The Wisdom of Menopause

by Christiane Northrup

  While you’re working on this, it’s important to keep moving the joint. What usually happens to women who develop this kind of shoulder pain is that they do exactly the opposite. But not moving the joint is the worst thing you can do, because then everything congeals, and you do, in fact, get a frozen shoulder from then on. I was determined to avoid this, so I worked on actively stretching the area twice a day—just to the point of pain, and then a bit beyond, to a slightly painful place, where I’d hold the shoulder until the fascia, ligaments, and muscles relaxed a bit. After I did this for several weeks, while working on identifying the metaphoric “weight” I was carrying on my shoulders, the shoulder pain gradually began to fade, and I eventually regained full range of motion.

  I wish that more women would realize the degree to which their musculoskeletal problems—be they with shoulders, hips, neck, or back—have an emotional basis. Simply acknowledging this possibility opens up huge vistas of healing.

  THE SUNLIGHT–BONE HEALTH CONNECTION

  Everywhere we turn, we are warned about the dangers of exposure to the sun, from premature skin aging to fatal skin cancer. Though these risks are well documented, they are overstated, especially for those of us who live in northern climates, where sunlight isn’t a glaring issue for most of the year. Women past menopause lose up to 3–4 percent of their bone mass every winter if they live in northern latitudes, above a line approximately from Boston through Chicago to the California-Oregon border.64 Even on a bright sunny day in December in northern Maine, you cannot get enough ultraviolet exposure to produce vitamin D unless you expose a great deal of your skin to the sun at midday for thirty to fifty minutes or so, a level of exposure that is uncommon. The problem is compounded if your diet is already low in calcium and vitamin D. Forty percent of individuals with hip fractures in northern latitudes are vitamin D deficient. In women whose diets are adequate in calcium and other nutrients, however, bone mass can be regained in the summer months with regular sunlight exposure.

  The truth is that sunlight can help you become healthier and can literally save your life. That’s because ultraviolet rays from the sun help your body manufacture necessary vitamin D. As with just about everything else, the key is moderation.

  Vitamin D is a hormone that helps your bones absorb calcium. If you don’t have enough vitamin D circulating in your blood, you won’t be able to use the calcium from your diet or from supplements. Therefore, it is an important factor in preventing osteoporosis. Right now the RDA for vitamin D is based on the amount you need to prevent rickets. Rickets is a disease where vitamin D levels are too low, resulting in the body’s decreased ability to produce new bone. In adults, this is called osteomalacia, a gradual softening or bending of bones secondary to failure of bones to calcify.

  To prevent rickets, you need just a minimal level of vitamin D (200–400 IU per day). But prevention of rickets isn’t the only benefit of optimal vitamin D levels. For example, adequate vitamin D can decrease hypertension, so people with higher vitamin D levels enjoy lower blood pressure.65 It can slow the progression of osteoarthritis and also decrease the prevalence of multiple sclerosis.66 According to the Vitamin D Council (a nonprofit educational organization; see www.vitamindcouncil.org), current scientific research shows that vitamin D deficiency is a major factor in the pathology of at least seventeen varieties of cancer as well as heart disease, stroke, hypertension, autoimmune diseases, diabetes, depression, chronic pain, osteoarthritis, muscle weakness, muscle wasting, birth defects, periodontal disease, Parkinson’s disease, and more. In fact, suboptimal levels of vitamin D may be one of the reasons why breast cancer incidence is higher in the northern latitudes than in the South. Research from Austria published in the Archives of Internal Medicine shows that those with low levels of vitamin D have more than double the risk of dying (from heart disease, among other causes) over an eight-year period.67 (For more information about the importance of vitamin D, I recommend reading The Vitamin D Revolution [Hay House, 2009] by Soram Khalsa, M.D.)

  But in order to lower your risk for these diseases, especially breast, ovarian, and colorectal cancer, you need much higher serum vitamin D levels than you can get with a teaspoon of cod liver oil or the usual vitamin D supplement. Your safest and most effective route for this is routine sun exposure.

