Ray Strand, M.D., has created a twelve-week online program called Healthy for Life for those who would like further support (including individualized guidance) in reversing glycemic stress and insulin resistance and starting to release body fat. In one trial of this program, participants lost an average of 15.2 pounds, decreased their cholesterol by an average of 9.8 percent (dropping their level by 60, 80, or even 100 points), and decreased their systolic blood pressure by an average of 12 points and their diastolic reading by an average of 6 points. More importantly, they reported feeling great and having no hunger. (For more information, visit Dr. Strand’s website at www.releasingfat.com.)43
Protect Yourself with Antioxidants
Every day, more and more research is showing the benefits of vitamins and minerals, especially those known as antioxidants. Antioxidants combat cellular damage from free radicals, which is one of the key underlying mechanisms leading to chronic conditions such as heart disease, cataracts, macular degeneration, and many cancers.
Free radicals are highly reactive unstable molecules that have lost one electron and are aggressively seeking a replacement—a process that, in your body, results in damage to everything from your DNA to the collagen layer of your skin. You can’t escape free radicals completely, because they are a by-product of normal metabolism. They are formed in our bodies when, for instance, molecules of fat react with oxygen in a process similar to the one that turns fat rancid or makes iron rust. But free radicals are also formed by exposure to ozone, tobacco smoke, car exhaust, chemicals outgassed from new carpet, and other pollutants. Exposure to radiation, insecticides, and excessive amounts of sunlight can also lead to the formation of free radicals. Free-radical damage results in cellular inflammation and the release of too many of the “bad” eicosanoids that appear to be involved in virtually every disease process known.
The body was designed to fight off free-radical damage in the same way that your immune system is designed to fight viruses and bacteria. One mechanism that your body uses to fight free-radical damage is to repair the damage once it’s been done. Another mechanism is to “scavenge” the free radicals before they cause harm: to supply the extra electron they need before they can grab it from vulnerable tissue. This is what antioxidants do.
Here’s a great example from a 2010 study done in South Korea that looked at the effect of dietary supplements on high-risk human papillomavirus (HPV) infection and cervical cancer. The researchers found that women with HPV who also took the antioxidant vitamins C, E, and A (as well as calcium) decreased their risk of developing cervical dysplasia (pre-cancerous lesions) by 79 percent.44
Antioxidants are found abundantly in fresh fruits and vegetables, especially the brightly colored ones. The amount of antioxidant in a given fruit, vegetable, grain, or protein source depends upon the soil in which it is grown or on which its food source is grown. Organically grown fruits and vegetables that are picked and eaten when ripe have the highest amounts of antioxidants and minerals in them.
Food is the best source for our antioxidants. They seem to work synergistically—that is, they’re more powerful in balance with one another and with other nutrients as they occur naturally. However, if you don’t manage to consume five servings of fruits and vegetables a day, supplements can still provide significant protection.
PERIMENOPAUSE SUPPLEMENT PROGRAM
Over the years I’ve seen hundreds of patients who have been helped by a good supplement program such as the one below.
Following this program means that you’ll have to give up the idea of getting everything you need in one tablet. You’ll probably end up taking ten or more capsules or tablets per day. Think of them as food, not medicine.
