Managing menopause symptoms

Managing the symptoms of menopause

Menopause occurs in most women between the ages of 45 and 55 years. For some it causes few problems, but for others it can make life extremely miserable. Interestingly in Asian countries where there is a high intake of soy and other phyto-oestrogens, menopause is rarely a problem.  These people mainly eat fermented soy which may be different and healthier than most soy products on our shelves. 
At menopause the normal female hormone cycles (oestrogens and progesterone) shut down, and particularly the lack of oestrogens cause symptoms of hot flushing, sleeplessness, palpitations and others.
Why do they happen?
The hot flushes (flashes in American English) are probably due to the lack of oestrogen. This affects the thermoregulatory nerves in the hypothalamus which keep our temperature within a very narrow range. The sudden absence of oestrogen makes the hypothalamus much more sensitive, and instead of waiting until the core temperature rises 0.4°C above normal, the hypothalamus starts to dissipate heat from the body at a much lower temperature. This starts with a hot flushing feeling in the chest and face which spreads around the body – due to dilation of the small arteries – to try and lose heat. This is then followed by sweating and frequently palpitations. Sometimes these are followed by chills and shivering as the body temperature has been lowered. When this happens at night it frequently disturbs sleep.
What can we do about it?
Stop the body temperature from rising particularly suddenly, keep the room temperature low use fans etc, wear clothes in layers which can be removed easily.
Avoid triggers such as spicy food, stressful situations, caffeine, alcohol, cigarette smoke, tight clothes and possibly sugar (especially sweet food at night).

Complimentary (natural) treatments –

• Soy and soy products, also grains, brown rice, tofu, nuts contain a variety of compounds which can help.
• Isoflavones and phytooestrogens (plant oestrogens) – such as

folic acid reduces alzheimer's and stroke

Folic Acid supplements reduce strokes, Alzheimers and possibly heart disease

Folic acid is routinely given to  pregnant women to prevent neural tube defects ( spina bifida and hydrocephalus), and is routinely added to  many breads and other foods because it is deficient in many diets.  

 However despite the fact low folic acid can lead to:  Raised homocysteine which is associated with coronary artery disease, Depression, diabetes and some forms of cancer - trials of supplementing people with folic acid have been disappointing - with little benefit seen, but none have shown any adverse effects. 
A number of recent studies however suggest that taking folic acid supplements might be very beneficial:

1. Reduced risk of Alzheimer's disease - in a study of  579 elderly non demented American men and women (click here) , those who took folic acid supplements had a 50% reduction in developing Alzheimer's in the subsequent 10 years. 
2. Reduces risk of stroke in people with high blood pressure - a presentation at the 2015 American College of Cardiology reviewed the China Stroke Primary Prevention trial.  They followed for 4.5 years, over 20,000 men and women with high blood pressure, half were given the BP reducing agent enalapril, and half took an enalapril combination tablet containing 0.8mg of folic acid.   The addition of folic acid reduced the development of stroke by 21%.   
3. May possibly reduce coronary heart disease.   In many trials using folic acid in patients with heart disease, aspirin was also given to the patients, and this may have a similar action to  folic acid and so mask any benefit from the folic acid. A London group reviewed 75 studies using folic acid (click here) in people with the MTHFR gene which raises homocysteine levels.  In the 5 trials with the lowest aspirin use, there was a 60% reduction in heart disease, but the 5 studies with the highest aspirin use, there was only a minimal insignificant benefit seen. 

So folic acid supplementation may reduce some cancers and coronary heart disease, but has now been shown to reduce the development of Alzheimer's disease and strokes (in people with high blood pressure).  

It does seem prudent  for everyone to take a good multivitamin supplement regularly that includes at least 0.5mg of  folic acid. 

Mediterranean Diet is best

The Mediterranean is the best diet

There is enormous confusion about what is the best diet to follow - low fat, low saturated fat, low trans fat, low carb, high protein, paleolithic, fasting day diet....the list is endless.  Most are complicated and unpleasant to follow for the rest of one's life.    Unfortunately Cardiology has made saturated fat the sole culprit for many years and is having difficulty in saying "we got it wrong".   The diets usually concentrate on what you cannot eat rather than what you can.
Many cardiologists (me included) have for years suggested that the mediterranean diet is the best and healthiest, from looking at the incidence of heart disease in countries round the north Mediterranean shores.   Even though many smoke, drink, are overweight and do little exercise, the incidence of heart disease in those is incredibly low (see graph).  Arrows point to NZ, the UK and Australia, the bracketed countries are Portugal, Spain and France
They also eat saturated fat in the form of cheese, and some meat as well.   It seems that it is what you eat that is important, not necessarily what you 'should not'. 