  Sunlight Versus Vitamin D Supplementation

  Our bodies were designed to get vitamin D from the sun. Our ancestors ran around the plains of Africa for millennia with large surfaces of their bodies exposed to sunlight. Exposure to outdoor sunlight is a much more reliable predictor of vitamin D levels in your body than your dietary intake. In fact, vitamin D intake in your diet correlates poorly with the amount of vitamin D in your blood. This is partly because oral vitamin D requirements have been found to vary tremendously between individuals. And while it is possible to take in toxic levels of vitamin D from supplements, it is impossible for sun exposure to result in too much vitamin D. That’s because our bodily wisdom contains a built-in mechanism whereby we manufacture exactly what we need from the sun—no more and no less. The vitamin D that your body makes on its own from exposure to the sun’s ultraviolet rays (specifically ultraviolet B, or UVB) is superior to oral supplementation for helping your body absorb calcium.68

  Sunlight alone can bring your vitamin D levels into the healthy range. If you expose your body to sunlight without sunscreen for about twenty to thirty minutes three to five times per week (which you must work up to gradually so that you don’t burn) for four to five months per year (between April and October in northern latitudes), you probably will get enough UVB rays to keep your bone mass intact, because your body has the ability to stockpile vitamin D for use during low-sunlight times. This is nature’s wisdom at work, because not all regions of the country are equal when it comes to ultraviolet exposure. If you have very dark skin, you need to be in the sun longer—even an hour or two hours to get the same result.

  The more skin you expose, the quicker you make vitamin D, which is why some experts recommend full-body exposure regularly. In fact, full-body exposure for fifteen to thirty minutes is the equivalent of an oral dose of 10,000 IU vitamin D. (But UV exposure beyond this does not give you higher vitamin D levels.) However, as we age, our bodies become less efficient at making their own vitamin D. So if you are older than sixty-five, you may need more time in the sun to get the same benefit. Here’s a general rule: if there’s enough sunlight to cause a reddening of your skin when you’re outside for any length of time, then there are enough UVB rays to assist your body in making vitamin D.

  How to Have Your Sun and Be Safe, Too

  Everyone can get the amount of sunlight she needs safely by getting outdoors regularly. The benefits of small amounts of UVB light are so striking that endocrinologist Michael Holick, M.D., Ph.D., and his colleagues at Boston University Medical Center are studying the effects of providing artificial UVB light to seniors. NASA has also contracted Dr. Holick to put this special light into spaceships for long missions to counteract the effects of weightlessness on bone.69

  I recommend ten to twenty minutes of exposure without sunscreen (except on your face) per day, more if your skin is dark. Early-morning or late-afternoon sun exposure is the safest. I personally take a forty-five-minute walk about four mornings per week during the warm months, wearing shorts and a tank top to ensure adequate sun exposure. When I can’t get out in the morning, I try for late afternoon or early evening, when there is still some sunlight available but when the risk of overexposure is minimal. Other than these “vitamin D–enhancing times” I wear sunscreen.

  Avoid midday sun and sunburn. Almost all skin cancers are associated with the harmful effects of sun overexposure without adequate antioxidant protection. In fact, UV exposure beyond pre-erythema levels (reddening of the skin) doesn’t enhance your vitamin D levels. In other words, vitamin D reaches maximum levels in light skin twenty minutes after exposure.

  Other easy ways to get a little vitamin D enhancement ar
e rolling down the window in your car as you drive, riding in a convertible, or even opening the windows in your house. Why not create a sunroom or sun corner—a place where you can easily open a window and expose yourself to warm sunlight without even having to go outside? This is a good option for city dwellers.

  What to Do When You Can’t Get Enough Sunlight

  Vitamin D is an essential hormone. In the absence of sunlight, you must get it in your diet. While it is nearly impossible to get the high levels of vitamin D you need in your blood without adequate sun exposure, vitamin D supplementation has definitely been shown to help women build or maintain bone mass.70

  People should take 2,000–5,000 IU per day. Depending on what your current levels of vitamin D are (see discussion on optimal levels below), you may need to “push” the vitamin into your cells with high doses for a while (e.g., 50,000 IU per week for eight weeks) under a doctor’s supervision. Then you can take 5,000 IU per day thereafter to maintain optimal levels.71 (A 2010 study of women age seventy and older showed that taking one superdose of 500,000 IU per year actually increased falls and fractures, so stick with a daily supplement, and take it along with a meal that contains some fat, to increase absorption.)72 You may need more or less vitamin D than the amounts suggested here. The point is that sunlight is more reliable than any supplement. Good food sources of vitamin D are liver, cod liver oil, and egg yolks.