Antioxidants
Vitamin C 1,000–5,000 mg
Vitamin D3 2,000–5,000 IU
Vitamin A (as beta-carotene) 25,000 IU
Vitamin E (as mixed tocopherols) 200–800 IU
Glutathione 2–10 mg
Alpha-lipoic acid 10–100 mg
Coenzyme Q10 10–100 mg
Omega-3 Fat
DHA 200–2,500 mg
EPA 500–2,500 mg
(total of 1,000–5,000 mg)
B Complex Vitamins
Thiamine (B1) 8–100 mg
Riboflavin (B2) 9–50 mg
Niacin (B3) 20–100 mg
Pantothenic acid (B5) 15–400 mg
Pyridoxine (B6) 10–100 mg
Cobalamin (B12) 20–250 mcg
Folic acid 1,000 mcg
Biotin 40–500 mcg
Inositol 10–500 mg
Choline 10–100 mg
Minerals
Calcium 500–1,200 mg (amount depends on calcium content of diet)
Magnesium 400–1,000 mg
Potassium 200–500 mg
Zinc 6–50 mg
Manganese 1–15 mg
Boron 2–9 mg
Copper 1–2 mg
Iron 15–30 mg
Chromium 100–400 mcg
Iodine 3–12.5 mg
Selenium 50–200 mcg
Molybdenum 10–20 mcg
Vanadium 50–100 mcg
Trace minerals—usually from marine mineral complex
OPTIMIZING MIDLIFE DIGESTION
Digestive problems, especially in the form of bloating and gas, are very common in women. Sometimes they begin at midlife and sometimes they develop only later, when you are in your sixties or seventies. I recently talked with one of my mentors from childhood, a woman who at the age of ninety still teaches yoga at a nursing home. Two of her biggest problems are constipation and heartburn, but otherwise she is doing well.
Being a Gut Reactor:
Digestion and Your Third Emotional Center
One of the first things you need to do in order to heal your digestive problems at midlife is to shore up your third emotional center. The third emotional center is located in the solar plexus area, and the health of this area affects all our organs of digestion, including the stomach, liver, gallbladder, pancreas, small intestine, and upper large intestine. Women with substantial weight problems usually have unresolved issues in the third emotional center.
The health of the third emotional center depends on a balance between responsibility to ourselves and responsibility to others, and also on our sense of self-esteem. It is adversely affected whenever we feel overly responsible for the welfare of others or when we avoid taking responsibility altogether. Gloria, a former patient I followed for years, illustrates the conflicts in the third emotional center very well. Gloria is the oldest of four children. Her mother always told her that she was responsible for her siblings because she was the oldest and should “know better.” Whenever any of her siblings was injured or got into trouble, she was blamed. As a result of having this responsibility placed on her at a relatively early age, Gloria developed a very acute “gut feeling” about when things were about to go wrong. This ability has served her well in her job as an executive assistant at a large hospital. Nevertheless, she still suffers from digestive upsets whenever there are conflicts at work—conflicts for which she always feels responsible. She once told me that she always seems to be caught in the middle between her boss and a coworker, and this conflict quite literally goes into the middle of her body. It is not surprising that Gloria has problems with her weight and her blood sugar, and that she tends to overeat whenever she feels bad about herself for not doing enough at work. In fact, she does far more than most, but she still feels as though she hasn’t done enough.
At midlife our job is to learn how to take care of ourselves instead of everybody else. If we don’t grasp how to do this, we soon learn that no one will do this for us. But as we begin to go about mastering this important skill, we often find ourselves feeling guilty. Who will do everything around the house or the office if we don’t? This feeling of guilt hits us right in our solar plexus, which is also the body center associated with self-esteem and personal power.
Self-esteem comes from feeling good about oursel
ves in the world. It is effectively created by developing skills in the outer world of work—one of the reasons why so many midlife women heal their lives and their digestion when they go back to college and get the degree they didn’t finish after high school. Our third emotional center is also related to how good we feel about our relationships, our bodies, our homes, and our lives in general. Sometimes a lifetime of weight and self-esteem problems are solved at midlife as we finally learn the self-acceptance and self-celebration that are part of self-esteem.
WHAT TO DO ABOUT BLOATING
During perimenopause there is a shift toward fat-accumulating hormones (cortisol and insulin) and away from fat-mobilizing hormones (estrogen and growth hormone). If your body is under stress of any kind, this shift will worsen. In addition, your abdominal fat cells have more cortisol receptors on them at midlife, so fat is preferentially directed toward them. This often results in fluid retention and bloating.45 Try the following to reduce bloating.
