The Wisdom of Menopause

by Christiane Northrup

  HORMONES AND ALZHEIMER’S

  An impressive number of studies have shown an association between estrogen use and the delay or even prevention of Alzheimer’s.41 This wasn’t the case with the 2006 WHI study, however, which showed an increased risk with Premarin and Prempro. Nevertheless, estrogen (as well as progesterone and testosterone) has been shown to stimulate the regeneration of damaged neurons. Estrogen also appears to increase the production of the neurotransmitter acetylcholine, which regulates memory, learning, and other cognitive functions. In fact, estradiol (a type of natural estrogen) binds to the areas in the brain that are associated with memory: the cortex, the hippocampus, and the basal forebrain. Estrogen has also been shown to enhance nerve cell branching.42 Research indicates that women with the highest endogenous levels of estradiol have the lowest risk for Alzheimer’s disease.43

  Despite the results of the WHI study, there is still convincing evidence of the beneficial effect of hormones—not just estrogen—on brain function.44 For example, as mentioned in chapter 8, women who have their ovaries removed before age forty-five have a fivefold increase in risk of mortality for neurological or mental diseases as well as an increased risk of developing Parkinsonism, cognitive impairment, and dementia later in life, according to a Mayo Clinic study published in 2009.45 And there is evidence that small baseline amounts of estrogen are essential for certain memory functions. Many women’s bodies produce enough throughout life, while some do not. The research of Barbara Sherwin, Ph.D., has shown that women’s verbal memory decreases following hysterectomy with removal of the ovaries, but then returns to normal following hormone therapy.46 Dr. Sherwin used only estrogen therapy, but other studies support a role for progesterone and probably androgens as well.47 Even transdermal estradiol, if begun soon after menopause, may give at least modest protection against Alzheimer’s, according to a 2009 study done at Emory University School of Medicine in Atlanta.48

  Ovarian hormones also bind to areas of the brain that are important for mood regulation. This helps to explain research findings indicating that estrogen has significant antidepressant effects and that progesterone decreases anxiety and promotes restful sleep. While the research on estrogen and memory is not conclusive, a small amount of bioidentical estrogen (and/or progesterone or testosterone) definitely helps the brain function of some women. If you’ve had your ovaries removed and are not producing small amounts of steroid hormone on your own, you may well want to consider adding a bit of hormonal support to your brain.

  NONHORMONAL WAYS TO PROTECT YOUR BRAIN

  Consider the following brain-health-enhancing practices.

  ~ FEED YOUR BRAIN WITH NUTRIENTS. A diet high in refined sugars and including partially hydrogenated fats is associated with depletion of many nutrients necessary for optimal brain function. For brain function, as for every other aspect of your health, I recommend a relatively low-fat diet that contains lots of fruits, vegetables, and whole grains. Studies have shown that demented and depressed patients often have inadequate levels of zinc, B vitamins (especially vitamin B1 or thiamine), selenium, and antioxidants such as vitamins E and C, compared with patients with normal mental function.

  Zinc, for example, is necessary for optimal transport of the B vitamins into the cerebrospinal fluid. This fluid bathes and nourishes the brain and spinal cord. Many women do not get adequate levels of zinc in their daily diets.49 In one study of severely demented patients, ten patients were given vitamin supplements for two months, while a control group was not. After one month, the patients who received the supplements showed clinical memory improvement.50 Some authorities also feel that Alzheimer’s is associated with the inability of some elderly people to absorb enough minerals, vitamins, and essential trace elements from their food.51 They may also have problems with transporting these nutrients from the blood to the brain. Since nutritional supplementation improves memory in people who are already demented, imagine the preventive potential of feeding your brain right!

  ~ QUELL POTENTIAL FREE-RADICAL DAMAGE TO YOUR BRAIN TISSUE. A great deal of brain health is affected by free-radical damage. Get serious about antioxidants. Make sure your diet is rich in vitamins C and E, the B vitamins (including folic acid), and selenium.52 Another class of powerful antioxidants is the proanthocyanidins (also called procyanidins) found in pine bark and grape pips. (The dosage ranges for these are given in chapter 14, page 610.) Studies have shown that the risk of stroke is very low in those women who eat at least five servings of fruits and vegetables per day. Clearly, brain protection is yet another reason to eat plenty of these nutrient-rich foods.

