androgen-dominant. When women become androgen-dominant, their risk of various serious degenerative disorders such as heart disease rises dramatically, and embarrasing problems such as facial hair or an overly husky, masculine-sounding voice set in. To describe the problems caused by UNOPPOSED estrogens, Dr. Lee should have chosen the phrase “progesterone deficiency”; this would focus attention on where it belongs and immediately suggest the right solution.) One effect of androgens is enlargement of the larynx so that the voice becomes lower in pitch. Shorter vocal chords result in a higher-pitched voice; longer vocal chords equal a deeper voice (think of the contrast in string length between the violin and the cello).

As the voice becomes less feminine, there is also a tendency to less melody (flatness) and to hoarseness. (Hoarseness is often due to hypothyroidism.) This has been known through observation for a long time, but finally someone decided to actually measure the vocal frequencies of HRT users and nonusers.

Lindholm (1997) divided 43 postmenopausal women (mean age 51.6) into 3 groups: no HRT, estrogen alone (2 mg of estradiol valerate), and continuous estrogen-i (2 mg estradiol and 1 mg i; if you are wondering about the use of estradiol valerate and norethisterone, this is European research and these rather obsolete products are still used in parts of Europe). Lindholm measured frequency and other voice characteristics at baseline and one year later.

Mean drop in frequency was smallest in the estrogen-alone group; the HRT group using norethisterone, a first-generation androgenic progestin, showed less of the preserving effect of estrogens on the female voice. The estrogen-only group could also read the longest without fatigue and hoarseness.

Lindholm concludes, “Estrogen has an organ-conserving effect on the larynx.” I realize that some of you may be saying, “What else is new.” After all, we’ve known for a long time that a boy’s voice dramatically drops in pitch when testosterone really kicks in at puberty. The postmenopausal change in women’s voice is obviously not anywhere as dramatic (though just recently I happened to hear the i rumble of one older woman’s laughter, and I was pretty startled).

The postmenopausal voice change is a problem to some women, professional singers being a prime example. To women who do a lot of public speaking, the flattening out of vocal melody and less volume may be a greater concern. Thus it is good to know that if the lowering of voice pitch and other voice changes present a problem, then there is a preventive solution. I’ve also noticed an interesting effect of estradiol on my mother’s voice. She is over 80 and her voice was beginning to sound very weak, as commonly happens to the elderly. When recently she began supplementing her 3-E cream with Estrace, her voice gained volume dramatically.

(Source: Lindholm P at al. The effect of postmenopause and postmenopausal HRT on measured voice values and vocal symptoms. i 1997; 28: 47-53.)

Gail:

A pity they didn’t have a group using progesterone (and of course natural estrogens) ; wouldn’t i think it would yield similar results to their estrogen only group? Also, my mother has experienced a lot of the hoarseness you mention, and is back on thyroid medication. Ivy: Judging from what I’ve seen happen in regard to nhrt and my mother’s voice, it would be my supposition also that natural progesterone does not interfere with estrogens’ benefits for the vocal apparatus. However, I want to stress that my mother’s voice kept deteriorating as long as she was on an inadequate dose of estradiol. Once an adequate dose was found, the improvement was dramatic, and now she no longer has that senile-sounding voice (she’ll be turning 86 this summer).

The effects of thyroid hormones on voice should be investigated more thoroughly. I’m so glad someone’s mother is getting a thyroid supplement; often it is so hard for the elderly to get their hypothyroid symptoms taken seriously rather than be dismissed as “aging.” According to Dr. Regelson, sooner or later ALL older persons become hypothyroid; few are treated.

What about the effect of testosterone replacement on the voices of older men? Well, we know what happens without it: elderly men develop the “piping voice” that Shakespeare described in “the seven ages of man.” The man’s voice loses the depth and sonority that it used to have. It rises in pitch, and begins to crack and sound weak. There is a kind of thinness to it. In the case of “grumpy old men,” the voice sometimes takes on a whiny quality, with all that depression and hostility exacerbating the rise in pitch.

In other elderly men, HOARSENESS AND GRUFFNESS overshadow the change in pitch. As in the case of women, this could be a symptom of hypothyroidism. Fortunately most men who wish to use T replacement start it before their voice begins to show the effects of androgen deficiency (remember Lynne’s comment about the guys at her holistic doctor’s office starting on testosterone before they even reach forty?)

Even so, does that extra testosterone (the dose is ADDITIVE, not suppressive) have an effect on how a man’s voice sound? Here we have only anecdotal reports, saying a strong “yes.” The voice gets deeper and louder at the same “voice pressure.” One man said that now his voice “rolls out like thunder.”

It’s interesting how a person’s age can generally be estimated just from hearing his or her voice on the phone. It seems that hrt does help preserve a more youthful-sounding voice in both sexes.

Gail:

Now you’re talking about my father!! He complains about the deterioration of his singing voice.

Ivy:

I hope that the impact of hormone replacement on voice is investigated in more detail. Perhaps the careers of singers could be extended. It must be heart-breaking for a singer to retire still in the prime of life just because just because s/he realizes that his or her voice is no longer what it used to be.