  Why Fortified Milk Isn’t the Vitamin D Answer

  Though all of us have been taught that it’s possible to get all the vitamin D we need from fortified dairy foods, that’s not always the case. When Dr. Holick studied the vitamin D content of fortified milk, he found that there’s often not enough vitamin D present because of processing problems. In fact, up to 50 percent of the milk tested had less vitamin D than noted on the label. Fifteen percent of the milk had no vitamin D at all! And in skim milk there is a problem getting vitamin D into the solution because vitamin D is fat soluble and requires some fat to blend with the product. That’s why skim milk products may have little or no vitamin D whatsoever.73

  Check Your Vitamin D Level

  Every woman should have her vitamin D level checked. This is a simple blood test available through your doctor (and now you can also order it yourself through My Med Lab at www.mymedlab.com; see Resources). A blood level of vitamin D of 20–25 ng/ml (50–62.5 nmol/l) or lower indicates a severe deficiency. We’re now finding that women with osteoporosis have vitamin D levels of 20 mg/ml (50 nmol/l) or lower! Be sure to ask your health care provider what your actual vitamin D level is, because having “normal” levels is not the same as having optimal levels. Ideas about the optimal levels of this vitamin continue to creep upward. Currently, an optimal level of vitamin D is 40–100 ng/ml (100–250 nmol/l), although expert opinion varies somewhat about the higher end of this range. Levels greater than 40 ng/ml (100 nmol/l) have been shown to decrease hypertension.74 Levels of 30 ng/ml (75 nmol/l) and above slow the progression of osteoarthritis. Studies of lifeguards and farmers—people who are out in the sun all the time—show that they have vitamin D levels of around 40 ng/ml (100 nmol/l). Get your serum levels checked! If your levels are low, get more sun exposure to prevent later problems, even if your bones seem healthy now.

  I once did a consult for a woman in her mid-forties who summered in Maine and ran regularly for exercise while covered in sunscreen and clothing. Though she lived most of the year in the Southwest, an area with abundant sunshine year-round, she avoided the sun at all costs because she was worried about skin cancer. When I ordered a serum vitamin D level, it came back at 10 ng/ml (25 nmol/l), indicating severe deficiency. Since then, she has been taking daily fifteen-minute early-morning sun baths in her backyard. Within two months her serum vitamin D level had increased to a very healthy range, and both her mood and her immune system improved dramatically. Within six months her bone density had also improved. She discovered some other benefits as well: she completely recovered from a tendency to catch colds and have aches and pains.

  Should You Use a Tanning Salon?

  Though dermatologists cringe at tanning salons because of the danger of overexposure, I recommend them for those who are at high risk for osteoporosis, depression, or certain cancers and who have no other way of getting UVB radiation.

  A short five-to ten-minute sun bath in a facility once or twice per week in the winter months can boost your brain serotonin levels, lift depression, help build bone, help calm arthritis, and maybe also help prevent some cancers. The key, as with natural sun exposure, is to be sure you never burn or get red skin, and also that your body is fortified with antioxidants. Any longer than this amount can cause more harm than good. We’ve all seen those people with leathery dark skin hanging around tanning booths, addicted to the high they get from the process.

  Take Antioxidants

  Increasing numbers of studies have shown that antioxidants such as vitamin E, vitamin C, proanthocyanidins, and beta-carotene help protect the skin from sun damage, and also help it heal more quickly. (See chapter 11 for further information.)

  Beware Drug-Induced Sun Sensitivity

  Remember that many very common drugs actually increase sun sensitivity and will therefore increase your chances for getting a sunburn if you stay out too long. These include the following: antibiotics such as azithromycin (Zithromax), minocycline (Minocin), tetracycline, and sulfa; diabetic medications of the sulfonylurea family; skin treatments such as Retin-A and Renova; and diuretics of the thiazide family. It’s always best to check with your pharmacist.

