November 10, 1997

CyberHealth Index

1. P.S. on osteocyte loss after estrogen withdrawal
2. Factors for early and late menopause revisited
3. Is the decline in DHEA related to menopause?
4. Why chocolate is a health food
5. Great Quotations: Sonya Friedman on childhood and adulthood

P.S. on the death of osteocytes after estrogen withdrawal

An important statement was accidentally omitted from the article on the programmed death of bone cells after estrogen withdrawal (CHW#3): “The loss of osteocytes was just as great in patients treated with biphosphonates to prevent the loss of bone mass.”

Tomkinson stresses that the loss of calcium is not the sole cause of bone fragility. One can prevent the loss of bone mineral density through non-hormonal means; however, it seems that it takes the right hormones to prevent the death of osteocytes.

We must bear in mind that this was a pioneering study on the subject, and for technical reasons the sample size was very small. Still, it’s fascinating work, and fits in well with findings such as increased neuron death and the loss of certain neurotransmitter receptors after loss of estrogen, for instance.

It seems that cells need constant chemical signals from other cells for their very survival, and hormones are an important part of this intricate chemical information network. In addition, estrogens, with their phenolic structure, serve as lipid membrane antioxidants. Thus it is not surprising that a degenerative cascade follows hormone loss, regardless of age.

FACTORS FOR EARLY MENOPAUSE REVISITED

Since writing about factors associated with early vs late menopause in CyberHealth #1, I’ve come upon a book by Dr. Ivan Strausz, “Women’s Symptoms” (Dell 1996), in which he lists early puberty, left-handedness, and long-term oral contraceptive use as factors for early menopause (p.228). If you remember, the study quoted in CyberHealth #1 (June 1997) associated long-term oral contraceptive use with a tendency to later menopause. I did a computer search again, and found only one other study which again favored the view that the use of the Pill correlates with later menopause.

This would be in agreement with the finding that a) pregnancies as opposed to childlessness are associated with later menopause; b) the general trend toward higher estrogen levels being correlated with late menopause (being on the Pill is a hyperestrogenic state, though nothing is as hyperestrogenic as pregnancy).

Dr. Strausz does not list his references, nor does he define “long-term.” It is possible that beyond a certain number of years, the suppressive effect of the Pill on the levels of FSH (follicle-stimulating hormone) is attenuated. Or else being on the Pill can’t really offset the general trend toward earlier age at menarche, less childbearing, and possibly less obesity among Pill users ( I am speculating).

Of course Dr. Strausz may also be wrong. And of course there are always individual exceptions to any general trend.

A free health newsmagazine given away at health food stores also listed long vs short menstrual cycles as being associated with late menopause. Again, no documentation was given, but this makes perfect sense: short menstrual cycles are associated with higher FSH. It would be interesting to see if inhibiting FSH and lengthening the menstrual cycle through the use of soy estrogens, for instance, or a low-dose estradiol and/or DHEA supplement (see the post below), would result in later menopause. As always, everyone agrees that obesity correlates with late menopause. There is also wide agreement that HYPOESTROGENIC STATES, associated with smoking, stress, low-calorie diet, low-fat vegetarian diet, or malnutrition, TEND TO INDUCE EARLY MENOPAUSE.

It’s interesting that European women tend to have somewhat later menopause than American women.

The amount of body fat and maternal age at menopause—these seem to be the best predictors. Factors which increase estrogen levels, such as regular drinking, regular sex life vs celibacy, adequate fat intake and sufficient nutrition vs low-fat dieting, also appear to play a role. No one has put it quite so directly, but it seems to me that we can state this as a general rule: being more estrogenic (due to factors such as obesity, drinking, pregnancies) inhibits the rise in FSH for a longer time and thus delays menopause; being relatively hypoestrogenic (due to factors such as smoking, celibacy, low-fat diet, stress) tends to hasten menopause. How does the drop in Melatonin fit in with all this? And what about the famous “biological clock”? The picture gets more and more complex the more closely we look.

Considering that the age at menopause appears to be related to life expectancy (some of you may have seen the reports in popular media about the greater prevalence of late menopause and late childbearing among female centenarians; there is a also a fascinating study of Seventh-Day Adventists along those lines; CH will have a separate article on this topic in a future issue), it does seem important to research the many factors influencing the onset of menopause.

While endocrinologists and gerontologists compare early versus late “reproductive senescence” and draw pretty obvious conclusions, oncologists point out that early menopause is related to lower breast cancer risk. Cardiologists reply by citing statistics on the huge prevalence of heart disease over breast cancer.

