The Natural Approach to Exhaustion and Menopause

By: Michael Lam, MD, MPH


Read Part 1

Exhaustion and Menopause Protocol

1. Exercise Considerations

The onset of exhaustion and menopause may be eased by routine exerciseProperly performed exercises have been shown to modulate hormonal imbalance through the menopausal years and beyond. For example, strength training has been shown to increase growth hormone secretion. Those who exercise regularly are also happier, less depressed, and have an optimistic outlook on life. A decrease in physical and mental exhaustion and menopause symptoms results in increased life expectancy. Statistically, life expectancy increases by two hours for every hour spent.

Precision anti-aging exercises must incorporate flexibility, cardiovascular and strength training exercises. All it takes is 5 minutes of flexibility training every day, 20-30 minutes cardiovascular training 3 times a week, and 15-20 minutes of strength training 2 times a week. A properly structured program takes an average of 30 minutes a day, which is less than 2% of the entire day. Just 30 minutes a day can help ease exhaustion and menopause symptoms.

2. Dietary Considerations

Population data has shown that Asian women generally do not exhibit exhaustion and menopause symptoms to the same degree as Western women. Many Asian women have no physical or mental exhaustion and menopause symptoms at all! Epidemiological studies suggest this phenomenon may be due to the dietary habits of the Asians. In particular, the high proportion of fruits and vegetables such as alfalfa, which contain phytoestrogens, in the Asian diet combat exhaustion and menopause.

Phytoestrogens are a diverse group of plant-derived substances that have estrogenic properties. The structure of these compounds is very close to estrogen, but their actions are much less powerful (about 1/1000 as potent). Consequently, when estrogen levels are high, phytoestrogens compete for estrogen receptors, reducing the number of estrogen receptor sites and thus decreasing the effects of excessive estrogen. The excess estrogens, in this case, are safely metabolized (broken down) by the liver. When estrogen levels are low, as in peri- and post-menopause states, phytoestrogens act as an estrogen supplement. Phytoestrogens therefore help balance both excess and insufficient estrogen by acting both as an anti-estrogen as well as a weak estrogen, respectively.

Asians also depend on soy (such as tofu) as a source of protein (rather than red meat). The active ingredient in tofu is a nutrient called genistein. Studies have shown that genistein may reduce the symptoms of exhaustion and menopause, prevent bone loss, and possibly provide a safe alternative for prescription estrogens. Those who are serious about optimizing their health during peri- and post-menopausal years may find it helpful to embark on a diet similar to Oriental women, in addition to any HRT. The Mediterranean diet, consisting of 50% complex carbohydrates (fruits and vegetables), 25% protein (from plant source such as tofu and from cold water fish) and 25% fat (from fish and from olive oil) is an excellent life-long anti-aging diet.

Calorie restriction (restricting dietary intake to that which maintains your weight at or slightly below ideal body weight) has been proven in many scientific studies to be a sure way to prolong life.

Your ideal body weight can be calculated easily. For women, the formula is 100 pounds plus 5 pounds for every inch above 5 feet. Therefore, for a women standing 5 feet 6 inches tall, her ideal weight is 100 + (5 pounds/inch x 6 inches) = 130 pounds. Give or take 5 pounds for large or small frame size respectively.

For the average American woman who is slightly overweight, this means reducing caloric intake by at least 25% from 2000 calories a day to 1500 calories a day. Any weight reduction must be done gradually, with recommended loss of no more than one pound per week.

Exhaustion and menopause and interactions with calorie restriction dietsThe lifespan of animals has been increased by 200% or more by calorie restriction alone. These calorie-restricted animals remain active, live longer, and get sick less frequently. Their fur and skin remain pretty and white, and their eyes remain clear and bright. The body self-adjusts and slows its metabolic rate to accommodate the lower caloric intake. This means less wear and tear on the body organs to process food and their by-products. Like an engine that is not revved as much, body components are stressed less when calorie intake is lowered.

While there is a universal agreement among scientists that calorie restriction works, the problem is that even the best Mediterranean diet cannot give you adequate amounts of nutritional factors for anti-aging purposes. Take Vitamin C as an example. For prevention of scurvy caused by Vitamin C deficiency, 65 mg of Vitamin C is all that is needed. However, the National Academy of Science now recommends a daily Vitamin C intake of 90 mg for men and 75 mg for women, with an established upper limit considered safe of 2,000 mg per day. The average RED contains 65 mg of Vitamin C. To reach 2,000 mg, you would have to consume 30 REDs a day. Similarly, a 5,000 calorie diet is needed to acquire the commonly recommended 400 IU of Vitamin E a day. Clearly, the catch-22 is that one cannot have calorie restriction and optimum nutrition at the same time from diet alone.