~ Decrease consumption of high-to moderate-glycemic-index carbohydrates. Yet another symptom of cellular inflammation and too much insulin is excess stomach acid. A diet lower in carbohydrates and higher in fat and protein very often results in complete and fast relief of heartburn and indigestion.
~ Eat three to five small meals per day. Consuming large quantities of food elevates insulin levels and makes bloating worse—even when the foods are healthy.
~ Include some protein, healthy fat, and low-glycemic-index carbohydrates in every meal or snack. However, fruit is best eaten alone. Consuming it with fat causes bloating and indigestion in many women.
~ Eliminate all breads and baked goods for at least a week. See if this makes a difference. Many women are sensitive to gluten.
~ Drink plenty of water. It helps the body rid itself of toxins.
~ Take probiotics. Every course of antibiotics you take disrupts normal gut flora. Over time, excess yeast can colonize the entire gut, causing allergies and indigestion. Taking a good probiotic regularly helps prevent problems. (Yogurt, by the way, generally doesn’t contain enough bacteria to be helpful—unless you make the yogurt yourself.)
~ Leave at least three hours between your last meal and bedtime. Going to bed on a full stomach can cause acid reflux.
~ Stop or cut way back on alcohol. Alcohol is a gastric irritant.
~ Use enteric-coated peppermint. This supplement can be very soothing for digestion problems. Take 2–3 capsules between meals. If rectal burning occurs, reduce the dose.
~ Take digestive enzymes. Digestive enzymes are naturally occurring catalysts that help the body process sugars, starches, proteins, and fats. Taking the proper enzymes can dramatically improve bloating and gas as well as a host of other health problems stemming from faulty digestion. Look for a pH-balanced full-spectrum formula such as Wobenzym N (www.wobenzym-usa.com). For more information on this important topic, read MicroMiracles (Rodale, 2005) by Ellen Cutler, D.C., an authority on digestive enzymes, or visit Dr. Cutler’s website at www.bioset.net.
MELBA: Stress and Antacids
Melba was forty-two and perimenopausal when she first came to see me. She had worked for ten years at the registry of motor vehicles. Every morning she had to face lines and lines of disgruntled drivers awaiting renewal of their licenses, getting new license plates, and the like. After several months of working in this job, Melba began to feel abdominal pain, bloating, and indigestion. After a routine check at her doctor’s office, she was told to “reduce stress” and eat a high-carbohydrate, low-fat diet. Her problem became worse, but a co-worker introduced her to the world of antacids. Soon she would not travel without a few rolls of Tums in her purse. At first she noticed immediate relief upon taking antacids, but then after a while she began to take them earlier and earlier in the day, until she was popping antacids from nine until five, when she left her job. Over time, however, she noticed that she began to feel weak and tired, and she lost her appetite. In addition, her bowel movements became all messed up. When she first came to see me for a routine annual GYN checkup, I suspected that some of her problems were related to both her diet and her excessive use of antacids. Within a week of eliminating refined carbohydrates and grain products, and also learning some stress-reduction skills, Melba was able to cut way back on her antacid use. Some days she didn’t need them at all.
Avoiding Antacid Addiction
Many women are addicted to antacids and acid medications such as ranitidine (Zantac) or the popular proton pump inhibitors such as Prilosec, Nexium, and Prevacid. Antacids have been known for many decades to be useful for indigestion, and even in the treatment of gastroesophageal reflux and ulcers. There are several types of antacids, but all of them work by blocking either the production or function of stomach acid. Conventional over-the-counter antacids such as Tums and Rolaids contain either aluminum hydroxide or magnesium hydroxide. Neither of them is without side effects. Aluminum hydroxide neutralizes stomach acid but tends to produce constipation. Prolonged and regular use may reduce the body’s phosphate levels, with resultant fatigue and loss of appetite. In addition to this, the jury is still out about whether aluminum consumption contributes to Alzheimer’s disease, so it’s best to avoid it whenever possible. Magnesium hydroxide, on the other hand, produces loose stools or diarrhea in some individuals. Although some antacids combine both aluminum and magnesium, there may still be side effects.