It is also high time to investigate why testosterone production declines more dramatically in some men than in others. Are factors such as diet, celibacy vs an active sex life, type and amount of exercise, feeling like a winner vs feeling like a failure important for maintaining healthy levels of the mighty T, and are these factors different for men and women? Stay tuned for future issues of CyberHealth.

(Additional source: Stoppard M, “Menopause,” Dorling and Kindersley 1994)

DOES THE DECLINE IN DHEA INFLUENCE THE ONSET OF MENOPAUSE?

One CHW reader alerted me to the fact that the questions I raise seem to outnumber the answers. I can’t help it. Hormone research is like clumsily putting together a gigantic jig-saw puzzle, and the more we know, the more we realize how much more we need to know.

DHEA continues to be in some ways a mystery hormone. We no longer doubt that it is an important one. Let me simply give you this quotation from a recent article: “The 44.5% fall in serum DHEA from 20-30 years to 40-50 years of age in women could well explain the bone loss and increased FSH/LH ratio that precede menopause and occur before a detectable decrease in ovarian steroidogenesis in perimenopausal women.” To put it in simpler terms: women lose almost half their DHEA before menopause even starts; this drop in DHEA levels may be a factor in premenopausal bone loss and in the gradual rise in the levels of FSH (follicle-stimulating hormone), two phenomena that occur before there is a significant decrease in ovarian hormone production.

1. bone cells can easily convert DHEA to estrone
2. Some metabolites of DHEA are estrogenic; in addition, DHEA can serve as a precursor in the production of various other steroids, including estrogens.

If we are correct in assuming that higher levels of estrogens keep FSH low, and if in women DHEA significantly contributes to the amount of estrogens, then it is plausible to theorize that the continuous steep drop in DHEA with aging does indeed play an important role in the onset of menopause. It would be fascinating to see if starting DHEA supplementation relatively early in life would indeed have an impact on bone health (quite likely) and on FSH and menopause (that’s the big question mark). Supplementation isn’t the only way to increase one’s DHEA production. The greatest enemy of DHEA is stress. Effective ways to reduce stress, such as meditation, listening to favorite relaxing music, or playing with one’s pet all help increase DHEA. Stress-producing type-A behavior, on the other hand, lowers DHEA.

DHEA is also inversely related to the percentage of body fat. Leaner men and women tend to have higher DHEA, which in turn helps to keep them slender. Pregnancy raises DHEA. In men but not in women, lowering insulin levels seems to be an effective way to raise DHEA. The scientist who has done most of the insulin-lowering studies, Dr. John Nestler, actually suggests that “the hyperinsulinemia of aging,” i.e. the rise in insulin levels with aging, causes the decline in DHEA.

In women but not in men, there seems to be a slight inverse correlation between waist-hip ratio and DHEA, and this correlation holds independently of age and insulin levels. In other words, the more typically female slender waist/curved hips figure is associated with higher DHEA independently of age. Again, is it the estrogenic contribution of DHEA that helps keep the waist slender and serves to preserve the favorable feminine fat distribution? Questions, questions, questions.

(Sources:

Labrie F et al. Marked decline in serum concentrations of adrenal C19 sex steroid precursors and conjugated androgen metabolites during aging. J Clin Endo Metab 1997;82:2396-2402;

Nestler’s DHEA/insulin research as discussed in Regelson W. The Superhormone Promise, Simon and Schuster 1996;

Denti L et al. Effects of aging on dehydroepiandrosterone sulfate levels in relation to fasting insulin levels and body composition assessed by bioimpedance analysis. Metabolism 1997;46:826-32)

The main reason is its flavonoid PHENOLICS—powerful antioxidants which have been shown to inhibit peroxide and superoxide free radicals. A report in Lancet (Sept 21 1996, p.834) states that COCOA POWDER INHIBITED LDL OXIDATION IN VITRO BY 75%, WHILE VARIOUS KINDS OF RED WINE INHIBITED IT BY 37-65%.

According to the Lancet report, BAKERS’ CHOCOLATE CONTAINS 8.4MG OF POLYPHENOLS PER GRAM, WHICH MAKES IT A STARTLING 260.4 MG PER OUNCE.

Look for chocolate that’s not loaded with sugar, and to which no extra fat (usually hydrogenated) was added. Chocolate has its own wonderful fat, cocoa butter, the saturated part of which contains a large proportion of stearic fatty acid, considered a benign fat (it doesn’t raise cholesterol while providing sustained energy).

If you are a purist, there is such a thing as pure chocolate. The least expensive brand, I’ve discovered, is Hershey’s Unsweetened Baking Chocolate.

Ingredients? 100% chocolate. It’s on the bitter side, but I’ve actually developed a taste for it. Great for hiking, since it doesn’t melt as easily as “candy”-type chocolate, and provides steady, sustaining energy.