Optimal nutritional supplementation therefore is a necessary foundation and pillar of a successful anti-aging program and in treating exhaustion and menopause. This will ensure that the body receives optimum amount of nutrients without an excessive number of calories.

3. Cruciferous Vegetables, I3C, and DIM

In addition to anti-oxidants, steps should be taken to neutralize the amount of excessive estrogen ingested. Environmental estrogen (also called xeno-estrogen) is omni-present in the developed world. Chemicals with weak estrogen effects are present in the pesticide sprayed on fruits, poly-carbons of our utensils made from plastics , hormone laced beef and poultry, and shampoos we use, just to name a few. Excessive estrogen is a leading cause of breast cancer in the female as well as a multitude of mental and physical exhaustion and menopause symptoms related to estrogen dominance, including pre-menstrual symptoms, pre-menopausal symptoms. Estrogen is also an antagonist of the small amount of testosterone in the female body. Elevated estrogen levels can be neutralized by a reduction of estrogen exposure through a proper wholesome fresh whole food diet, especially a diet rich in cruciferous vegetables such as broccoli, cauliflower, cabbage, kale, bok choi, and brussels sprouts.

Fortunately, scientists are able to isolate the active ingredient of cruciferous vegetables. It is called Indole-3-Carbinol (I3C). Unfortunately, I3C has drawbacks. Numerous studies have shown that I3C, and in particular its reaction product ICZ, are associated with a number of unwanted activities that are not compatible with safe, long-term use. I3C supplementation is not recommended. Fortunately, I3C combines with stomach acid to form 3,3-Diindolylmethane (DIM). DIM supplementation is available. It is safe.

Exhaustion and menopause symptoms can be lowered through the consumption of cruciferous vegetablesDIM is a balancer of estrogen metabolism. Let us review the pathway of estrogen metabolism first. Estrogen is metabolized in the liver . One of its metabolites – 16 alpha hydroxy estrone – is a carcinogenic metabolite implicated in propagating and promoting many hormone-sensitive cancers. Studies have shown that it was not the absolute amount of it, but the ratio of another estrogen metabolite called 2 hydroxy estrone to 16 alpha hydroxy estrone that was the more important predictor of cancer risk. The 2 hydroxy estrone is therefore known as the good or protective estrogen, and the 16 alpha hydroxy estrone has been deemed to be the bad or carcinogenic estrogen. One of the most efficient and healthiest ways to increase the ratio of these estrogen metabolites in favor of the good estrogen, is to eat large quantities of cruciferous vegetables or take DIM supplements.

In addition to the estrogen balancing effect, DIM stimulates progesterone production and compete with testosterone for protein binding. This helps to maintain testosterone in its free form. As estrogen metabolism slows due to the aging process (especially prevalent when coupled with obesity and regular alcohol use), estrogen metabolism is reduced. DIM reduces the conversion of testosterone to estrogen. Once absorbed, DIM promotes healthy estrogen metabolism and improve exhaustion and menopause symptoms of estrogen-related imbalances.

Over 40 studies on DIM is on file in the National Library of Medicine database. As little as 0.5mg/kg body weight/day of DIM has been demonstrated as an effective dose. DIM can be used in conjunction with phytoestrogens such as isoflavones. Its use is cautioned in women taking the oral contraceptive as it theoretically may reduce effectiveness.

The use of DIM is compatible with other phytonutrients such as soy, black cohash, red clover, and chasteberry extract. Especially popular in recent years are soy products which contain isoflavone, a phytoestrogen that is 500 times weaker than estrogen. More than 1,000 medical and scientific papers have been published on isoflavones. There are three primary isoflavones in soybeans: genistein, daidzain, and glycitein. In various experimental models, isoflavones have exhibited properties that suggest they may help to lower the risk of cancer, heart disease, osteoporosis, and for the relief of menopausal symptoms such as hot flashes. In addition to breast cancer, soybean isoflavones may help reduce the risk of several types of cancer, including lung, colon and rectal cancer.

As a result, soy products have been heavily promoted in recent years. It should be noted that only soy that is fermented (such as miso or tempeh) is completely beneficial; as unfermented soy can do more harm than good in our body due to its toxic metabolites, if the intake is too much.