In a paper presented to the American College of cardiology 2015, a Greek study followed 2,500 adults for 10 years.  those eating the typical mediterranean diet (rich in fresh fruit and vegetables, oil and fish) developed 47% less heart disease! That is HUGE - heart disease was halved by eating this very palatable diet. (It also reduced diabetes, obesity and blood pressure).

So what should we eat?

• Avoid processed foods as much as possible (filled with trans fats), and also reduce the sugar intake, which is the major cause of today's obesity epidemic.  Moderation with salt and red meats.
• Add the mediterranean foods : fresh fruits and vegetables, whole grains, beans, nuts, fish, olive oil and even a glass of red wine.     

That does not seem a hard diet to follow, in fact it is probably nicer than the ones we currently are trying to stick to.  Throw away all the diet books you have, none have been proven to be beneficial in the long run (even the low fat diet) - and here we have double proof with both population and trial evidence

Exercise program helps Parkinson's disease

Exercise helps patients with Parkinson's disease

Parkinson's disease is not nice, especially as most patients are aware of their disease and cannot do much about it.    There are some good drugs, and supplements can help (see my web site (click here)), but patients wonder if there is more they can do.    Because of instability and the risk of falls, they have had a mixed picture on the benefits and disadvantages of exercise.    

How ever two recent studies leave no doubt that mild exercise is very beneficial:
1. In a paper in neurology (click here) half of 230 patients with Parkinson's disease were given 30-40 minutes exercise 3 times per week.   The exercise reduced the risk of falls by 60%, in those with mild disease, but made no difference in those with more severe disease.   However at all levels there were major benefits :  "the exercise group scored significantly (p < 0.05) better than controls on the Short Physical Performance Battery, sit-to-stand, fear of falling, affect, and quality of life,"  So starting exercise early after the diagnosis is made is best. 
2. A study of Tai Chi in Parkinson's patients (click here ) had similar results - with improved functional capacity and reduced falls. 

So for patients with Parkinson;'s disease, starting an exercise programme or Tai Chi or both will both slow down the disease process and hugely reduce the risk of falls. 

lowering BP in the elderly reduces mental function

Are we lowering Blood Pressure too much in the elderly.

For many years doctors have strived to bring the blood pressure down to what was considered ideal levels ( 120-130/80-90), no matter how old the patient was.   In the elderly with stiff arteries this is difficult and often requires high doses of multiple drugs to achieve this.

 There is little to no evidence that this is beneficial in the elderly, and the side effects and in many cases falls due to a drop in BP on standing are common. 
Now comes a study from an Italian group published this year in JAMA (click here for abstract) which also shows that lowering BP in the elderly affects their mental function.   They studied 172 people with a mean age of 79 and followed them for 9 months, measuring cognitive function using the Mini Mental score.  Those on BP lowering drugs with a BP lower than 128 systolic had a significant decline in mental function compared with those with BP 129 - 144, and even those above 145mmHg systolic.
So lowering BP to low levels in older people has not been shown to reduce the risk of adverse events, and now we discover it reduces mental function!
The answer - don't try to lower BP with drugs unless the BP is consistently greater than 145-150 systolic

statin drugs cause diabetes

Statin drugs definitely cause diabetes

Statin drugs are the probably most successful drugs of all time, and are being recommended for many conditions beyond high cholesterol and artery disease - usually following some small change when data from studies is dredged or combined - this type of analysis can usually achieve any answer the researcher is seeking and needs to be considered with great caution - especially when there is a downside to the therapy.   For a while people were considering adding a statin drug to a 'polypill' to be taken by everyone over the age of 45 - 50 years. (The polypill was to contain a statin, ACE inhibitor, beta blocker, aspirin and folic acid).  But the adverse effects of statins on muscles, brain and nerves, liver, and other organs are becoming increasingly appreciated.   Many of the trials with statins started after a run in phase where people were on statins, but if they had significant side effects, they did not enter the trials. 

NOW we have proof that statins cause a major increase in the development of diabetes (almost doubles the risk), in a well researched trial from Germany (click here for full article). They followed 8,749 non diabetic people for almost 6 years.  625 developed diabetes and those on statin drugs had a 46% increase in diabetes compared to those not on statins (Fig 1).

  The dose of statin also made a difference (fig 2). 
So statins reduce the risk of heart attack and death, but double the risk of diabetes.  Where does this put us now?
First - medicine is always balancing the risk vs the benefits of treatment, and there seems little doubt in people who have definite heart disease ( heart attack, coronary disease, angioplasty, bypass surgery) statins do reduce the risk of further events and should be recommended.  However if there is a risk of diabetes, then only a low dose of the statin drugs should be used.
However in primary prevention, and especially in women, where the risks are small and evidence of absolute benefit is not very strong - many people, including me, are suggesting caution unless the cholesterol is exceptionally high or there is a very strong family history.   (In these people, I would probably recommend a coronary calcium scan before starting them on statin drugs.)  If there is a risk of diabetes, then possibly Pravastatin would be the best one to use.  In the West of Scotland Study (WOSCOPS), using this drug in primary prevention, there was actually a reduction in diabetes in those taking the drug.   There were too few in this recent German Study on Pravastatin to reach any answers. 