ESTROGEN LEVELS AND HAIR: A READER’S EXPERIENCE

Linda writes:

Regarding hair: I was going to ask you if you or any of your readers had noticed the “hair phenomenon” that I have noticed and your statement that “estrogens promote the growth of scalp hair, while they inhibit the growth of hair elsewhere on the body” reminded me to do that. So, my question is: have you ever noticed that prior to and around the time of ovulation hair on the legs grows very lightly so one could almost skip shaving? During pregnancy I noticed the same thing (for 9 months!), plus a definite addition to hair volume. False pregnancy might have its benefits!

Ivy:

Personally I didn’t pay all that much attention to hair on the legs during different phases of my menstrual cycle—I hope other readers will come forth on this one. But here is what I noticed post-meno. When I started using DHEA at 50mg/day, the hair on my forearms got really dark and prominent, and my leg hair was growing . . . well, more vigorously. I tried bleaching the arm hair, and that messy, irritating experience was one of the factors that made me reduce my DHEA dose (except on especially stressful days). I also raised my E and P somewhat. Result: within a few months, the hair on my forearms was even lighter and more sparse than before menopause, and the hair on my legs shows what I’d call a wimpy, retarded growth. The shaft of each little hair seems thinner.

Hurrah! Even though I’m a dark brunette, there is no need for bleaching or frequent leg shaving. The key, obvious enough, turned out to be the right balance of female and male hormones—or, if you like, becoming hormonally more “female.” I must say I enjoy being a “female female”! Also, because I often apply my 3-E cream to my arms, I wonder if there may have been some topical effect. But it’s probably simply adequate serum estradiol. I think my hormones are better balanced now than they were before menopause; one sign of that is clear skin (at long, long last!) and that “bushiness” of hair I’ve always longed for. And finally, finally my hair is no longer in the oily category—but neither is it dry and straw-like, the way it almost instantly turned right after menopause and before nhrt. (Both my skin and hair went from oily to itchy-dry practically overnight.)

You may be puzzled by Linda’s use of the phrase “false pregnancy.” In our private correspondence, I believe I spoke about “low-grade pregnancy” as a model for postmenopausal hormone replacement. Interestingly, this came up recently when a friend who suffers from asthma told me that she had practically no asthma during her pregnancies. This is a big clue about the influence of hormones on respiratory passages, and the possible value of mimicking pregnancy (at lower hormone levels) for asthma sufferers.

ANDROGENS AND HAIR

Lynne writes:

Supplementing DHEA even a little bit makes me feel better. If I take too much my hair gets slightly oily.

A month ago my husband cut down on his doc’s mega dose of T cream because his hair began to thin—this idea I got from you! Almost immediatly, it started growing back, thick with curls. It seems less grey too.

Ivy:

Dr. Arnold Schwartz has developed a DHEA analogue that supposedly doesn’t have the androgenic effects while it provides even greater anti-cancer benefits. Since no drug company was interested, Dr. Schwartz is trying to pursue this on his own. Normally I’m rather against altering natural hormones, but here I feel that the androgenic side effects of DHEA are really turning women off, so possibly an analogue would be a blessing. I’ve noticed that on especially stressful days it’s OK for me to use more DHEA and not pay the price for it. But if I take an extra dose simply because I feel like a little more zest, sometimes as soon as the very next morning a bump starts forming on my chin, and I have to zap it with something (fortunately I’ve developed an effective arsenal of i). As for T and hair, well, the price of maleness etc. I only hope your husband didn’t go TOO low; he should be over 600 in the morning. You don’t want to sacrifice the benefits of T: more red blood cells, higher metabolic rate, muscle building, bone building. But his well-being is the best indication. Some men say that if they take too much T, they get “edgy,” or else they are annoyed by too many erotic fantasies and unwanted erections. Since teenage boys and young men with sky-high T levels often have bushy, healthy hair, and baldness is seen as men grow older and more T-deficient, we can’t blame T alone, or even DHT alone. Don’t forget those high CORTISOL levels in alopecians! And atherosclerosis!

Nevertheless, it is often pointed out that men castrated before puberty generally don’t grow bald. But Dr. Peter Proctor reminds us that even castration is no sure prevention, since eunuchs sometimes produce sufficient adrenal androgens to cause some thinning out of hair. As for less grayness, I suspect factors other than T—perhaps less stress and/or better nutrition.

With hormone doses, as with everything else, we need to find what suits US:

our comfort, life style and preferences. Experiment, experiment, experiment. At first, the optimum dose may seem like an unreachable grail, but—seek and ye shall find.

(Source on DHEA analogue: Schwartz AG, Pashko LL. Cancer prevention with DHEA and non-androgenic structural analogs. J Cel Biochem Suppl 1995; 22:210-17)

PHYTOESTROGENS MAY INHIBIT DHT PRODUCTION

When it comes to clean arteries and feminine beauty, there is no doubt that high estrogen levels really do the job. Every woman wants a slender waist, flawless skin and thick, luxuriant hair—but almost as universally, women are afraid of the unwanted effects of estradiol, which is a phenomenally powerful hormone (testosterone is a weak hormone by comparison). Consequently, women are interested in weak estrogens, phytoestrogens in particular. Can they have estrogenic effects on skin and hair? There is a hint that the answer is yes. Genistein and i have been found to inhibit 5 alpha-reductase, which should result in less conversion of testosterone to skin- and hair-hostile DHT. Eating freshly ground flax seed is the best way to insure a supply of i.