Isoflavone and DIM work under different pathways. While studies have shown that supplementation with 200 mg/day of soy isoflavones increase the production of estrogen metabolites, the effect is much less than that seen with absorbable DIM or I3C. As competitors to estrogen, phytoestrogens may interfere with normal brain aging. Recent studies suggest that soy phytoestrogen may be associated with accelerated brain aging and cognitive decline in both women and men. Mother nature has taught us that excessive use or ingestion of any one food is not good. A proper balance is the key. From a nutritional supplementation perspective, both DIM and isoflavone supplement should be considered, both in optimum and not in mega doses.

4. Nutritional Supplementation

Middle aged woman dealting with exhaustion and menopauseThe body goes through 3 phases of aging. Before age 35, it is in the sub-clinical phase where symptoms of aging are hardly detectable. The transition phase starts at age 35 and ends around age 45 or so. During this phase, gross signs of aging starts become evident as the body prepares itself for menopause. From age 45 onwards, the body enters phase 3, or the clinical phase of aging. During this phase, rapid decline in physical health and symptoms of exhaustion and menopause, and most of all, aging come into full bloom. The nutritional needs of the menopausal woman are different from her child-bearing years. Some of the differences

  1. Musculo-Skeletal System. Osteoporosis sets in, and additional calcium and magnesium in a balanced ratio is needed to enhance bone health. Magnesium and malic acid are other nutrients essential for the maintenance of proper joint function. Over 75% of Americans do not meet even the recommended daily allowance (RDA) of magnesium, which is 300 – 400 mg.
  2. Digestive System. Our digestion slows and absorption of vital nutrients decreases with age. Enzymes such as amylase, cellulase, bromelain, and lipase may be needed to help digest protein and enhance gastro-intestinal heath. They should be part of the daily supplemental intake.
  3. Neurological System. Mental function, especially memory and concentration, usually decreases with age and the decline is accelerated during times of chronic exhaustion and menopause. Fortification with potent B vitamins is needed to enhance the memory and concentration functions of the aging brain. Deficiency of B12 leads to symptoms mimicking Alzheimer’s disease. 24% of adults age 60 – 69 are deficient in Vitamin B12, and over 40% of adults over 80 are deficient. Those with memory impairment worse than normal should also consider phosphatidyl-serine and ginkgo biloba as additional nutrients.
  4. Cardiovascular System. The risk of atherosclerosis and cardiovascular disease rises substantially during peri- and post-menopause as estrogen levels decrease. Ascorbyl palmitate, L-lysine, and L-proline should be incorporated to promote vascular heath. Coenzyme Q10, lipoic Acid, and L-carnitine are important nutrients if heart function is compromised.
  5. Dermatological System. Our skin starts to thin during peri-menopause as collagen repair slows. Hair loss becomes more diffuse and global. To maintain hair health, extra Vitamin C to fortify collagen formation is helpful, along with minerals like zinc and boron.
  6. Hormonal System. Hormonal health, in addition to the sex hormones, is on the decline during menopause and beyond. The level of growth hormone declines about 14% per decade after age 20, as do many other hormones. Hormonal modulation is enhanced by Vitamin E. This is an important vitamin for anyone who is experiencing exhaustion and menopause. Vitamin E has the additional benefit of possessing cancer prevention properties. This has been well documented in hundreds of scientific double-blind placebo controlled studies. One catch – you have to take Vitamin E consistently for at least 1 – 2 years for it to have any effect. L-Glutamine is an important amino acid with pro-hormone properties.Studies have shown that glutamine increases growth hormone release in our body. Growth hormone has been shown to reverse our physical age by up to 15 years in a double-blind placebo controlled landmark study conducted by the late Dr. Rudman and published in the New England Journal of Medicine.
  7. Symptoms of blood sugar level issues, exhaustion and menopauseEndocrine System. As you age, your pancreatic function declines, leading to glucose imbalance. Just as “pausing” of the ovaries leads to menopause with decreasing estrogen output, “pausing” of the pancreas leads to decreasing secretion of insulin. This can lead ultimately to diabetes. To normalize blood sugar levels, adequate chromium is a must. Over 90% of Americans are deficient in meeting the RDA of 50 mcg of chromium a day. Many anti-aging researchers recommend 200 mcg a day, which would require a 5,000 calorie diet! Chromium polynicotinate is the most bioavailable form of chromium and supplementation may be beneficial to help normalize blood sugar levels.
  8. Immune System. The biggest fear for anyone over 45 is cancer. By age 50, about 30% of the body’s cellular protein has been damaged by free radicals. Cancer is one of the leading causes of death in all countries. Damaged proteins lead to mutations that can result in cancer. Strong antioxidants like grape seed extract, citrus bioflavonoids, selenium, and beta-carotene are well-documented free radical scavengers and cancer fighters. For extra cancer protection, consider calcium d-glucarate and additional antioxidants such as coenzymeQ10, quercetin, and green tea.
  9. Stress. As the body cycles through its daily diurnal phase, extra Vitamin B12 and ginseng will enhance the body’s ability to cope with stresses during the day, while herbs such as kava kava and valerian should be taken to help produce a calming effect for rest and relaxation at night.