Mobile phones do not seem to cause brain cancer

Mobile phones do not seem to increase the incidence of brain cancer

Case reports have suggested the development of brain tumours in the temporal and parietal lobes and blamed the excessive use of mobile phones as the cause.There have been conflicting evidence from a number of studies (Swedish Hardell group study (small increase in some specific cancers), and Interphone studies (6,000 people - no effect), the Million Women study (no effect), and a Danish study of 420,000 people - also no effect on any cancers.  
Nevertheless people are still being cautious, especially in their prolonged use in children today who seem to be unable to function without some device attached to their ears. 



A paper in the Australian and NZ Public Health Journal (click here) gives more reassurance. In a country of 4 million people with an almost 100% uptake in the cancer register, they have studied the incidence of brain cancer between 1995 and 2010 - starting just after mobile phone use became widespread in this country.
They found no increase in the incidence of brain tumours in fact there was a significant fall in all brain cancers between the ages of 10 and 65 years of age.    There was a slight rise in people over 70 years, but these people probably use mobiles the least and improved diagnostic testing probably explains this rise. 
So should we be using mobile phones with impunity?   I dont think so, any radiation does have the potential of damaging DNA and I still believe we should be cautious.   Use mobile phones - yes, but not for prolonged periods and also do not 'store' the phones near the reproductive areas ( pockets and pouches) as they are always searching for signals.   In a world where we are being continually bombarded with radiation, sprays, toxins etc, it seems prudent to reduce these exposures to our bodies to the minimum - they can do us no good, and additively, they may cause harm. 

free on line medical journals

Free Medical Journals on Line

Information is so available now, but the quality and accuracy of many papers and statements just cannot be checked or trusted, so many Authoritative Medical Journals are making their publications this link  which gives links to a huge number of journals including New England J of medicine, Mayo Clinic Proceedings, Canadian/Australian/British medical journals and many more.    You can also search by topics.

These journals are free, and for many they provide an index of previous journals which can be searched to look up out references you want to check. 

This openness in sharing information which is usually only available to the medical profession or medical libraries, enables much better integration of our health services, and hopefully more complementary therapies will start entering these medical journals. 

Benefits of probiotics in children

Probiotic Benefits for Children

Most people appreciate the value of pro and prebiotics in children who have had antibiotics or diarrhoea, but the blog GreenMedInfo  lists a spectacular number of benefits (the web link can be seen by clicking on the green link words), especially to do with infections and allergies.   
This is not totally surprising as we are now realising the importance of gut health, the bacteria in our gut, the immune component of the gut and relationship to many of today's diseases.
Maybe we should be giving them regularly to our kids (as well as ourselves) from the time they start taking solids.

1. There is evidence to suggest probiotics are safe and effective in treating persistent diarrhea in children.
2. Saccharomyces boulardii has therapeutic properties in the treatment of acute diarrhea in children.
3. Lactic acid bacteria as probiotics reduce the risk for infantile eczema.
4. Probiotic and prebiotic supplementation improves the symptoms of children with atopic dermatitis.
5. Probiotics and prebiotics significantly prevent eczema and atopic eczema in infants.

Homeopathy does work

Homeopathy proven to be effective. 

A paper published in 'Systemic review Journal'  (click here for full text)  reviewed for the first time Randomised Controlled trials published in peer reviewed journals - comparing Homeopathic treatment vs placebo (dummy treatment).  They analysed 32 controlled trials involving 24 different medical conditions, and confirmed that Homeopathy worked.  To quote the paper:  "There was a small, statistically significant, treatment effect of individualised homeopathic treatment that was robust to sensitivity analysis based on ‘reliable evidence’."

The Forrest graph (see fig) shows all of these trials with the 'mean' and 'one standard deviation' for each trial and sum of results at the bottom.    For the majority of the trials the 'mean' was on the right of the vertical line showing benefit from homeopathy, with the sum (meta analysis) at the bottom confitming a definite statistically significant benefit from homeopathy.    Many drug trials do not have results better than these. 
Yet again in medicine, we need to appreciate that "just because we do not understand how a therapy works - does not mean that it is not effective".   To be brutally fair, at the cellular level, we have no idea how most drugs work either. 

More benefits from Breast feedfing

Breastfeeding prepares baby for solids

Here’s another good reason to breast feed: it prepares the baby’s gut for solid foods. The milk also reduces a baby’s chances of suffering colic when solids are added to the diet, a new study has found.

Breast milk appears to build healthy microbial communities in the baby’s gut that is the perfect preparation for solid foods, and babies who are not exclusively breastfed in the first few months of life are more prone to stomach ache and colic, say researchers from the University of North Carolina.