  ~ BOOST YOUR LEVEL OF VITAMIN D. Researchers have recently discovered a link between vitamin D levels and Parkinson’s disease. A 2010 study following more than 3,000 people from Finland for twenty-nine years showed that the higher the subjects’ levels of vitamin D, the lower their risk for the disease.53

  ~ AVOID SMOKING AND EXCESSIVE ALCOHOL INTAKE. Cigarettes are well-known factors in causing cardiovascular disease and small blood vessel changes that decrease oxygen to your brain, among other areas. And excessive alcohol intake affects the basal forebrain, an area associated with memory.

  ~ EXERCISE. Researchers at the Aging Research Center of the Karolinska Institute in Sweden found that those who exercise at least twice per week reduced their risk of dementia in general by more than 50 percent and of Alzheimer’s specifically by 60 percent. The study, which is the first to show a long-term relationship between physical activity and dementia later in life, examined 1,449 participants at midlife and again twenty-one years later at ages sixty-five and seventy-nine. At the follow-up exam, 117 showed evidence of dementia and 76 had Alzheimer’s. But those who exercised had a greatly reduced risk of dementia and Alzheimer’s even after adjusting for other lifestyle factors. Interestingly, the greatest benefit was seen in those with a genetic susceptibility to dementia and Alzheimer’s.54 Several newer studies confirm these findings, including a few that show significant improvement in cognitive function after only six weeks of a moderate aerobic exercise program.55 Exercise definitely turns on a whole-body mechanism that helps to keep the brain healthy. It also increases blood flow.56 Basically, any activity that increases heart rate and results in sweating will work!

  ~ ENHANCE YOUR BRAIN’S ACETYLCHOLINE LEVELS. Many factors can affect your acetylcholine levels and, subsequently, your memory. If you’re already on estrogen or other hormones to treat other symptoms, stick with them—though I wouldn’t recommend hormones solely for Alzheimer’s prevention, be reassured that they are probably helping your acetylcholine levels. And avoid drugs that are known to decrease acetylcholine levels.57 You’d be amazed by how many of these there are and by how few doctors realize their adverse affect on brain function. Check the label of any medication used for sleep, colds, or allergies to see if it contains diphenhydramine. Examples of such medications include Sominex, Benadryl, Tylenol PM, Excedrin PM, and Tylenol Severe Allergy. The cough suppressant dextromethorphan also affects acetylcholine and has other anticholingeric effects that can impair memory. It is found in Robitussin DM and a wide range of other cough and cold remedies.

  ~ BOOST YOUR DHEA LEVELS. Studies suggest that DHEA (and the related hormones progesterone and pregnenolone) act as neurotransmitters in the brain and can promote the same kind of dendritic and axonal branching between brain cells that is seen with estrogen. The best way to enhance levels of DHEA is to follow the adrenal restoration program on page 135.

  Other Brain Food Choices

  The food supplements listed below have been shown to help memory in many people. Try just one at a time, so that you know if it works for you. Use your intuition to pick one to start with. Your first impulse will usually be the right one.

  GOTU KOLA: Widely known as a “memory herb,” gotu kola (Hydrocotyle asiatica) also increases circulation to the brain. The usual dosage is 90 mg per day. Note: Gotu kola is a stimulant and should not be taken at bedtime.

  OMEGA-3 FATS: Nerv
e fibers throughout your body are coated with a fat called myelin. For good brain and nerve function, you need small amounts of high-quality (not partially hydrogenated) fat in your daily diet. Two studies on rats and one on mice have shown that a diet supplemented with the omega-3 fatty acid DHA (docosahexaenoic acid) significantly improves memory—one study showed dramatic improvement after only four days!58 Dutch researchers who tracked more than 1,600 adults between the ages of forty-five and seventy for six years concluded that those who ate more omega-3 fats regularly scored higher on a battery of tests involving brain health, including memory.59 I recommend consuming fatty fish such as salmon or sardines, ground flaxseed, or fish oil in supplement form. DHA made from algae is a good choice for taking oil in supplement form, particularly for vegetarians. I recommend supplementing with a combined total of 1,000–5,000 mg of DHA and EPA per day. Mercury-free fish oil supplements (including USANA BiOmega and Vital Choice Alaskan Sockeye Salmon Oil) are also available. (See Resources.)