All readers of CH probably know that saw palmetto extract inhibits 5-alpha-reductase. It is also anti-estrogenic.

(Source: Evens BA et al. Inhibition of 5-alpha-reductase in genital skin fibroblasts and prostate tissue by dietary lignans and isoflavonoids. J i 1995; 147:295-302.)

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INFORMATION WANTED FROM READERS!

CH READERS WITH ASTHMA: PLEASE WRITE ME FOR A FEATURE ON ASTHMA AND

ESTRADIOL COMING UP IN A FUTURE ISSUE. Specifically, changes in symptom severity during the menstrual cycle (ovulation vs PMS), and during pregnancy, and the impact of any hormone replacement.

T CREAM: A READER’S EXPERIENCE

Bess writes:

Despite my feeling less sexual than I used to, I do believe using the T-cream continues to make me more “visible” to men…. Not as if I were 30, mind you, or even 40….but pretty darned visible for nearly 55. Also, I remember reading (somewhere) that testosterone and pheromones are linked, and so it made sense to me that women would literally be less “visible” (or in this case, subliminally sexually “smellable”) after menopause. I also feel the T-cream helps all my body sensations, that lovely skin touching, that sensitivity….makes it so much more enjoyable than without it. It’s as if T-cream brought some of my body back from “bored and yawning” to i-la-la, that feels SO nice. And I have to say that ALL of my skin surface seems to be affected, not just the erectile parts – the nipples and clitoris. My skin is simply more sensitive to touch, generally.

T CREAM MAY NOT WORK WELL IF YOU ARE HYPOESTROGENIC AND/OR HYPOTHYROID

Bess also writes:

If my forehead and eyelids are nice and oily, thus (presumably) indicating an adequate (or more than adequate, possibly) level of T, why has my libido not gone wild? The skin sensations are still lovely etc. While my libido is better than before T, it is not exactly a “wild mustang”……

Ivy:

My first guess would be suboptimal estradiol levels. Other women have confirmed it: good things generally don’t happen unless you are taking 2mg of Estrace or equivalent. And if you are under heavy chronic stress, you may need more.

Estradiol increases the density of receptors for testosterone. When serum estradiol goes up, you actually need less testosterone to maintain a lively sex drive.

If low estradiol has been excluded as a possible cause of less-than-satisfying libido in spite of testosterone replacement, I’d suspect low thyroid. Unfortunately blood tests aren’t very sensitive, so it’s best to note the symptoms, such as cold hands and feet, an orange tinge to the face, puffy eyelids, sluggishness, constipation, and yes, low libido (you can find out about many other symptoms of hypothyroidism in the thyroid chapter of my book, “Hormones Without Fear”).

When you are hypothyroid, every cell in your body is a hypometabolic mess, so everything will tend be low—except for cholesterol. The production and metabolism of sex hormones will be faulty. That’s part of the reason why hypothyroidism appears to increase breast cancer risk. Both thyroid and testosterone increase the release of DOPAMINE, the neurotransmitter that is crucial for sex drive (and also lowers breast cancer risk).

If hypothyroidism too has been excluded as a possible cause of low libido, maybe it’s the low-protein diet. Testosterone and thyroid hormones increase the release of dopamine, but so does a high-protein meal. Apparently the crucial aminoacid is TYROSINE, a precursor for dopamine and hence also for norepinephrine. In fact some people take tyrosine as a supplement to increase their energy and motivation (also closely related to dopamine). I find that a little tuna salad works better for less.

A high-carbohydrate meal, on the other hand, can make you feel sluggish and definitely “not in the mood.”

When a woman is postmenopausal, however, it’s the interaction of estradiol and testosterone that needs to be particularly examined. We know the following: estrogens increase the density of testosterone receptors. Hence when you increase your dose of Estrace (for example), there are suddenly all these extra testosterone receptors ready to intercept the hormone of desire. Consequently it takes very little supplemental T to produce a strong effect. I didn’t realize this back when I was experimenting with increasing the potency of my 3-E cream. I kept my T dose the same. Result: wild, intrusive libido. I couldn’t concentrate on work until I cut my T dose in half. The funny thing is that my mother had the same experience when she increased her 3-E to match mine. She suddenly called me in distress over her over-active libido. That was not long after her 85^th birthday. So no, it’s not a question of age.

Finally, sometimes a doctor inexperienced with nhrt confuses percentages with milligrams and instead of writing “2% T cream” writes “2 mg T cream.” 2% = 20 mg. 2mg/g applied i won’t do anything for you. 10mg (dermal) is generally the minimum effective dose, but there are individual variations here.

NETWORKING WORKS! SEVEN BRAZILIAN i FOUND

You may be wondering if Jorge’s request brought results. Well, Barry Mizes of Madison-Bajamar found five Brazilian MDs on his list of doctors ordering from that pharmacy; I found one on the CH subscription list; and Jorge himself discovered #7.

So please, no more email of the sort, “I’d like to try nhrt, but I live in Kansas.”

Again, I’ve seen this time after time: if a person is truly interested in nhrt, lo and behold, they somehow manage to obtain the prescriptions. If a person is not sure and waffling, there is always going to be some kind of excuse, even from someone living in Los Angeles.