Another wonderful thing about pure chocolate is that you are not likely to eat too much. One or two little squares, and you feel perfectly satisfied.

This is chocolate without fear, chocolate without guilt—health and pleasure combined.

The usual caveat about chocolate is that it contains caffeine and thus shouldn’t be consumed in the evening, at least not by those sensitive to caffeine. Well, I am fairly sensitive to caffeine, and just about anything can disturb my sleep, yet I’ve never had those problems with pure chocolate.

The commercial hot chocolate mix, on the other hand, proved to be a disaster for me at any time of day, bringing on a sugar high followed by a hypoglycemic crash. So I suspect that the problems with chocolate reported by some people—insomnia and cravings—are really caused by the added sugar, not chocolate. Just a speculation.

Again, please don’t misunderstand: pure chocolate is not the same thing as a typical chocolate bar, loaded with sugar and hydrogenated fat.

For some, pure chocolate is not acceptable because of too much bitterness (I love it, but agree that it’s an acquired taste). In that case, try semisweet chocolate prepared without hydrogenated fat. I found a wonderful brand at Trader Joe’s.

Chocolate, like coffee, has also been accused of aggravating the fibrocystic breast disease. Research evidence is inconclusive. For about three miserable premenopausal years, I denied myself all coffee, tea, and chocolate, and my breasts only got more sore as I became ever more progesterone-deficient with age (I didn’t know anything about hormones back then, and my gynecologists seemed equally ignorant). But it’s possible that too much chocolate does have a bad effect on fibrocystic breasts in some women. As the ancient Greeks said: nothing in excess.

Chocolate’s treasure house of polyphenols is a boon to those who can’t tolerate red wine. (In any case, women on ORAL estrogens should limit their alcohol intake; we’ll have more on that in a future issue.) Some suggest that chocolate and red wine should be consumed together for a synergistic effect. I don’t think we have any studies on this, but on the anecdotal side, Jeanne Calment, who lived to be 122, was known for her fondness for both. One time, asked about the secret of her longevity, she is supposed to have replied, “Two pounds of chocolate a week.” She may have been joking, but . . .

(Parenthetically, the U.S. is #16 in life expectancy; France is #2.) Sometimes I have some raisins or red grapes with my chocolate as a kind of wine substitute. Raisins are known to be very rich in antioxidants.

Antioxidants are, in effect, nature’s own preservatives. I like Pearson and Shaw’s motto: “Preservatives preserve YOU.”

A historical note: chocolate was brought to Europe by Columbus.

Late-breaking news: it is possible that a cup of freshly brewed coffee has the antioxidant power of three oranges! At least these are the in-vitro results of a UC Davis professor, Dr. Shibamoto. They do need confirmation.

Kolodie writes:

Have you read Eating Right For Your Blood Type…a fascinating and oh so important book to get a hold of! About Soy…Milk…Wheat…Meat. For instance Type O was the first blood type and should be eating red meat at least 5 times a week. Ouch for vegetarians! Blood type A should be mostly vegetarian…check it out.

Ivy replies:

Beware of blanket prescriptions! For instance, I think that eating red meat 5 times a week might be right for anemic women, regardless of their blood type, but wrong for those who suffer from iron overload. Should all type O’s adopt the motto: “A day without a hamburger is like a day without sunshine”? I have my doubts.

Likewise, should all type A’s never touch red meat and vegetate, so to speak, on soyburgers and rice cakes? Again, I have my doubts. I’m type A, and in my late thirties and early forties I tried to be a vegetarian, or mostly vegetarian (for much too long). I was sick as a dog, bloated, always tired, chronically hungry. I lost my period (but the drop in hormone production wasn’t yet severe enough to produce hot flashes).

My once prolific creativity was prolific no more. My once lively sex drive hardly asserted itself anymore. My fingernails were covered with white spots; I was malnourished no matter what ever-growing number of supplements I took—and, as though to illustrate the “overweight and undernourished” principle, I ballooned on all those carbs. I was petite no more; one day I looked into the mirror and could no longer deny that I was fat.

Believe me, it’s not that my diet wasn’t rich in tofu and beans and brown rice and oatmeal and just about every variety of plant food. Flax seed oil, nuts, you name it. On paper, it should have provided more than enough nutrients. It should have been fantastic.

I particularly remember that every morning I could barely move; and after almost every breakfast I felt so sick I had to lie down. (A vegetarian friend of mine says she has to lie down after every meal, she feels so heavy and bloated and tired from what she calls “the metabolic burden.”) Now that I know more about phytic acid, wheat intolerance, high-glycemic starches and insulin surges, excess fiber, absorption problems and so forth, I can see that perhaps some sort of different, fermented, non-grain-based vegetarian diet might have turned out to be compatible with my body. I am not against the vegetarian diet—if you find the kind you can thrive on.