  PHYTONUTRIENTS: Many plant foods are very rich in what are known as phytonutrients, which have a beneficial effect on the lining of the blood vessels through their antioxidant effect. In fact, studies have shown that women who eat the most fruits and vegetables daily have a much lower risk of stroke. A meta-analysis done by University of London researchers and reported in the Lancet showed that people who ate at least five servings of fruit and vegetables a day lowered their stroke risk by 25 percent.60 Since small-vessel disease and stroke are inextricably linked, it’s clear that plant foods rich in a wide variety of beneficial substances can help preserve good brain function.

  In Japan, where consumption of soy is far higher than it is in the United States, the incidence of Alzheimer’s and other dementias is much lower than it is here. Wake Forest University Health Sciences was awarded a patent in 2003 based on their research into the use of soy to prevent Alzheimer’s disease.61 Preliminary research has shown that soy phytoestrogens affect the brain like estradiol, but not as strongly.62 Soy isoflavones also act as antioxidants in the brain.63 Several studies indicate soy can help boost memory as quickly as six weeks after adding it to your regular diet.64 One recent study showed that postmenopausal women consuming 60 mg of soy isoflavones a day for six weeks improved their nonverbal short-term memory, mental flexibility, and planning ability.65 Another study of postmenopausal women showed that consuming soy isoflavones improved verbal memory.66 And since soy definitely helps the cardiovascular system, it may also help prevent the strokes that are so common in dementia.

  Substances Your Brain Doesn’t Need

  ALUMINUM: Aluminum has been found in the brains of Alzheimer’s patients, and this disease has been associated with increased tissue levels of aluminum along with decreased levels of zinc and selenium. Although the nature of the link is not clear, there is evidence to suggest that aluminum is, indeed, a brain toxin in individuals who are genetically predisposed to Alzheimer’s. If you have any Alzheimer’s sufferers in your family, I’d recommend that you avoid aluminum cookware, antiperspirants containing aluminum, soda from aluminum cans, and baking powder containing aluminum. (Use Rumford’s, for example, rather than Calumet or Clabber Girl.)67

  EXCITOTOXINS: Aspartame, with the proprietary names Equal and NutraSweet, is an excitotoxin, which means that it causes nerve cells to overfire. In susceptible people this can lead to the death of brain cells. This is one of the reasons aspartame has been associated with a multiple-sclerosis-like syndrome in some women.68 The aspartame in diet colas seems to cause the worst problems in susceptible women.

  Many women are addicted to diet cola, drinking several liters per day without taking in much else in the way of other nutrients. This is a setup for a wide range of neurological symptoms in susceptible individuals, including headache, dizziness, anxiety attacks, memory loss, slurred speech, numbness, muscle spasms, mood swings, severe depression, personality changes, PMS, insomnia, fatigue, hyperactivity, heart palpitations, arrhythmia, chest pain, hearing loss, ringing in the ears, blurred vision, decreased sense of taste, skin lesions, nausea, digestive disturbances, water retention, and seizures. If you have a history of such problems, avoid this artificial sweetener, especially in the form of diet colas. (Aspartame-induced symptoms go away when consumption is stopped.) The herb stevia is a safe sweetener. MSG (monosodium glutamate) is another excitotoxin that not only adversely affects the brain, but is also added to junk food to stimulate appetite. You don’t need it!

  SERMS (SELECTIVE ESTROGEN RECEPTOR MODULATORS): Given the role of ovarian hormones in brain function, the antiestrogen drugs tamoxifen (to prevent breast cancer) and raloxifene (to prevent osteoporosis) stir up some legitimate concerns about the whole-body effects of estrogen deprivation over time. Just as tamoxifen blocks the effects of estrogen on the breasts, there is also compelling evidence that it blocks some of the effects of estrogen on the brain.69 Raloxifene (Evista), a drug prescribed to women to prevent osteoporosis, also affects the brain. This is one of the reasons hot flashes (which are mediated in the hypothalamus) are listed as one of the side effects of SERMs. Depression is also among a host of other side effects. Though these drugs have their place and may be appropriate for some women who are truly at very high risk, the very real potential drawbacks of these drugs are not getting enough attention.