In these days of networking and information revolution, forget excuses! Networking works: you give and you get. In fact I want to use this opportunity to acknowledge Jorge as a source of some valuable information he sent me, including steering me onto a great article on coconut oil. Both of us now enjoy the benefits of coconut oil, with its valuable medium-chain saturates and anti-viral and weight-loss benefits (an example of another wonderful traditional food that dangerous ignoramuses trying to pass themselves off as experts have almost succeeded in destroying).

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BLOATED NO MORE: HOW TO END AN EMBARRASSING DIETARY-HORMONAL PROBLEM

A reader who prefers to stay anonymous reports that she has a peculiar problem: when she wakes up, her belly is reasonably flat. Then as soon as she eats breakfast, she begins to feel bloated, and pretty soon her belly starts sticking out. By evening she looks positively pregnant! She still has her periods, and has observed that the problem is worst during the premenstrual week, and essentially disappears during the 48 hours around ovulation.

Recently at a health food store I saw that the saleswoman was thin, even frail, but had a painfully protruding belly. She’d unbuttoned her jeans for relief. She looked pale and tired. I chatted her up on the general subject of digestion. “I think women have a MUCH worse digestion than men,” she said with deep conviction. “Except around ovulation?” I ventured. “Yep,” she replied. “Absolutely. Yep.”

As for the PMS bloat, it’s proverbial, and we needn’t go into that.

Imagine that some women feel like that EVERY DAY. I had my worst problems with abdominal bloating in my early forties, when I was experimenting with a vegetarian diet. I became so malnourished that I lost my period—an example of NUTRITIONAL CASTRATION—so I wasn’t able to observe cyclic changes. But waking up reasonably flat-bellied, and getting increasingly more pregnant-looking as the day wore on—not to mention that heavy, distended, gassy feeling—that was quite awful. And the chronic fatigue then went with it.

Then I discovered the low-carb diet, which got rid of 90% of the grains, and the problem seemed history.

Then came menopause. Suddenly, even on what I considered low carbohydrates (I was eating plenty of stir-fried veggies, a bit of rice, one slice of bread a day), I began to experience some bloating again. I was still struggling with the problem when one night the phone rang and a newly menopausal friend, shell-shocked from all the symptoms, shrieked, “Why does my belly suddenly stick out so much?”

I also remember, back when I was reading the MenoList, that once in a while a woman would say, “I feel so gassy all the time!” but would get no advice. The topic is generally ignored, perhaps because it’s considered too “gross.” Snoring in relation to menopause is also ignored, and thus women remain unaware of the hormonal factors involved, and how they might restore better function of the respiratory passages. And yet it’s become OK to discuss urinary incontinence and vaginal atrophy. But never mind. CyberHealth bravely goes where no newsletter has gone before.

While bloating is more common in peri and menopausal women, it is by no means confined to them. Check the February 1998 issue of Allure magazine. It has an article on bloating, with the blithe revelation that BIKINI MODELS ARE PUT ON A GRAIN-FREE DIET to eliminate that “belly overhang.” Now that gave me a pause, since bikini models are rarely past 25. Then I realized that they also tend to be abnormally thin, and are probably hypoestrogenic. And, like almost everyone in this country, they too are the victims of the “curse of the pyramid,” the government food pyramid, that is, recommending that the largest proportion of calories in our diets should come from processed grains such as bread, cereal, and pasta. The promotion of tofu and soy milk has only magnified the problem. Many women will privately admit that tofu and soy milk make them gassy and bloated and they loathe the taste (is their body trying to tell them something?), but they feel they ought to disregard these signals of distress and listen to the diet gurus, not to their own bodies.

The promotion of cow milk for osteoporosis prevention likewise makes some women feel that they must disregard the distress of milk-caused bloating if they are to save their bones. This reminds me of a man who said that he loves butter and dislikes margarine, “but I want to do what is right.” Food has become our religion and diet experts our prophets. We are willing to suffer rather than commit dietary “sins.” And grains especially have become a sacred cow, if you pardon this somewhat mixed metaphor. Once I had an absolutely worshipful attitude toward oatmeal, even though not only did I loathe the taste, but day after day having oatmeal for breakfast made me so sick that I had to lie down with a heat pad on my belly. I was too bloated and heavy to move. It got worse and worse, until I had cramps and nausea too. Still, because the health experts insisted that oatmeal was the healthiest breakfast, I was determined to keep on eating oatmeal even if it killed me. I’d feel morally at fault if I’d follow my perverse fantasies of scrambled eggs, the memories of foods I used to have in childhood, strange dreams in which I smelled and tasted foods I had not eaten for decades, including an unforgettable dream in which I extremely vividly felt the taste of butter and woke up in ecstasy. The more “health food” I ate, the sicker I felt. And the deeper I went into denial about it. After all, I had a strict religious upbringing, and I wanted to do what is right, and eat only the politically correct food. Frankly, back in my oatmeal-and-beans-and-veggie-burger days almost every meal made me feel so sick and heavy, so tired and lethargic, that I only longed to lie down. A friend of mine who was an even stricter vegetarian confessed that she MUST lie down after eating because of what she called “the metabolic burden.” “Intestinal discomfort and low energy” is another polite way to describe the problem. “Intestinal repercussions” is a euphemistic masterpiece.