  SHORE UP YOUR EARTH CONNECTION WITH

  PLANT MEDICINE

  Traditional herbalists teach that when we consume plants regularly, our bodies take in their energetic qualities as well as their vitamins and minerals—a perfect way to help us connect with nature and shore up our first emotional centers. Oats (Avena sativa) and oat straw (the grass, leaf, and flower of the oat), for example, thrive in chilly, wet climates characterized by harsh winds and sudden storms. These hardy plants are rich in calcium, iron, phosphorous, B complex, potassium, magnesium, and vitamins A and C.75

  The noted herbalist Susun Weed has found that regular consumption of herbal infusions with their highly bioavailable nutrients helps increase bone density as well as providing other benefits. One of my nutritionist colleagues also recommends them. Using infusions regularly is a very inexpensive and effective way to increase mineral intake.

  How to Make an Herbal Infusion

  Infusions are stronger than herbal teas. Use 1 oz (30 g) of dried leaves (two handfuls of cut-up leaves, or three handfuls of whole leaves). Put in a quart or liter jar. Fill jar with boiling water, put the lid on, and steep for four hours at room temperature. This can be kept in the refrigerator.76 Use 2 cups daily.

  When using oat straw or other plant medicines, open yourself to the wisdom of the earth and nature as they have manifested in the plant you are taking into your body. Be patient and persistent. Feel your bones becoming as strong and sturdy as the mountains and rocks that form the backbone of the planet.

  STRAIGHT, STRONG, AND FLEXIBLE FOR LIFE:

  MASTER PROGRAM FOR HEALTHY BONES

  AND JOINTS

  Taking care of your bones and joints—supporting the structures that support your body—is a vital part of midlife health. Fortunately, there’s a lot you can do to ensure that your joints maintain or even improve their range of motion and that your body stays in proper alignment. The same is true of shoring up your bones. No matter how many risk factors you identified, it’s never too late (nor too early) to build your bones—even if you are ninety or already have osteoporosis. As long as you’re alive, your bones are dynamic, living organs that respond daily to every aspect of your life, from your emotions to your diet.

  Following this master plan for bone and joint health will go a long way in helping you flourish on all levels, including the ability to move fluidly and stand tall in every way—both physically and emotionally.

  ~ CUT
BACK ON OR ELIMINATE ALCOHOL AND CAFFEINE. As noted earlier, alcohol interferes with bone remodeling, and caffeine increases the excretion of calcium in the urine.

  ~ QUIT SMOKING. Acupuncture can help you a great deal with this.

  ~ FOLLOW THE PERIMENOPAUSAL DIET PLAN OUTLINED IN CHAPTER 7. Eat five servings of low-glycemic-index fruits and vegetables per day. These are all high in potassium and boron, which help protect your bones by reversing urinary calcium loss.77

  ~ MAKE SURE YOUR DAILY SUPPLEMENT PROGRAM INCLUDES THE FOLLOWING (even if your diet is good):

  Magnesium 400–1,000 mg (because of farming practices, many foods are low in this key mineral, so it must be supplemented)78

  Calcium 500–1,200 mg79

  Vitamin D3 2,000–5,000 IU (see discussion below)

  Vitamin C 1,000–5,000 mg

  Boron 2–9 mg80

  Zinc 6–50 mg

  Manganese 1–15 mg

  Copper 1–2 mg

  Vitamin K2 0–140 mcg (see discussion below)

  ~ GET YOUR VITAMIN D LEVEL CHECKED. Research shows that women with the lowest levels of vitamin D were 71 percent more likely to have a hip fracture than women with the highest levels, so be sure you get enough of this important vitamin.81 To find out what your blood level is, have your doctor order a 25-hydroxyvitamin D test. If your levels are very low, start with eight weeks of high-dose vitamin D supplement (between 5,000 and 10,000 IU per day). Once you’re in the optimal range, between 40–100 ng/ml, you can take between 2,000 IU and 5,000 IU a day (depending on how much sun exposure you get). I also recommend limited sunbathing, working up to ten to thirty minutes of exposure (the darker your skin, the more time you need) during early morning or late afternoon, three to four times per week—but never enough to burn the skin. In the winter, you can use a tanning booth for five to ten minutes once or twice per week. (See the section on vitamin D earlier in this chapter.)