~ AVOID FREQUENT CONSUMPTION OF CAFFEINATED BEVERAGES AND REFINED SUGAR. There is evidence to suggest that they may play a role in recurring depression.
If mild depression and/or anxiety is your primary problem and you’re already taking a good multivitamin plus omega-3 fats and magnesium, then the next thing I’d add is St. John’s wort. It has a history of hundreds of years of safe use. If after two months you’ve not noticed any difference, switch to 5-HTP. Reports on 5-HTP use have been particularly positive from people suffering from weight problems and insomnia in addition to depression. Be sure to get it from a reliable source, because of the possibility of contamination. If you also suffer from symptoms of panic disorder, obsessive-compulsive disorder, or anxiety plus depression, then I’d recommend a trial of inositol.
Remember, each of the suggestions above works well in some people but not in others. This is true whether you opt for medication, exercise, psychotherapy, nutritional supplements, or another approach. You need to be willing to experiment in order to find the approach that seems to beckon to you. If you suffer from anxiety, depression, mood, or memory problems, I highly recommend that you read Unstuck: Your Guide to the Seven-Stage Journey out of Depression (Penguin Press, 2008) by my colleague James S. Gordon, M.D., a holistic psychiatrist. Other resources include The New Feminine Brain (Free Press, 2005) by neuropsychiatrist Mona Lisa Schulz, M.D., Ph.D., and The Chemistry of Calm by Henry Emmons, M.D. (Simon and Schuster, 2010).
Supplements to Combat Depression
The following vitamins, herbs, and other supplements have proven extremely useful for lifting depression. In conjunction with the lifestyle suggestions presented in the previous section, they work well for many women. Note: If you are taking prescription medications for depression, do not combine your drug therapy with any of these supplements without consulting your physician.
VITAMINS AND OTHER NUTRIENTS: Deficiencies of biotin, folic acid, vitamin B6 (pyridoxine), vitamin B12, and vitamin C have all been linked to depression. Vitamin B6 deficiency, for example, has been shown to lower levels of serotonin. Vitamin B6 has a role in the production of the monoamine neurotransmitters, which are important for mood stabilization. Deficiencies of calcium, copper, magnesium, and the omega-6 fatty acids may also relate to depression.
Fish oil may be particularly helpful. A large clinical trial published in 2009 showed that fish oil may benefit half of all people with moderate to severe depression (although not those whose depression was accompanied by anxiety).25 The omega-3 fatty acids contained in fish oil support the serotonin system by helping serotonin get to the brain, where it’s needed. Omega-3s have been shown to lower risk of all kinds of mental illness, and may also help reduce stress.
For preventive and/or therapeutic benefits, consider adding the following nutritional supplements to your program.26
~ Pyridoxine (B6): Recommended dose, 50–500 mg per day. Pyridoxine should be taken with the other B complex vitamins listed on page 262.
~ Vitamin C: Recommended dose, 1,000 mg per day.
~ Omega-3 fats: EPA and DHA 1,000–2,000 mg twice per day.
~ Magnesium: Magnesium deficiency is associated with anxiety in many women. Taking 400–1,000 mg a day can often work wonders and is, along with a good multivitamin and omega-3 fat source, the first thing I’d recommend.
ST. JOHN’S WORT: This herb, which contains the active ingredients hypericin and hyperforin, has been very well researched, with some studies indicating that it is as effective as Prozac in treating mild to moderate depression. The usual dose is 300 mg of herb standardized to 0.3 percent hypericin and 3 percent hyperforin, three times per day.
VALERIAN: If you have an anxiety component with your depression, add valerian to your St. John’s wort. The usual dose is 100–300 mg standardized extract containing 0.8 percent valerenic acid.
GINKGO: If your depression is associated with attention and memory problems and you are age fifty or older, consider Ginkgo biloba in addition to St. John’s wort. The usual dose is 40–80 mg three times per day.