When bloating started to happen after menopause, oatmeal had been history for a long time. Eating less tofu helped a great deal, but didn’t eliminate the problem 100%. That happened only with (1) adequate nhrt (including natural thyroid if necessary; poor digestion can be one of the numerous symptoms of hypothyroidism) and (2) ruthless elimination of all grains other than rice and an occasional lime-treated corn tortilla (3) more emphasis on eating plant food raw rather than cooked (raw plants contain enzymes that aid digestion).

Now I can tell a non-bloating meal within minutes of finishing eating: I feel recharged with energy. I can think better. I feel like doing things, not like lying down.

How did I discover that lime-treated corn tortillas and rice did not cause bloating and post-meal fatigue? The hard way: through trial and error. But if you want to check through various nutrition books, these are indeed the easiest to digest. Everyone agrees that rice is the most easy-to-digest grain, in great contrast to other grains. Rice does not contain enzyme inhibitors.

As for tofu and beans, even thoroughly soaked beans, I discovered that a small—really small—quantity won’t cause too much bloating, but I definitely look flatter-bellied and feel lighter, healthier, and much more energetic when I eliminate those too. This was a shocking discovery: zero tofu, zero cooked beans = I feel SO MUCH BETTER!!! (This is sad since yes, I do know all the benefits of tofu and beans. I’ve just ordered Sally Fallon’s cookbook, “Nourishing Traditions,” that may help me get around this by revealing better methods of soaking and fermentation. And I hasten to say that RAW SPROUTED MUNG BEANS, at least in small quantities, will not cause the problems that cooked beans do.)

Why are beans so particularly notorious for their ability to cause bloating? In addition to enzyme inhibitors, beans contain complex sugars, farrinose and i, that we simply don’t have the enzymes to digest. Even too hefty a portion of cooked vegetables can cause bloating in a susceptible person. Don’t worry: I’m not suggesting eliminating veggies, only going easy on COOKED veggies, listening closely to your body. RAW VEGGIES are highly recommended.

Experimenting with cooked veggies, I’ve discovered that adding butter or ghee to them seems to prevent most “intestinal repercussions.” (As for flavor, string beans especially sing with ecstasy.) I had no explanation for this until I found this quotation from Udo Erasmus’s “Fats that Heal, Fats that Kill”:

“By slowing down the stomach emptying time, fats promote more complete digestion and help ensure that no undigested food enters our colon to feed yeasts, fungi and strange bacteria. Fats and oils also inhibit the growth of fungi and yeasts.

Short-chain fatty acids such as butyric acid found in butter serve as food for beneficial bacteria in our intestine. Others, like caprylic acid, slow down the growth of yeast cells.”

But I’m getting ahead. Let’s state the known hormonal and dietary causes of abdominal bloating, aka abdominal distension (not water retention, though the two may be present simultaneously).

Bloating occurs when undigested food collects in the intestines and gets fermented by intestinal bacteria. The process of fermentation produces gas. And the pressure of the gas produces that pregnant look and the discomfort that goes with the distention.

Fatigue seems to accompany bloating, particularly if bloating happens day after day, not just after an occasional meal that turns out to be “physiologically incorrect.” Sometimes the fatigue persists for only an hour or two after eating; then the heaviness dissipates and you begin to recover: energy starts flowing again and the lights go on in the brain. But in the worst cases the bloating just gets worse as the day goes on, and the fatigue that goes with it is truly chronic. This seems only logical: if you are not digesting food properly, if you are not absorbing necessary nutrients, obviously you can’t produce enough energy. On top of it, you are being poisoned with the toxic metabolic wastes of the yeast and the bacteria causing the fermentation.

It’s been claimed that some bloaters produce so much alcohol in their intestines that it shows up in their blood! This may not be altogether far-fetched, since some symptoms resemble alcohol toxicity. But why does the food remain undigested? It seems that at twenty we could eat anything we wanted . . .

HORMONAL CAUSES OF BLOATING

In youth we had plenty of hormones and plenty of digestive enzymes. Digestion actually starts already in the mouth, with the enzymes contained in the saliva. What happens after menopause? Dry mouth. There is simply much less saliva production, in parallel to other body fluids (tears, synovial fluid, vaginal lubrication etc). So that’s the beginning of the problem: a huge drop in estradiol, less saliva, less pre-digestion by saliva. Furthermore, estradiol, DHEA, and other steroids are important regulators of digestive enzyme production and intestinal motility. Estradiol stimulates the stomach and the pancreas, and also speeds up peristalsis (the movement of the intestines). In addition, it increases the absorption of various nutrients such as calcium and silicon.

In women the hormonal cause of the decline in digestion with age has to do mainly with the drop in estradiol. Note in our reader’s report that bloating seems least around ovulation, and worst at the end of the cycle. But also aging per se is associated with less and less secretion of gastric acid and pancreatic enzymes. This decline starts about the age of thirty. Women who take Provera may also complain of bloating. Provera seems to slow down the intestines. This is not surprising, considering it’s an analog of progesterone. Progesterone reduces the muscle contractions of the intestine. This is an adaptation to pregnancy; back in the days of food scarcity and high-fiber diet, the woman’s body tried to obtain maximum nutrition for the fetus by slowing down the passage of food. Hence pregnant women are more likely to suffer from constipation.