Summary of the daily nutritional consideration for women 45 and over:

Ascorbyl Palmitate: 100 – 200 mg
L-Lysine: 150 – 250 mg
L-Proline: 100 – 200 mg
Amylase: 1,500 SKBU
Cellulase: 500 ECU
Lipase: 4800 IU
Ascorbic Acid (Vitamin C): 1,000 – 3,000 mg
Magnesium: 400 – 1,000 mg
Malic Acid: 100 – 500 mg
Grapeseed Extract: 50 – 100 mg
Citrus Bioflavinoids: 50 – 100 mg
Selenium: 200 – 300 mcg
Beta Carotene : 15,000 – 30,000 IU
L-Glutamine: 1,000 – 2,000 mg
Chamomile: 50 – 200 mg
Calcium: 500 -1,000 mg
Chromium: 200 mcg
Vitamin E: 400 – 800 IU
Beta Carotene: 15,000 – 30,000 IU
DIM: 35 – 50 mg
Progesterone Isoflavone Extract: 200 mg
Natural Progesterone Cream: 20 mg a day

Discussion

Menopause can be seen as an estrogen and progesterone deficiency disease in an aging body. Many have found estrogen replacement a relief for their exhaustion and menopause symptoms. However, more than 50% of all women taking conventional estrogen (unnatural) replacement therapy go off it after 1 year. Its side effects such as bloating, lethargy and fatigue can be as unbearable as the symptoms of menopause. Obviously there is much to be desired.

For women who find hormonal replacement therapy necessary, the choice of whether to use the natural versus unnatural forms of hormone remains a difficult decision. Both forms have cardio-protective properties and prevent osteoporosis. While unnatural forms have been documented to also be associated with an increased risk for certain types of cancer, the natural forms have not yet had sufficient long term studies to show results regarding their relation to cancer risk. While there is no proof that cancer will not occur with the natural form, there is no reason to suspect that it would since the natural form is identical to that produced by the human body. Regardless of whether the natural or unnatural form is used, the risk of cancer associated with hormone replacement therapy is real and cannot be discounted.

The Big Picture

Successful exhaustion and menopause relief strategies often go hand in hand with anti-agingThose who are age 45 or over are in the clinical phase of aging, a phase where declining bodily function is grossly evident causing rapid deterioration. This phase lasts for approximately 35 years based on the current life expectancy in developing countries of 78 years. Exhaustion and menopause symptoms are most prominent for the first 10 years or so of this phase.

It is so easy to become preoccupied by focusing on managing exhaustion and menopause symptoms that one misses the big picture – how to optimize bodily function from age 45 onwards, realizing that exhaustion and menopause is just one short phase within that continuum.

The goal in any peri- and post-menopausal program should be the same: to keep the body in optimum anti-aging health. The best protocol is comprised of a consistent regimen of:

1. Balanced anti-aging diet
2. Precision anti-aging exercise
3. Optimum nutritional supplementation
4. Stress reduction.

During the approximately 10 years of transition years from pre- to post-menopause, faithful adherence to the above protocol will resolve many of the uncomfortable associated physical and mental exhaustion and menopause symptoms for the vast majority. If hormone replacement therapy is desired, before proceeding, consult a physician who is well versed in both natural and conventional forms of hormone replacement therapy.

Read Part 1

© Copyright 2013 Michael Lam, M.D. All Rights Reserved.


Exhaustion and menopause

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21 Comments

  • Anonymous says:

    Thank you for the nutritionaI consideration! I would be interested in using the product Adrenal Stress Control however I hesitate due to the ingredient FOS, What other choices may give similar collagen support throughout the body including the hair, gums, vascular, joints etc.? If collagen support is ingested orally does it get through the blood brain barrier or will it only go below the neck? Thank you.

  • T. says:

    Thank you for the vast resource of information. I don’t see why a woman with very little or no estogens would benefit from progesterone cream? If balance is the goal than it seems to me that no progesterone would be appropriate.
    Also, the DIM balances estrogen, therefore, does that apply to topical estrogen supplementation or only women that still produce estrogens? Thank you.

