Perimenopause/Menopause Interview notes

Perimenopause is the time period where the body’s hormone balance is changing; menopause actually marks the one-year anniversary of the cessation of menstrual cycles (menstruation). Most menopause formulas are actually targeted at perimenopause symptoms.

The recent clinical evidence for, and availability of, products that don’t contain soy, isoflavones, or phytoestrogens should greatly help those who won’t or can’t use products containing those components. This now opens the perimenopause category to those who were previously shut out.

This is a strong category but with a lot of competition among products and claims that inevitably leads to some confusion; not only among consumers but for some store personnel, as well. Product information from manufacturers can either clarify or confuse, depending on the message that they’re trying to send: are they trying to tout their own product as better than everyone else’s, or are they accurately representing the science and trying to provide real consumer choice?


Vitex (Vitex agnus castus), or chaste tree berry, contains small amounts of Agnusides, the active component of chaste berry. Chaste berry extract has been researched to corroborate traditional usage for supporting healthy female hormonal levels during menopause.

Dong Quai (Angelica sinensis) root is a traditional herb for female hormonal support, but has not been historically used for perimenopause/menopause.

Ipriflavone (7-isopropoxy-isoflavone) is a natural-identical soy-free isoflavone (bioflavonoid) that supports bone health, helps maintain healthy bone density, and supports post-menopausal calcium metabolism.

Natural Progesterone Skin Cream typically provides 20 mg of Natural Progesterone USP per use. Look for products with no artificial colors or fragrances that are paraben-free. Synthetic progesterone is not nature-identical.

Black Cohosh (Cimicifuga racemosa) is an herb that has been traditionally used by Native Americans to alleviate the symptoms of menopause and other female complaints.

Red Clover (Trifolium pratense) is an herb particularly rich in biologically active compounds called phytoestrogens that are recognized for their role in the support of healthy estrogen levels.

Soy Isoflavones are naturally occurring phytoestrogen plant compounds (Genistein, Daidzein and Glycitein) that are particularly concentrated in soybeans and which support high or low estrogen levels.

Pharmaceutical Drugs, including synthetic forms of female hormones, have side effects that may contraindicate their use since they are isolated synthetic substances, so many women prefer to avoid them. Since the normal change of life is not a disease state, the use of traditional natural substances to manage health makes sense to most people.


Women need to carefully review any label cautions and interactions, as well as the usage suggestions, to avoid any known interactions with medications. Even if no interactions have been noted, caution should be used when adding any new substance, however natural, to a medication regime.

People often mistakenly think that all estrogen compounds are alike. However, phytoestrogens are plant-based food compounds found in virtually all legumes that are about 1,000 times weaker than the usual circulating body-produced estrogen forms. That difference and the source makes plant estrogens much safer. Even soy isoflavones, which are phytoestrogens, have some key differences from endogenous estrogens formed in the body: much like cruciferous vegetables, soy isoflavones may actually prevent the conversion of estrogens into harmful forms (like 16α-hydroxyestrone), promote their breakdown by Phase II detoxification, and increase their excretion in the urine.

Another myth is that symptoms of perimenopause can all be treated the same. Everyone’s hormone levels are unique and complicated, so not every product will work for every person. Some trial and error may be required, and some consumers elect to have their hormone levels checked to help them choose which products are most likely to be right for them.

Fish Oil: Excerpts from a magazine interview with me

The balance of fatty acids in the body can promote inflammatory or non-inflammatory states. Higher amounts of omega-3 fats in the diet have been shown to modulate inflammation and keep it within healthy ranges. The various cellular and tissue damage that can occur from chronic inflammatory states are certainly not healthful. This basic mechanism of action implies a wide-ranging and powerful effect of omega-3 fats to support wellness. Additionally, these fats are part of brain and nerve structures, so they help to maintain the health of those tissues, as well.

Omega-3 and omega-6 fats have been called “essential fatty acids” since the body can’t manufacture them from other fats, as it typically can for other types of fat. The optimal ratio of omega-6 to omega-3 fats is somewhere between 1:1 and 3:1. The common American diet has been estimated to be over 15:1, a marked deviation from a healthy norm.