INOSITOL: Inositol is an effective over-the-counter alternative to many commonly prescribed antidepressants.27 The exact mechanism of action is unknown, but it appears to be linked with the serotonin system, affecting the same pathways of brain chemistry as do the tricyclic and SSRI antidepressants, though without the side effects. I’ve prescribed inositol for several patients, who have tolerated it well. One, a person with a very significant family history of depression, used it following the loss of a loved one. She reported, “In the past, before inositol, I would have gone through my grief and then fallen into a black hole. This time I could still feel all of my feelings deeply, but I was able to move through them without a depression hangover.” Usual therapeutic starting dose is 12 g per day; however, inositol has been shown to be well tolerated in doses as large as 18–20 g per day. (See Resources.)
5-HTP: 5-hydroxytryptophan is a compound naturally produced in the body from the amino acid tryptophan, which is an important precursor to serotonin. Although tryptophan is found in many foods, it can be difficult to consume enough tryptophan in the diet to overcome serotonin deficiency. (Tryptophan supplements were once widely used as sleep aids, but they were taken off the market after some products were found to be contaminated.) 5-HTP can be extracted from plants and is now available as a nutritional supplement. It has been used for decades in Europe as an approved treatment for both depression and sleep problems. The side effect of nausea is sometimes reported, but an enteric-coated formulation should help avoid this. The usual dose is 100–200 mg three times per day. (For more information, see 5-HTP: The Natural Way to Overcome Depression, Obesity, and Insomnia by Michael Murray, N.D. [Bantam, 1998]; also see Resources.)
SAM-E: S-adenosyl-L-methionine has been found to be instrumental in promoting cell growth and repair. On a molecular level, it also contributes to the formation of key neurotransmitters, the basis for its mood-stabilizing activity and the promotion of mental clarity. Additionally, SAM-e has antioxidant and anti-inflammatory properties, and thereby supports immune function and joint health, mobility, and comfort.28 The usual dose is 800–1,600 mg per day. (See Resources.)
MEMORY LOSS AT MENOPAUSE:
IS THIS ALZHEIMER’S?
Many women experience “fuzzy thinking” or “cotton head” during perimenopause. They complain of forgetting names, misplacing objects, or having difficulty balancing their checkbook. This is usually not a memory problem or the beginning of Alzheimer’s disease. It is, instead, the result of a shift of attention from the outer world to the inner world. Our inner guidance is attempting to get us to pay attention to ourselves and our innermost world instead of the outer world. As our hormones change and our brains rewire, this fuzzy-headed feeling is common. Some women become terrified because of their need for a high degree of intellectual control—a response that makes the problem far worse. Others find themselves willing to trust the process once they’re reassured that it’s normal, part of the wisdom of perimenopause that focuses our attention inward. The same thing often happens both premenstrually and during the postpartum period.
Memory problems at midlife are also due to temporary overload from the many external demands on your limited time. It’s like trying to make a phone call on Mother’s Day: you can’t get through because all the circuits are busy. If you can’t remember something instantly, just relax, do something else for a while, and give yourself the time, space, and respect that allows your brain to retrieve stored information. Getting anxious and putting yourself down for forgetting only makes the problem worse.
But Aren’t We Losing Brain Cells?
A woman’s brain reaches its peak size at about age twenty, followed by a gradual decline in size throughout the rest of her life. If bigger is better, that would mean that we also reach peak wisdom and intelligence by age twenty, which is obviously not the case.