In women on nhrt, the dose of progesterone usually isn’t large enough to have this kind of impact. However, many women on nhrt take ridiculously low doses of estradiol, often because of having trusted Great Male Menopause Experts who told them they didn’t really need any estrogen, but grudgingly let them have a microdose (why don’t we castrate these guys, and then tell them they don’t need testosterone?). Thus, the women on suboptimal nhrt may be taking an unbalanced dose of progesterone, with not enough estradiol to speed things up.

DIETARY CAUSES OF BLOATING

The dietary cause of bloating is mostly the consumption of hard-to-digest grain starches. Part of the grain starch is the so-called “resistant starch.” It’s not easily broken down into simpler sugars. In addition, these starches make all of digestion difficult sincece they contain substances that inhibit the action of our digestive enzymes (this was discovered already back in 1944). Furthermore, the phytic acid in grains and beans inhibits the absorption of minerals.

The bread that our ancestors ate was very different from the mass-produced, yeast-laden junk food of today. It was a fermented product: dense and chewy and chockful of nutrition. Fermentation is one of the ways one can make grain and other seed foods more digestible. But “leavening” is time-consuming, and has been virtually abandoned in favor of yeast-raised bread.

What, no grains? Wait, don’t forget what I said about rice. Rice is a big exception as far as the digestibility. RICE IS WONDERFULLY DIGESTIBLE. IT DOES NOT CONTAIN THE COMPOUNDS THAT INHIBIT OUR DIGESTIVE ENZYMES

And there seems to be a consensus that rice-eating populations are healthier than wheat-eating populations—and that’s true even in China, where wheat is consumed in some northern regions.

The youthful appearance of Asian people, their smooth skin and glossy hair, should also give us a pause.

And once I read that rice protein inhibits cancer growth, that was it. Now my prayer is: Give us this day our daily rice.

However, you don’t need to give up on wheat entirely. Any quality health food store should have SPROUTED WHEATBERRIES. Eaten raw, they are a powerhouse of enzymes and nutrients.

This brings us to the extremely relevant issue is RAW vs COOKED. Raw food contains its own enzymes; in effect, it practically digests itself! When you eat a radish or some cucumber, there is hardly any metabolic burden on your body. Pineapples, bananas, avocados, grapes—these are known to be exceptionally high in enzymes.

Cooking destroys those natural enzymes. So does pasteurization, if you ever wondered why some people insist on certified raw milk and butter. (Raw butter, for instance, contains lipase. In my experience, however, even pasteurized butter seems to improve digestion.)

Some extremists say that we should all become “raw fooders.” The more moderate position is that 50% of our food should be consumed raw. I’m not the sort who likes to bother with proportions and measurements, so I’ve adopted a pragmatic principle: every meal should include SOME raw food. This includes breakfast. If having a salad for breakfast like my super-healthy Japanese friend seems too revolutionary, think grapefruit. If preparing a salad for other meals is too time-consuming, just buy a package of arugula or something in the salad-greens category, and sprinkle them liberally on your plate. Add extra-virgin olive oil and some balsamic vinegar. Enjoy.

I repeat: raw food. You need raw food. The worse your digestion, the more you need raw food. You need enzyme-rich raw food. Yes, with every meal. Dr. Atkins didn’t quite get it right: not low carbohydrates, but raw carbohydrates. We need plant food. But it should supply its own enzymes. Milk can be a big digestive problem for some persons. While goat milk is regarded as considerably easier to digest, if you are sensitive, even goat milk can give you that heavy feeling. As we already mentioned, part of the problem is that pasteurization kills enzymes. But raw milk is expensive, and one does wonder about its safety. An alternative here is FERMENTED MILK PRODUCTS, including buttermilk.

DIVERTICULOSIS, STRESS, AND OTHER CAUSES OF BLOATING

As we age we are likely to develop some degree of DIVERTICULOSIS. This means that the intestines have little pouches here and there; partly digested food gets trapped in these pouches and ferments. Also, very likely we weren’t yet the victims of the diet gurus telling us to eat veggie burgers and other processed grain products, and avoid salt like the plague. But salt isn’t just a source of sodium; it is also the most important source of chlorine, essential for the production of hydrochloric acid, which in turn is necessary for the digestion of proteins. Sea salt is considered superior to commercial salt.

The gurus have also discouraged people from consuming butter, with its wonderful short-chain fatty acids that are so supportive of the good flora and so useful against intestinal pathogens. Butyric, propionic, and caprylic acid in particular are known to have anti-fungal properties. Also, digestion is a PARASYMPATHETIC activity. This means that it’s aided by a state of relaxation, and impeded by stress. Many of us have discovered that a stressful business lunch sits inside us for hours like stone, while a relaxed dinner with friends seems to be digested with no effort. I wonder if a book entitled BLOATED NO MORE would outsell “Co-Dependent No More.” There must be millions of sufferers out there who have no clue as to why their belly sticks out so much, and it only gets worse the more they try to eat “healthy” foods such as unsoaked oatmeal and beans and broccoli and lots of whole-wheat bread.