The benefits of most other non-omega-3 fatty acids in fish oil are not well-defined in the scientific literature. Fish oil naturally contains a range of fats, including cholesterol, triglycerides, and stearic acid. The ones that are considered less desirable, cholesterol and triglycerides, are sometimes removed from fish oils to further concentrate the omega-3 portion and allow higher strengths in fewer capsules.

All natural oils contain various mixtures of fatty acids in varying amounts. Omega-9 fats are best known as being abundant in Olive Oil, and are considered non-inflammatory and especially healthy if substituted for most omega-6 fats that are pro-inflammatory. Some natural oils are fairly well balanced, such as flax and hemp seed oils, or walnut oil. Others, like fish oil, tend to be predominantly omega-3. Most vegetable oils are mostly omega-6 fats and their predominance in the modern diet has been blamed for some of our poor health.

Some consumers do know about various sources of fish oil, and some have advantages or disadvantages. For example salmon is a favored source of omega-3 fats, though salmon oil typically contains less than other common fish oils. Traditional fish sources may be better accepted by those who won’t or can’t eat shellfish. The fisheries in Norway and Peru are among the best managed traditional fisheries on earth.

Krill, a small crustacean shellfish, is a unique source of omega-3 fats since krill also naturally bonds the fatty acids to phospholipids, which are essential for cell membranes and which enhance the bioavailability of the oil. Krill oil also contains the powerful antioxidant pigment astaxanthin, which is responsible for the color of shrimp and salmon. Krill is considered the best managed fishery in the world, with trained observers on each boat monitoring the harvest. The krill harvest limit can be rapidly adjusted to support a healthy population, and the total world harvest (most of which goes into pet foods) is only a fraction of the allowable sustainable harvest level.

Thyroid supplements

People typically seek thyroid support nutrients as a way to enhance their energy levels, enable proper control of their body temperature, and support a strong metabolic rate.  We take these nutrients, both individually and in formulas, in order to assure adequate levels to support optimal thyroid function, since a deficiency or insufficiency of key nutrients could reduce the operational efficiency of the thyroid gland.   Proper thyroid function supports a lean body composition and helps prevent fatigue.  Under the control of complex feedback and signals from the hypothalamic-pituitary-thyroid axis, the thyroid gland regulates body temperature and metabolism rates, playing an important role in weight management and energy states.  By the same token, if any of the important nutrients are not available to the thyroid in sufficient amounts, metabolic rates and energy levels could suffer. ¹

Natural thyroid support supplements work primarily by providing precursors of thyroid hormones, along with various cofactors, in order to encourage proper thyroid function.  In some cases, the lack of adequate nutritional resources prevent the thyroid gland from maintaining optimal efficiencies, and if the gland can’t maintain healthy levels of its important hormones, then it can’t adequately support the body’s metabolism.  Unlike medical treatments, nutritional approaches focus on providing what the body needs in order to assure that the thyroid has its particular needs met and can function optimally. 

The key nutrients for thyroid function are the mineral Iodine and the natural amino acid L-Tyrosine. 

Humans require iodine for cellular metabolism and for normal thyroid function; specifically for the production of thyroid hormones.  Thyroid hormones regulate many important biochemical reactions, including protein synthesis and enzymatic activity, and are critical determinants of metabolic activity.  Iodine is a nutrient that can sometimes be obtained from the soil, but many soils are deficient.  Areas that are mountainous, very rainy, or prone to floods/erosion tend to have soils that are low in iodine, increasing the risk that foods grown in those areas will be iodine-deficient.  Table salt is commonly iodized, but those using non-iodized salt or on low-sodium diets can’t rely on that source.  Multivitamin formulas, thyroid support formulas, kelp and some other seaweeds, and some multimineral formulas provide supplemental iodine.  The U.S. Recommended Dietary Allowance (RDA) is 150 mcg (micrograms) daily for adults ages 18 and older, 220 mcg daily for pregnant women, and 290 mcg daily for lactating women. The Tolerable Upper Intake Levels (UL) for adults ages 18 and older is 1,100 micrograms daily. ^{2-3 ]}

The common sources of iodine in dietary supplements include Potassium Iodide, Kelp, and other seaweeds.  While kelp and some seaweeds are fine for getting the relatively low RDA level of iodine intake, those seeking much higher levels are usually advised to consider Potassium Iodide.  This is because seaweeds typically contain less than 1% iodine, along with a lot of other metals and minerals - including some that we may want to avoid getting too much of - so consuming high doses of seaweeds on a daily basis may not be our safest option.  And iodine is a mineral nutrient that needs to be replenished daily.