Luckily, eventually I’ve discovered the low-glycemic omnivorous diet, and that’s what I thrive on. My weight is now back to what it was in my twenties, and I glory in my 25-inch waistline. I am proud of my body, since I’ve earned it through disciplined, aware nutrition. Not through “eating right for my blood type,” but through eating right for ME.

I agree that I could probably do OK without meat, but I’d have to eat lots of seafood, and I mean every day, practically at every meal, in order to compensate. Once in my teens I lived for about 6 weeks in a fishing village and ate “fresh catch” every day; I never felt better. The wonderful omega-3 fats found in fish may have had a lot to do with it.

I am very glad that I summoned the courage to give up politically correct nutrition and got interested in physiologically correct nutrition. When I returned to omnivorous diet, every cell in my body seemed to be singing with joy. The energy seemed just incredible to me, and the cheerful mood that went with it. The only part I didn’t like was having periods again. (Thank God for menopause! I feel I was born to be postmenopausal.) Don’t believe everything you read. Human physiology is ever so much more complex than any health guru knows, and everybody is different. My disastrous adventure with vegetarianism taught me a lesson I’ll never forget.

At the same time, someone else with type A blood might do OK being mostly vegetarian, just as the book says. That’s fine with me. But we need to find out what works for us through individual experimentation, and not follow any dietary advice blindly—that’s what I learned the hard way.

I’ve heard from a few other women who also felt they wrecked their health by sticking to a vegetarian diet even though their bodies were screaming that it wasn’t right—like me, they tried to be politically correct and ignored the signals until they got truly sick. If I hadn’t been through this awful experience, I wouldn’t be constantly saying in CH, “Listen to your body.”

Actually the blood-type book is to praised for recognizing SOME individual differences. Most diet gurus are more “totalitarian” than that. Some preach that we should all return to the Paleolithic hunter-gatherer diet: lots of protein and low-glycemic carbohydrates such as nuts and berries; no grains. They cite the superior stature and excellent bones and teeth of our Paleolithic ancestors, their apparent freedom from degenerative diseases.

Other gurus think that every should eat a primarily or totally vegetarian diet, heavy on grains, and cite the lower prevalence of cancer among vegetarians.

The Paleolithic school fights back by pointing out the stunted stature in agrarian societies, the undersize children, the frail-looking women with tiny breasts and thin bones, the non-husky men with relatively small genitals; they further point to the low quality and poor bioavailability of plant proteins, and the digestive burden they create; they don’t think lowering the levels of sex hormones through diet is a good idea, considering all the benefits of these hormones.

The vegetarian camp triumphantly points out that there is less baldness and less prostate cancer among men in mostly vegetarian societies. The Paleolithic group, on the other hand, cites the fact that Okinawans enjoy a longer life expectancy than the rest of the Japanese population, and the Okinawans consume considerably more meat and fat; in fact, their favorite dish is pork fried in lard. And so it goes.

And then there are those who divide people into “fast burners” and “slow burners”; the fast burners supposedly absolutely require animal food, especially the highly bioavailable, high-grade protein found in eggs, red meat, and dark fish. Personally I do feel more satisfied and energized after eating the more nutritious drumsticks rather than white meat, salmon rather than flounder. My guess is that the more “intense” individuals, somewhat like athletes, do indeed need high-octane fuel. But it is only a guess.

True, I SUSPECT that a low-glycemic diet is best for just about everyone past a certain age, especially if you are sedentary and can’t burn off those excess carbohydrates. And I think the variety of foods we eat should be as wide as possible, to insure that we obtain the greatest possible range of nutrients, some of which we haven’t even discovered yet. But I am not about to pose as a “diet dictocrat,” and apologize if I have ever sounded like one, forgetting to include my usual disclaimer about listening to your own body. Our biochemical individuality makes any dogmatic stance unacceptable.

Also, even if blood types developed in certain chronological order, this doesn’t necessarily imply that the optimal diet must follow this chronology.

In fact, the hunter-gatherer school sometimes argues that since hunting-gathering is so ancient and agriculture so recent, our metabolism evolved during the hunting-gathering stage and is poorly adapted for consuming grains. Unless some controlled research is performed, we’ll be fruitlessly arguing forever.

The only thing we seem to know for sure is that growing children, pregnant women, athletes, and the elderly all have different nutritional needs.

And if you are doing well on a vegetarian diet, I’d never tell you that you must change—not even if you are type O.