Other antacids, such as Tums, have calcium carbonate as their main ingredient. (Tums is also being heavily marketed to women as a way to prevent osteoporosis.) Though these can help with indigestion, over time they cause acid rebound, a condition in which the excess calcium actually stimulates increased acid secretion. In addition, chronic excessive calcium carbonate intake is associated with a pattern of abnormal blood chemistry known as milk alkali syndrome, producing elevations of blood calcium, phosphate, bicarbonate, and other abnormalities. Over time, kidney stones and even progressive kidney disease may result.46 The irony is that while many people believe that indigestion and heartburn are due to excessive stomach acid, which is why they are led to take antacids in the first place, chronic indigestion results, in part, not from excessive stomach acid, but from deficient stomach acid. It’s no wonder that the most common side effect of the heavily promoted proton pump inhibitors is diarrhea and nausea—classic signs of digestive problems! And if stomach acid is chronically lacking, it can lead to nutritional deficiencies of vitamins such as B12, which can set the stage for both chronic anemia and dementia over time.
If you have an imbalance of protein and carbohydrate in your diet, with refined carbohydrates predominating, this diet may be promoting a decrease in the production of gastric acid and overproduction of inflammatory substances, which may be (1) suppressing your immune system, (2) increasing inflammation in the stomach lining, and (3) increasing stomach discomfort and other pain. Since it is well documented that high blood sugar results in a decrease in gastric acid secretion, it’s not surprising that refined carbohydrates are a setup for indigestion. Hundreds of individuals who switch to a low-glycemicindex diet have noted a complete disappearance of gastritis, reflux, and indigestion. I have personally experienced this myself since changing my diet. I used to have to take Tums or Di-Gel after dinner sometimes, and I never connected it with the bread I was eating until my problem disappeared along with the bread and rice (and cookies, I might add). This diet has been shown to improve the quality of the protective mucus in the stomach lining and also to normalize muscular control, preventing reflux and spasm.
If you find yourself popping antacids regularly, here’s what I’d suggest.
GET OFF THE ANTACID MERRY-GO-ROUND. If you need to take one, use one without aluminum. And use it for as short a time as possible.
TAKE YOUR ANTIOXIDANTS. Low levels of vitamin C, vitamin E, and other antioxidant factors in gastric juice have been shown to encourage the growth of Helicobacter pylori, a bacterium whose overgrowth is associated with ulcers. Higher antioxidant intake
may prevent these bacteria from growing and also improve the healing of the stomach and intestinal lining.
TRY DEGLYCYRRHIZINATED LICORICE (DGL). DGL may also help reduce H. pylori and stimulate the body’s natural internal defenses. Unlike antacids, DGL does not reduce acid in the stomach. DGL improves both the quality and quantity of protective substances that line the intestinal tract, increases the life span of intestinal cells, and improves the blood supply to the intestinal lining.47 DGL is available in most natural food stores.
TAKE THE RIGHT MINERAL SUPPLEMENT. Though the calcium in Tums is better than no calcium at all, you’re much better off taking a calcium supplement that also contains magnesium and vitamin D, which help the body efficiently utilize calcium.
TRY SEACURE. Seacure is a polypeptide supplement made from predigested whitefish; it appears to nourish the bowel directly during the absorption process. It can be very easily absorbed by anyone who can take food by mouth, no matter how ill they are. Seacure has helped many of my patients recover from a broad range of digestive problems, including chronic indigestion, irritable bowel syndrome, and ulcerative colitis, as well as the side effects of chemotherapy. It also provides the many well-documented benefits of eating fish. The recommended dose is three capsules in the morning and three capsules in the evening.
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