L-Tyrosine is an amino acid that is important to the structure of most proteins in the body. It is also the precursor of a number of neurotransmitters and hormones, including the major catecholamines dopamine, norepinephrine, and epinephrine (adrenaline), which are stress hormones made by the adrenal glands.  In addition to these functions, tyrosine also helps produce melanin (the pigment responsible for hair and skin color) and helps in the function of the adrenal, thyroid, and pituitary glands.  Because of these varied responsibilities and the ability of various stresses and dietary deficiencies to reduce tyrosine levels, people sometimes supplement tyrosine (as natural L-Tyrosine) in order to support proper thyroid function. ^4-5   

How do Iodine and L-Tyrosine affect thyroid function?  The thyroid gland’s epithelial cells prepare large quantities of tyrosine into a glycoprotein “scaffold” that is the structural backbone used to form the thyroid hormones thyroxine (T4) and triiodothyronine (T3).  The scaffold and iodine are both secreted into the lumen of the thyroid gland, where an enzyme facilitates the hormone synthesis.  Other enzymes then separate the hormones from the scaffolding in steps, liberating them into their circulating forms.  A few tyrosines are incorporated into these hormones, but most are left in the scaffolding structure’s remains that will be recycled by the body. 

Selenium is an essential mineral nutrient that is necessary for normal thyroid hormone metabolism.  Selenium-containing enzymes control the synthesis and degradation of the biologically active thyroid hormone, T3.  Selenium deficiency may worsen the effects of iodine deficiency on thyroid function, and adequate selenium nutritional status may help protect against some of the neurological effects of iodine deficiency.   Additionally, selenium-based antioxidant enzymes protect the thyroid gland from peroxides produced during the synthesis of these hormones. ^{2, 3, 6}

Zinc, another essential mineral responsible for hundreds of critical chemical reactions in the healthy human, is also important for maintaining normal thyroid homeostasis. Its complex roles include effects on both the synthesis and mode of action of the hormones.  Thyroid hormone binding transcription factors, which are essential for modulating gene expression, contain zinc bound to cysteine-related compounds.   In some studies, low zinc status was associated with decreased thyroid hormone levels.  ³

Copper is believed to have a role in thyroid hormone function, perhaps related to selenium status. ³

Guggul (Commiphora mukul) is an Indian Ayurvedic herb that contains the active compound Guggulsterone, which has been shown to stimulate thyroid activity. ^7-8

 
These ingredients, both singly and as thyroid support formulas, are in demand by consumers wanting to assure adequate thyroid function in times of dietary insufficiencies and various stresses.  Of course, these nutrients and their many functions in the body have a host of potential benefits to those supplementing with them if they may not get adequate amounts from their diet for their individual requirements. 

 

REFERENCES

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1.  Zoeller RT, Tan SW, Tyl RW. General background on the hypothalamic-pituitary-thyroid (HPT) axis. Crit Rev Toxicol. 2007 Jan-Feb;37(1-2):11-53. Review. PubMed PMID: 17364704.
2. http://ods.od.nih.gov/factsheets/Iodine-HealthProfessional/
3. Arthur JR, Beckett GJ. Thyroid function. Br Med Bull. 1999;55(3):658-68. Review. PubMed PMID: 10746354.
4. http://www.umm.edu/altmed/articles/tyrosine-000329.htm
5. http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/thyroid/synthesis.html
6. http://ods.od.nih.gov/factsheets/selenium/
7. http://www.drugs.com/npp/guggul.html
8. http://www.peoplespharmacy.com/2005/10/18/guggul/