    • Dr.Lam says:

      You are looking at things in theoretical perspective, but the body is very complex. The decision on whether to use hormone replacement depends on the entire clinical picture and not on lab alone.

      Dr.Lam

  • T. says:

    Thank your for the beta-carotene amounts. It is listed twice is that an accident or is it very important? Also, I know the food sources to obtain it from but why isn’t Vitamin A mentioned? Finally, how might a person know that their body is using it adequately?

  • T. says:

    Thank you for the nutritional cocktail. It surprises me on how long it takes to achieve the goal of optimal nutritional and supplemental supports. In addition, I am not clear on the what it is that grape seed extract may do or benefit a menopausal woman. I thought it was an aromatase inhibitor reducing an already low estrogen state and reducing testosterone, is that accurate?

    • Dr.Lam says:

      it is part of a cocktail mix to enhance antioxidative properties. its other hormonal properties are relatively minute.

  • T. says:

    Is Resveratrol a phytoestrogen too? Is it true that Resveratrol usually raises testosterone and cortisol levels in women and lowers estradiol levels?

    • Dr.Lam says:

      Resveratrol has phytoestrogenic properties and that can act both positively or negatively in your body, depending on the state of your function and hormonal balance. It is not a strong supporter of androgen or steroid.

      Dr Lam

  • T. says:

    I liked the segment on the Big Picture. Anti-aging strategies are appreciated,yet it hasn’t been fully experienced. I hope to find more tools to experience a much better level of health. Lifestyle, diet, exercise and supplementation are a balancing act. I am wondering about the significance of Beta Carotene in those doses for menopause women with hypothyroid. Also I am surprised to not see much reading material on Flax oil with and without lignan.

  • T. says:

    Thank you again for such considerate informed responses! I looked through the estrogen dominant article. I use progesterone cream and still the symptoms and blood work show low estradiol and progesterone. I don’t know if it is the right place to comment since my symptoms are four-fold. Menopause, adrenal, increased A1C and long-standing hypothyroid.
    I get some mild support with these supplements:
    calcium-magnesium, D3,fish oil, flax lignin, free form proline, buffered vitamin c, progesterone cream. Thank you.
    I am still symptomatic in very early menopause. I am most focused on building collagen but actively working on bringing down my A1C of 5.8. Hasn’t happened yet!

  • T. says:

    I read about the phyto-estrogenic effects of black cohosh. I also know that black cohosh is stated to be used for 6 months then stop for a period and restart. Of course I need consistent benefits, so I am wondering about using dandelion and milk thistle as dual temporary support after the black cohosh. I also wonder if I use dandelion milk thistle instead of black cohosh, could it be used daily for long-term use since I am very low estradiol.

    • Dr.Lam says:

      milk thistle helps the liver. whether it helps black cohosh depends on the person. Everyone is different. it is normally NOT used as temporary support for black cohosh. you may be very low in estradiol but be estrogen dominant. Please make sure before you start anything. Click Estrogen Dominance for more information.

      Dr Lam

  • T. says:

    Thank you for your fast reply! I don’t understand why a proline supplement is needed for my body to show some improvement when I eat meats, eggs, fish, beans, nuts with digestive enzymes on a regular basis. I also use betaine for heavy protein meals.

    • Dr.Lam says:

      It is not needed in general , but in select cases, it can be a good supplement if your goal is more collagen. it all depends on the person.

      Dr Lam

  • T. says:

    Thank you for your resources Dr. Lam. I am still seeking the right dosages and combinations of proline lysine to build collagen. I am just starting to see some small benefit from Buffered Vitamin C 500mg twice a day and free form proline 250mg. twice a day. It has greatly reduced my bladder urgency and frequency. I want to know more on how to use proline or lysine so I can progress. My local stores only carry free form proline 500mg or proline lysine 275mg in combination. I also see a proline, lysine MSM vitamin C formula but I am uncertain on which products since I monitor my daily sugar levels since my A1C is 5.8 with diet and exercise. My estradiol and progesterone are both below normal on my lab tests and my symptoms also tell me those hormones are below standard but my testosterone is within normal range. I need the right collagen support that will make a positive impact on my blood sugar and collagen.

    • Dr.Lam says:

      For collagen building, proline / lysine / vitamin C dosage are in the 1000s. Note that there are 70 trillion cells in the body. Sufficient dosage is needed .

      Dr Lam.

  • Alexandrea Hubbult says:

    Thank you Dr. Lam for all your wisdom. Im going through menopause at the moment and your information is helping me get through this with ease.