In fact, studies have shown that throughout our lifetime, as we move from naïveté
to wisdom, our brain function becomes molded by our experience. Think of your brain as a tree that requires regular pruning if it is to acquire its optimal shape, size, and function. Brain cell loss with aging is akin to pruning the nonessential branches. In addition, while the number of neurons may decline, the interconnections among them continue to grow. These connections—created by dendritic and axonal branching—actually increase with age, as our capacity to make complex associations increases. In short, the older and more experienced you become, the more efficient and sophisticated your brain. It’s also worth noting that while learning abilities decrease during perimenopause, they rebound to premenopausal levels afterward, according to a 2009 study of more than 2,000 women.29 Recent research has shown that in response to learning, new brain cells continue to form in the hippocampus, the area of the brain associated with memory, throughout one’s lifetime.30
Dementia of all types, including Alzheimer’s, is associated with free-radical damage to brain tissue, which results from the overproduction of inflammatory chemicals at the cellular level, eventually leading to the damage or death of brain cells. Free-radical damage and the resulting tissue inflammation are the final common pathway by which emotional, physical, and environmental stressors of all kinds adversely affect every tissue in our bodies, including our brains.31
Studies show that those who are well educated, in good health, and financially secure, with above-average intelligence and social status, and who actively pursue their interests as they age have a very good chance of preserving their memory as they grow older. In fact, they may even improve it, whether or not they’re on estrogen.32 In addition, those with a strong sense of purpose in life are almost two and a half times less likely to develop Alzheimer’s disease, according to a 2010 study.33 (The study also showed that purpose in life reduced the risk for cognitive impairment not related to Alzheimer’s.)
Doctors are now able to use a lumbar puncture test (also called a spinal tap) to examine the fluid surrounding the spinal cord for evidence of abnormal development of two different proteins—beta-amyloid proteins (which form the plaques associated with Alzheimer’s) and tau proteins (which form the tangles often found with the disease). A new study shows that those who already have Alzheimer’s test positive for these two proteins 100 percent of the time.34 It’s too soon to say if the test can predict whether patients who currently exhibit only mild cognitive impairment will go on to develop Alzheimer’s in the future, although researchers suspect this may well be the case.
There’s no point in having a predictive test such as this unless there’s a specific, documented path you can take to prevent the onset of the disease. Given the fact that the brain responds to such factors as a meaningful life, nutrients, exercise, community, learning, supplements, and so on, such a program would need to be holistic in nature. Neurologist David Perlmutter, M.D., an expert in nutritional influences on neurological disorders and co-author of Power Up Your Brain: The Neuroscience of Enlightenment (Hay House, 2011), believes such predictive studies as the lumbar puncture research are designed fundamentally to pave the way for pushing drug therapies on those identified as being likely to develop Alzheimer’s. “In reality, we are all at risk,” Dr. Perlmutter notes, “and that risk is substantial, approaching 50 percent by the time we reach eighty-five years. So implementation of a preventive program is far more meaningful, as it has far-reaching benefits well beyond brain health.” I’m certain that this holistic approach is the direction in which we’re headed. But this approach is not yet mainstream. Stay tuned.
Preventing Alzheimer’s: Some Lessons
from the Nun Study
Even with reassurance that it’s normal to go through some transient changes in thinking and focus during perimenopause, many women still fear becoming demented and unable to live independently as they get older. Alzheimer’s disease currently affects about 5.3 million Americans, including 5.1 million people (one in eight) age sixty-five and older. Every seventy seconds, someone in America develops the disease, and experts estimate that by the year 2050, someone will develop Alzheimer’s every thirty-three seconds.35 Not surprisingly, it’s also the leading cause of dependence and institutionalization in the elderly. It appears at an earlier age in women than in men, and up to two-thirds of cases reported have been in women—in part simply because women live longer. According to estimates from the Aging, Demographics, and Memory Study (ADAMS), 14 percent of all people age seventy-one and older have dementia.36 Given these numbers, each of us will want to do everything we can to care for and enhance our brain function at perimenopause—long before memory problems or dementia have a chance to develop.
Alzheimer’s disease was named after Alois Alzheimer, a German neuropathologist who, in 1906, looked under a microscope at the brain tissue of a fifty-five-year-old woman who had spent the last years of her life in a mental institution, where she was prone to paranoia and fits of anger. Alzheimer identified two substances in her brain that have come to be associated with the disease: dense plaques formed by the protein beta-amyloid outside the brain cells, and stringy tangles within the nerve cells themselves. Whether these plaques and tangles are the cause of Alzheimer’s dementia is controversial. We do know, however, that there’s a great deal of overlap between the senile dementia caused by cerebrovascular insufficiency and stroke and that which is associated with the plaques and tangles of Alzheimer’s disease.