HOW TO UNBLOAT

Here is a summary of my recommendations of how to eliminate bloating, including some I haven’t mentioned yet:

• yes, it could be estrogen deficiency. Correct it, and I don’t mean microdoses.
• try eliminating all cooked or otherwise processed grains except rice
• keep beans, tofu, and certain COOKED vegetables (especially of the cabbage family) to a minimum
• eating sugar is like pouring gasoline on the fire; Candida loves it
• eat as much raw food as possible
• if milk is difficult to digest, try buttermilk instead
• see if a strong digestive supplement, such as Great Earth Ergozyme (the only kind that worked for me; others were too weak) or Enzymatic Therapy’s Mega-Zyme might work for you
• if meat seems difficult to digest, try marinating it before cooking
• if cheese produces that “heavy sensation,” try the delicious kefir cheese
• try taking 500mg pantothenic acid after each meal. It increases intestinal motility.
• if possible, try a brisk walk after each meal
• try to arrange for a pleasant, relaxed atmosphere during meals
• a vigorous belly massage sometimes helps a little
• a supplement called FOS (fructo-oligosaccharides) feeds the good bacteria, helping them drive out yeast and other bad bugs
• caprylic acid, found in goat milk, also helps the intestinal flora and strengthens the walls of the intestines
• butter may help also; it contains the short-chain fatty acids that are anti-fungal
• I hesitate to recommend fasting, but if nothing else works, fasting generally will; just fasting during sleep has a wonderful effect
• my grandmother’s favorite remedy was ACTIVATED CHARCOAL. The problem to watch out for is possible interference with the absorption of prescription drugs.

NOTE: If digestive deficiency, bloating, and post-meal fatigue persist no matter what you do, you could be HYPOTHYROID, or suffering from another serious disorder. Do see a doctor.

A side note on symptoms of hypothyroidism when your doctor insists that your levels are “within the normal range.” Ray Peat makes an intriguing claim that unsaturated fatty acids create thyroid resistance (i.e. the tissues become less sensitive to the thyroid hormones). Coconut oil, on the other hand, supports thyroid function, according to Ray Peat. He doesn’t document this statement, but there might be something to it. His article on coconut oil is absolutely compelling and has convinced me to start using it. Within a short time I began experiencing the benefits that he describes.

Write me if you’d like the text.

(Sources: Sally Fallon, “Nourishing Traditions,” ProMotion Publishing, 1995;

Stoppard M, “Menopause,” Dorling-Kindersley 1994. I also wish to thank Grace Aaron for drawing my attention to the problem of salt avoidance and the deficiency of hydrochloric acid.)

Lynne writes:

Just a quick note: A lot of nutritionists recommend a grain based diet. However, the ones I go to have surprised me by telling me how HARD they are to digest for many people. I always felt guilty for avoiding them—except for brown rice. Oatmeal or oat bran will knock me right out. I don’t mean make me sluggish, I mean I couldn’t drive because my eyes would cross with the spaceys. A friend of mine reports she loves corn but sees it come out in the exact same form it went in, so how could it do any good? I think her body is not able to digest whatever coats the corn and so passes it right through. You’re right. Grains are/were a sacred cow. Maybe it is whole grains that people can’t digest—I mean not ground up whole grains. Maybe—you could find this out—if they have some strange protein coating. As for beans, both Earl and I can eat these every day without the slightest touch of gas. One caveat: don’t even think of eating sugar within two hours of a bean meal. You may actually explode. So many people eat those traditional baked beans with molasses and wonder why they get gas. They blame it on the beans and not the sugar.

Ivy:

Sally Fallon suggests soaking oatmeal overnight, and preferably for 24 hours, in a mixture of water, buttermilk, and sea salt to make it more digestible. I’ve considered it, but just having a delicious dried fig for fiber has so much more appeal.

In my understanding, it’s not “some strange protein coating” on whole grains that makes them so difficult—it’s bran, another holy of holies in modern health food religion.

Sally Fallon, bless her daring spirit, also denounces granola as “extremely indigestible.”

One of the things your bean paragraph reminded me of is that during WWII there was a flour shortage, so the Germans invented a kind of bread baked with ground beans. The unfortunate consumers nicknamed the bread “dynamite.” Still, you are very lucky to have an easy time with beans. You are right, the kind with sugar seem bigger offenders. Obviously, sugar is just more fodder for fermentation.

It seems to me I can manage chili beans, but not the the black-eyed-pea salad sold in the Deli section. Is it that chili beans are more “pre-digested”?

I used to soak black and red beans for 24 hours, use cumin and whatnot, but basically my enzymes aren’t up to it—though late in the evening is easier. Breakfast and lunch, I can’t eat anything that’s hard to digest and likely to produce fermentation.

A note on brown rice vs white rice. It puzzles health-conscious Americans why Asians, and we’re talking of billions of people famous for their health and longevity, staunchly prefer white rice. Well, rice bran contains phytic acid, which interferes with the absorption of nutrients such as zinc. Rice bran contains wonderful nutrients as well, including precious tocotrienols, and there is a way of preparing brown rice that neutralizes phytic acid, but it does take some doing.

Having suffered from horrendous zinc deficiency back in my brown-rice-and-tofu days (my fingernails were covered with white spots; I see a vegetarian friend of mine has the same problem), I’ve decided to stick to a small amount of white rice, especially with dinner, and basically forget tofu (what a relief, to join a biochemist cyber-friend who said that tofu never passes her lips—a brave woman safely far away from Southern California, where you risk being crucified if you say anything like this out loud).