  If you’re currently taking tamoxifen or raloxifene, it’s doubly important for you to follow some of the suggestions outlined above to protect your brain function. Many women report alleviation of their tamoxifen-associated depression, for example, when they take high doses of soy. This may be because of soy’s hormonal effects. (For a fuller discussion of SERMs, see chapters 5 and 13.)

  MAXIMIZING MIDLIFE WISDOM

  Your brain is like your muscles. If you want it to stay in peak form, you have to use it regularly. Brain function is also profoundly affected by our expectations and attitudes about life. While there is no formula—hormonal or otherwise—to “cure” aging, there are many things you can do to preserve your mental vitality.

  STEP ONE: Catch yourself indulging in any stereotypical thinking about the aging process. For example, if you forget something, don’t say “I’m having a senior moment.” This phrase and others like it are nothing but ageist, self-fulfilling prophecies. Don’t ever allow yourself to make comments such as “I’m too old for this.” I’ve seen this kind of thinking in women who are only in their early thirties! My mother told me that when she turned sixty, her mailbox was suddenly full of ads for all kinds of health aids, ranging from incontinence diapers to hearing aids. She simply tosses this information in the recycling bin at the post office. In 2009, at the age of eighty-four, she trekked to a Mt. Everest base camp in Nepal at an altitude of 18,000 feet with my sister Penny. The trek was fifty miles in and fifty miles out over the roughest terrain in the world. Several years before this, my mother had fallen on some ice and injured her back. She slowly made her way back to full physical activity in the next year or so. She told me that the biggest impediment to becoming her usual active self again was not in her body but in her mind. When the invitation came to go on the trek to Everest, she took it as a sign and got on with the training.

  Take your cue from my mother and start viewing yourself as a younger person, unfettered by the age-related problems the media tell us all to expect. When I use an exercise machine, for example, I always program in my age as forty! Though “thinking young” may seem simplistic, it is one of the most important health behaviors you can adopt. In fact, buying into negative stereotypes about aging (such as “as you age you become useless”), which tends to happen in childhood, actually translates into an increased risk of premature death.

  Consider this: a study of 600 people age fifty and older by Yale researcher Becca Levy, Ph.D., showed that those who had a more positive view of aging as relatively young adults lived an average of 7.5 years longer than those with less positive views—even after factoring in such variables as age, gender, socioeconomic status, loneliness, and ov
erall health. How the subjects viewed aging had a greater effect on their longevity than having low blood pressure and low cholesterol (each of which is associated with living up to four years longer) or having a lower body mass index, no history of smoking, and a tendency to exercise (each of which can add up to three years to your life). “Our study carries two messages,” the study reports. “The discouraging one is that negative self-perceptions can diminish life expectancy; the encouraging one is that positive self-perceptions can prolong life expectancy.”70

  One of the ways that I routinely “program” my own mind for youth and vigor is with affirmations. Here are a couple of my favorites (I say these out loud every morning when I’m working out on the elliptical trainer):

  “My body is now radiantly healthy, beautiful, flexible, strong, and eternally youthful. The spirit of Divine Love and Power now manifests throughout my entire body as radiant health, radiant beauty, and radiant youth.”

  “I give thanks that my body, mind, spirit, and behavior now align to easily maintain my ideal size and weight.”

  STEP TWO: Stay mentally active and socially connected. Continuing to expose yourself to new ideas, new people, and new environments is as necessary to staying mentally healthy as physical exercise is to maintaining the health of your heart, muscles, and bones.71 Remember that learning causes actual growth of new neurons, even in an older brain.72 Step outside the comfort of familiar territory. Cultivate a wide social network of individuals from diverse age groups. Take classes, get together with friends, learn a new sport or activity, start a new career or business, engage in volunteer work. Tone your brain cells and neural pathways with new ideas, new connections, and new thoughts every day. I started taking Argentine tango classes in 2008 and was positively terrified to be a beginner at a place where I didn’t know a soul. It was a humbling experience that required a lot of courage. But now, after two years of regular dancing, I have a whole new circle of friends, and a whole new range of motion in my hips and torso. (For more on the benefits of tango, see “Shall We Dance? The Triumph of Tango,” on page 238.)