Alzheimer’s also has a genetic component.37 But even if Alzheimer’s runs in your family, that does not mean you will inevitably get it. Brain function is multifactorial, meaning that it is affected by many different aspects of our lives, from the amount of antioxidant-rich vegetables we eat to the level of education we’ve attained. It is also shaped by events and behaviors that begin in childhood and continue into old age. That’s why there will never be a hormone or magic bullet that can guarantee brain protection for life. However, you can affect your brain health by the lifestyle choices you make.
Nowhere has this been more convincingly demonstrated than in the famous study of a group of hundreds of nuns belonging to the School Sisters of Notre Dame, who have donated their brains for study after death.38 Because these women have spent much of their lives in the order, there is a wealth of data about each woman, often spanning many decades. One surprising finding was that a greater or lesser capacity for complex thought—known as “idea density”—in early life was correlated with the likelihood of developing Alzheimer’s disease in later life. Upon entering the convent (usually in her early twenties) each of the nuns was required to write an autobiography. When linguistics experts analyzed these years later, they found a startling correlation between the nuns’ language skills and the eventual occurrence of Alzheimer’s. The lower their idea density, the higher their risk.
Another fascinating finding from the Nun Study is that the presence of plaques and tangles in the brain does not always predict the mental status of an individual. One of the nuns had strikingly good mental status and attitude before her death in her late eighties; researchers were startled to find severe loss of neurons and multiple amyloid tangles in her brain at autopsy. This evidence supports a great truth: that the physical body and the spirit are inextricably linked. For people who are optimistic, lively, and engaged, as this particular nun was, anatomical limitations often seem not to result in disability. A similar finding was reported in a 2010 study of 1,157 people that showed that mentally stimulating activities delayed the onset of dementia, but if symptoms do eventually appear, deterioration is more rapid than normal.39 It’s almost as if the mental activity is strong enough to cover up the signs of the physical changes, holding them off for as long as possible. That means that those who are mentally active end up staying mentally healthy for a greater percentage of their lives, even if they do end up getting dementia eventually.
On the other hand, the Nun Study has shown that small-vessel disease, in the form of mini-strokes, is strongly predictive of dementia. Chronic depression also
seems to be correlated with Alzheimer’s. When we shut off the circulation of blood to an area of our body, we are shutting off life force. Similarly, depression is a shutting down of the life force within us.
Not surprisingly, researchers have recently found that there’s a direct correlation between cardiac index (the amount of blood, relative to a person’s size, that is pumped by the heart) and brain volume. Researchers from the Framingham Offspring Cohort, part of the Framingham Heart Study, found that people with low cardiac indexes—and even people with cardiac indexes that were merely on the low side of normal—had smaller brains.40 The effect shows up even in people who are otherwise perfectly healthy and do not at the present time have heart disease. And because having more brain volume is associated with better brain health, this means that the more you can do to keep your heart and circulatory system healthy, the healthier your brain will be, too.
Another serious challenge with Alzheimer’s, of course, is the huge emotional toll it takes on those who care for loved ones with the condition. As poignantly shared in The Shriver Report: A Woman’s Nation Takes on Alzheimer’s, a 2010 report produced by Maria Shriver in partnership with the Alzheimer’s Association, women account for 60 percent (about 6.7 million) of the 11.2 million Alzheimer’s and dementia caregivers in this country. One-third of these women caregivers are “on duty” twenty-four hours a day, seven days a week, and 60 percent say they become caregivers because they don’t have other family to shoulder the responsibility. Many are stretched in multiple directions—one-third of the women also have children or grandchildren under eighteen living at home with them.
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