I realize that this is perhaps the most daring article I’ve yet written. Dr. Zava’s discussion of the ravages of phytic acid and his courageous expose of “soy junk food” has been an inspiration to me. His use of this eye-opening phrase caused a shock. Believe me, I have no interest in shocking anyone just to be a naughty girl. My motivation is to help liberate people from being enslaved to politically correct food and encouraging them to trust the wisdom of their own bodies. In the next issue of CyberHealth: my secret weapon against bloating and weight gain: the ecstatic salad.

* * * * * CARE OF THE SOUL * * * * *

THE HEALTH-GIVING EFFECTS OF HAVING A PURPOSE IN LIFE “During those times when we are moving in a forward and a higher direction, we are quite pleased with ourselves. Life seems worth living, even during the worst of times.”

• Jacquelyn Small, Embodying Spirit: Coming Alive with Meaning and Purpose,” p.18

This reminds me of Nietzche’s: “When you have the WHY of your life, you can endure almost any HOW.”

When we are working toward a purpose, petty worries fall by the wayside. It really doesn’t matter if we are the perfect size, or have color-matched clothes, or the right eyeshadow, or any other trivia that women’s magazines try to foist on us as a substitute for purpose and meaning. All kinds of time-wasting activities simply fall by the wayside.

Even more importantly, when we know what to do, depression, too, falls by the wayside. There is just no time for depression, no time to see the doctor about getting a prescription for Prozac, no time for the side effects of Prozac. When we have a goal in life, we don’t need Prozac. But the best quotation I’ve ever found on the life-giving powers of having something to live for comes from a March 1998 Visions magazine interview with the futurist writer Barbara Marx Hubbard:

“Take me, a 68-year-old grandmother of five, who supposedly would be quieting down by now, but what’s happening is, I’m rising up. Why? Because of the creativity of a woman, or a man too, has no age and it has no known limitations. I believe that creativity is regenerative, it is health-giving. It communicates to the cells: ‘Cells we have something to do.’ So the cells are actually juiced.

Also, I think that with women menopause can be a time of metamorphosis, particularly as you are no longer reproducing the species. Nature in its first form is not particularly interested in you. But if you find around that time that you have a deep urge for something to do in the world that is creative, then I think what happens is that the fact that your body doesn’t have to reproduce itself frees it for a more transformational experience. When I turned 50, I had a very deep experience of committing to the birth of my Self with the same passion that I committed to the birth of my five children. Within each human being is a self (a potential Self) that takes as much nurturing to bring forth, in fact more, than to bring forth a child. In the case of a child, all you have to be is the nurturer and garden for it. If you’re going to bring forth your full potential Self, then you actually have to commit to nurturing an unknown.” (p.15) You can probably guess which part of this extraordinary passage excites me the most: the statement about the cells being “juiced” when you are doing something you feel passionate about. While this is not the scientific language of dopamine and neuropeptides, we all certainly understand what Barbara is talking about. And intuitively we KNOW that she is right. In addition, if I understand correctly the phrase “nature in its first form,” the author is saying that nature at the physical level is not interested in you—but the universe understood in the sense of collective cosmic intelligence might be extremely interested in you now that you’ve entered your power years. Now that you are free, it is time to begin your great work.

A P.S. ON KINDNESS: DOING GOOD AND FEELING GOOD

I’ve come across this passage in Sarah Breathnach’s “Simple Abundance”:

Today, act as if you are a woman with repose of the soul. Greet everyone you meet with a warm smile. No matter how busy you are, don’t rush your encounters with co-workers, family, and friends. Speak softly. Listen attentively. Act as if every conversation you have is the most important thing on your mind today. Look your children and your partner in the eyes when they talk to you. Stroke the cat, caress the dog. Lavish love on every living being you meet. See how different you feel at the end of the day.

(Meditation for March 19)

I think of the misguided trend in early feminism, when some women tried to show they were equal by cursing, using vulgar language, and trying to come across as very tough and aggressive, self-promoting, and having a “kick-a**” attitude toward others. But most women soon rejected the idea that it’s best to imitate the worst of machismo. A different trend emerged within feminism. Voices arose pointing out that women’s strength always lay in the power of love and kindness, empathy and intuition, nurturing and tenderness; the ability to stay calm and understanding and conciliatory in situations where a man might respond with testosterone-driven rage. The Taoist sages observed this centuries ago: the soft overcomes the hard.

Here is what one CyberHealth reader writes about kindness:

Linda writes:

In #9 you talked of kindness. I wanted to share with you two of my very favorite quotes: This one hangs right above my computer, “No act of kindness, no matter how small, is ever wasted” by Aesop. And my other favorite which I saved from a tea bag long ago: “Silence may be golden, but kind words warm the heart.”

Ivy:

Thank you, Linda, for sharing these beautiful quotations. They empower women to stay on the difficult path of feminine wisdom, which is to spread loving kindness in an often hostile world.

Please keep writing to CyberHealth. The more we share and help each other, the stronger we all become.

The material contained herein is intended as information only, and not as medical advice.

Books by Ivy Greenwell:

1. HORMONES WITHOUT FEAR (available from Madison-Bajamar, 800-255-8025) 
   A REFERENCE GUIDE TO NATURAL HORMONES FOR MEN
2. HOW TO REVERSE OSTEOARTHRITIS (including extensive information on hormones and arthritis)
3. HOW TO HELP PREVENT BREAST AND OVARIAN CANCER