Adding solids or formula in the first few months changes the gut bacteria, and makes the introduction of solids more difficult.
The researchers analysed the gut bacteria of babies aged from two weeks to 14 months, and discovered a clear difference in the microbiomes of babies that had been exclusively breastfed andthose given formula as a supplement.

Once solids were introduced, babies that were exclusively breastfed started producing 20 new bacterial enzymes that eased digestion, and which were not found in the gut of babies who had also been given formula.

(Source: Frontiers in Cellular and Infection Microbiology, 2015; doi: 10.3389/fcimb.2015.00003)

Story from WDDTY:  http://www.wddty.com/breastfeeding-prepares-baby-for-solids.html

Low vitamin D levels doubles size of a stroke

Low levels of Vitamin D double the size of a stroke.

In a paper presented at the International Stroke Conference 2015,  studied 96 patients after strokes – those with low vitamin D levels (<30ng/ml) had MRI evidence of brain damage TWICE that of those with higher Vitamin D levels (17 vs 8 mls).  The ‘poor 90 day outcome score’ was also doubled in those with low vitamin D levels.

Neurologists are seriously looking at checking vitamin D levels, but this is really after the horse has bolted.   Other studies which have shown low vitamin D levels increase cardiovascular risk, double the risk of having a stroke, increase risk of hip fracture post stroke – it does seem logical to maintain adequate vitamin D levels, and the only guaranteed way to achieve this is with supplementation.  

As you will see with this and subsequent posts, there are many good scientific and proven reasons why in today’s world we need to supplement our diet to enable our bodies to function the way they were designed to.   Until, we start doing this, from childhood all through life, then the disastrous direction that health is going, will continue unabated.

Dietary fat intake advice has been wrong for 30 years

No Evidence to support dietary UK and USA fat recommendations

The British Medical Journal states that the advice the profession has been giving people on diet for the past 40 years  – was untested, and was frankly WRONG.

A paper in the BMJ Open journal full paper reviews all the worthwhile trials where a low fat and saturated fat diet was compared with controls.  With over 1200 people in each group followed for over 5 years, the mortality from heart disease was 30.2%  in the treated and 29.8%, even though those

on the low fat diet had 6% lower blood cholesterol levels.

By reducing the fat in the diet, doctors have encouraged the increased intake of sugars – which many believe has led to the huge increase of obesity and diabetes in our world today.

In 1977 the USA and 1983 the UK health authorities advised people to eat less than 30% of their energy as fat and less than 10% saturated fats.  They had no research showing any benefit from the low fat diet, the ‘Ancel Keyes 7 countries study’ showed those countries with the highest fat intake had, the greatest incidence of heart disease (BUT it was in fact a 22 country study, and Keyes only published data from the 7 countries which fitted his theory).

So for almost 40 years people have been told to eat the wrong diet, and the incidence of obesity, diabetes, heart failure, cancer, neurological diseases… have all risen – and we wonder why – or do we?  More sugars, fructose, packaged food, preservatives and sprays – are all the result of reducing the ‘natural’ fats from our diets.   Fats our grandparents ate with impunity and which we were designed to eat. 

Integrative health blog - what is it?

Do we really need another health blog?Why is this one any different?

Health today is going out of control.   Diseases which were rare in our grandparent’s time and before ( diabetes, coronary disease, cancer, obesity, Alzheimer’s and other neurological illnesses..) are all rising with frightening speed (see graphs).

People are aware that the medical profession, while in most cases doing its best, is very effective in treating symptoms, is almost useless in preventing these diseases, and rarely provides a cure - ‘Band aid’ medicine.   

Many a so called ‘Alternative practitioners’ attempt to provide what the medical profession does not, in many cases with success, but often one wonders if the care and concern they show for their clients also plays a part in their ‘success’.   We are now understanding the power of mind body medicine, the placebo effect and the ability of the patient to heal him/her self.

The patient/client has the choice of seeing one of these practitioners, but is almost never given the advice or option of seeing others who may be able to help better, or complement the therapy.   This is where Integrative Medicine is slowly establishing

a role.   Where a medical practitioner acts as a conductor and suggests therapies which may help, and looks at the patient as a whole, not a mixture of spare parts ( heart, kidneys, brain, lungs, gut, mind etc).

In this blog I will give my honest opinion on modern medical treatments and complementary therapies taken from over 30 years of specialist medical practice, and having spent the last 15 years working in conventional and complementary practices.   Although I have a subspecialty of Cardiology, I have remained a General Physician role, so look at the whole body, not just organ systems.    I also have a web site (www.drgerald.co.nz) which provides my recommendations for specific diseases.   I am also happy to advise people and give consultations on line if they wish (geraldlewis@zoho.com).