Managing Perimenopause

Today, more and more American women are seeking alternative approaches to HRT. Whether you are trying to ease hot flashes, manage mood swings or prevent heart disease, changing your diet, adding vitamin and mineral supplements and choosing helpful herbal remedies can make you feel better. While the list below is not all-encompassing, it highlights a few important strategies that can help ease perimenopausal symptoms. If you’re looking for a more comprehensive guide to managing perimenopausal symptoms, pick up a copy of my blog The Ultimate Nutrition Guide for Menopause (John Wiley and Sons, 2003).

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DIETARY STRATEGIES Trigger Foods

Eliminate foods in your diet that can worsen hot flashes, insomnia or mood swings. Caffeine-containing foods and beverages like coffee, tea, dark chocolate, colas, certain orange sodas and root beers affect hot flashes and the quality of your sleep. My first recommendation to clients wanting to cut down is to avoid caffeine in the afternoon.

Replace these beverages with caffeine-free or decaffeinated beverages like herbal tea, mineral water, fruit and vegetable juices or decaf coffee. Keep in mind that certain medications, including Midol®, Excedrin® and Anacin®, can pack a lot of caffeine.

Keep your alcohol intake to no more than one drink a day, preferably none when you’re experiencing hot flashes or when you’re under stress. Drinking alcoholic beverages can bring on a hot flash, interrupt your sleep and affect mood. To lessen alcohol’s effect, try to drink alcohol with a meal. If you drink alcohol on an empty stomach, about 20 percent is absorbed directly across the walls of your stomach and reaches the brain within a minute, but when the stomach is full of food, alcohol has less chance of touching the walls and passing through, so the effect on your brain is delayed. When you’re out socializing, drink no more than one drink every hour. Since the liver can’t metabolize alcohol any faster than this, drinking slowly will ensure your blood alcohol concentration doesn’t rise. To slow your pace, alternate one alcoholic drink with a non-alcoholic drink. One drink is equivalent to 5 ounces of wine, 12 ounces of beer,

10 ounces of wine cooler or 1.5 ounces of liquor.

If you are experiencing hot flashes, stay away from spicy foods. Many women complain that certain spices can trigger a hot flash.

Soy Foods and Isoflavones

Foods made from soybeans are getting plenty of attention these days. Studies have found that soy foods not only have the ability to protect from heart disease (read more about this in chapter 11, “Heart Disease and High Cholesterol”), but they may also help ease menopausal hot flashes. A twelve-week Italian study looked at the effects of soy protein on hot flashes in 104 women aged 48 to 61 years.1 The study found that, compared to the placebo group, the women who consumed 60 grams of soy protein powder reported a 26 percent reduction in the average number of hot flashes by week three, and a 33 percent reduction by week four.

Soybeans contain naturally occurring compounds called isoflavones, a type of phyto or plant estrogen. Genistein and daidzein are the most active soy isoflavones and have been the focus of much research. Isoflavones have a similar structure to the hormone estrogen and, as a result, they have a weak estrogenic effect in the body. Even though isoflavones in soy are about 50 times less potent than estrogen, they are able to offer women a source of estrogen. When a woman’s estrogen levels are low during perimenopause, a regular intake of foods like roasted soy nuts, soy beverages and tofu can help reduce hot flashes.

While it’s true that a daily intake of soy has helped a number of my clients ease their hot flashes, studies don’t find it to be a stupendously effective remedy. It tends to decrease the frequency and severity of hot flashes by 20 percent, a modest effect at best. Will a 20 percent improvement mean that much to your symptoms? It might and it might not. I meet many women in my practice who tell me that any improvement is welcome.

How much soy should you eat? The precise answer to this question has yet to be answered. Most experts believe that a daily intake of 40 to 80 milligrams of phytoestrogens is probably needed to help alleviate hot flashes and reduce other health risks. See the Isoflavones in Soy Foods table on page 35 in chapter 1 to see how many phytoestrogens are found in common soy foods.

Wondering how to use soy foods? To get you started, try some of my suggestions below:

• Use a calcium-fortified soy beverage on cereal or in a breakfast smoothie.

• Use a calcium-fortified soy beverage in cooking and baking (e.g., soups, casseroles, muffins, pancake batters).

• Add canned soybeans to chili or soup.

• Cube firm tofu and add to soups—homemade or store bought.

• Grill firm tofu on the barbecue. First marinate tofu in balsamic vinegar or brush with hoisin sauce and then make tofu kebabs with vegetables.

• Substitute firm tofu for ricotta cheese in lasagna and cheesecake recipes.

• Use silken tofu in creamy salad dressing or dip recipes.

• Replace one-quarter of the all-purpose flour in a recipe with soy flour.

• Snack on roasted soy nuts—plain, barbecue, garlic or onion flavored.

• Add roasted soy nuts to a green salad.

• Replace ground meat with TVP (texturized vegetable protein) or veggie ground round in chili, pasta sauce and tacos.

• Try veggie burgers (with soy protein) and veggie dogs on the grill.

If you’re having difficulty making soy foods a regular part of your diet, consider using a high-quality soy protein powder. Throw a scoop of soy protein powder into a home- made breakfast smoothie or a glass of orange juice. But keep in mind that soy protein powders vary in quality. Depending on how the manufacturer extracts the protein from the soybean, you can end up with little or a lot of isoflavones. Look for products made with isolated soy protein. Soy protein isolates are the purest form of soy protein— the protein is completely separated, or isolated, from the carbohydrate and fat portion of the soybean. Most are made using a water extraction process, which preserves the naturally occurring isoflavones.

My advice is to buy a product that’s made with Supro® brand soy protein isolate. It’s manufactured using an isoflavone-friendly process and it’s also the soy protein isolate that’s used in scientific studies. Products that use Supro® include Genisoy’s protein powder, Twin Lab’s Vege Fuel®, GNC’s Challenge 95% ISP®, GNC’s Challenge Soy Solution®, Nutrel’s Soy Serenity® and Soy Strategy® and Naturade’s Total Soy®.

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