FIGHTING MENOPAUSAL SYMPTOMS WITH NUTRITION

1. FIGHTING MENOPAUSAL SYMPTOMS WITH NUTRITION Dr Ila Gupta

2. The menopause is caused by a fall in the amount of the hormone oestrogen produced by the ovaries . Menopause is a time of transition, the end of the fertile years and an individual experience for every woman. The decline or absence of oestrogen can mean changes to energy levels, memory, bone health, hormones, urinary and heart health.

3. Menopause - Basic Facts • Generally occurs between 45-55 • average age of 51 yrs • < 10% reach menopause before 46 • Factors leading to earlier menopause • Genetic predisposition to the age of onset • A woman has a 5% chance of entering menopause before age 46, however if she has a first – degree relative who entered menopause before 46 her risk goes up to 25% • shorter cycles • smokers - avg 2 years earlier • Low BMI • Nulliparity • Lack of OCP use • With increasing life expectancy women can expect to spend at least 1/3 of their life in an estrogen deficient state

4. Perimenopause • Many women experience an array of symptoms as their hormones shift during the months or years leading up to menopause • Menopause is a point in time, but perimenopause (peri, Greek for “around” or “near,” + menopause) is an extended transitional state • It’s also sometimes referred to as the menopausal transition http://www.health.harvard.edu/newsweek/Perimenopause_Rocky_road_to_menopause.htm

5. Symptoms • Hot flashes • Irregular periods • Vaginal drying • Sleep disorders • Depression • Irritability • Osteoporosis • Cardiovascular disease

7. Physiologic Changes • Slowing of metabolism • Weight gain • Changes in lipids • Increase in heart disease • Osteoporosis

8. Physiological Changes as Age Advances • SARCOPENIA: That is the age related loss of muscle mass. • GASTROINTESTINAL CHANGES: Enzymes secretion decreases leading to reduction in digestion and absorption. • CARDIOVASCULAR CHANGES: There are cardiovascular changes taking place with increased blood pressure making salt intake critical. • METABOLIC CHANGES: There is also decreased insulin secretion that causes Carbohydrate intolerance. • CHANGES IN BONES – become soft and fragile.

10. Women from the eastern and western worlds often have very different experiences of the menopause and it is thought that differences in dietary characteristics may account for this.

11. Role of Vitamins http://www.ion.ac.uk/information/onarchives/perimenopause

12. Role of Minerals

13. Role of Herbals

14. Clinical Evidences

15. Vitamin E • Placebo-controlled, randomized, crossover trial: • Patients received 4 weeks of vitamin E 800 IU daily, then 4 weeks of an identical-appearing placebo • Vitamin E was associated with a minimal decrease in hot flashes (one less hot flash per day than was seen with a placebo) • Unlikely to be of clinical benefit • Found inavocado, nuts such as almonds or hazelnuts and seeds. Spinach and other green leafy vegetables. Vegetable oils like sunflower and olive oil. Wheat germ, wholegrain foods, milk and asparagus.) Barton DL Prospective evaluation of vitamin E for hot flashes in breast cancer survivors J Clin Oncol. 1998 Feb;16(2):495-500.

16. Soy Products • Source of isoflavones which have both hormonal and nonhormonal properties • Conflicting results of benefit • Review of 11 RCT of soy and isoflavone supplementation found no significant benefit in 7 of 11 studies • 4 that had positive effect showed a modest response (15% reduction over placebo) Kronenberg F et.al. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials.Ann Intern Med 2002 ;137(10):805-13.

17. Ginseng: Panax ginseng • 384 women were randomized to receive ginseng versus placebo • No significant improvement of vasomotor symptoms • Treatment group reported a slightly improved quality of life Wiklund IK et. al. Effects of a standardized ginseng extract on quality of life and physiological parameters in symptomatic postmenopausal women: a double-blind, placebo-controlled trial. Swedish Alternative Medicine Group Int J Clin Pharmacol Res. 1999;19(3):89-99

18. Black Cohosh • Most of the clinical trials looked at Remifemin (black cohosh product) • Efficacy tied to levels of triterpenoid glycoside • There have been 4 randomized studies but only 1 placebo controlled* • 85 patients (59 on tamoxifen, 26 not on tamoxifen) • No significant difference between the two groups Jacobson JS et.al. Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. J Clin Oncol 2001;19:2739-45.

19. Red Clover: • Study published in JAMA in 2003 • 252 women assigned to receive red clover supplements versus placebo • No clinically significant reduction of symptoms Tice JA. Et.al. Phytoestrogen supplements for the treatment of hot flashes: the isoflavone clover extract (ICE) study: a randomized controlled trial. JAMA 2003;290:207-

20. Nutrition For Symptomatic Management

21. Nutrition For Symptomatic Management • To reduce an attack • Avoid spicy food, coffee, tea, alcohol • Eat lentils, soya products • Wear loose cotton clothes • Avoid hot water bath just before sleeping • Medical treatment options • During an attack • Try to relax • Cool down the body temperature with moist wipes, switch on the fan

22. Normal bone Micro-fracture Osteoporotic bone Leads to fracture Osteoporosis

24. Osteoporotic bone Treatment of Osteoporosis Hormonal Nutrition Non Hormonal • Calcium • Vitamin D • Vitamin K2-7 • Others • Estrogen • Tibolone • SERMS • Raloxifine • Bisphosphonate • Alendronate • Risedronate • Others

25. Need for a Nutraceutical therapy for Management of PMO • Currently available therapies are only Antiresorptive drugs • Reduces osteoclastic activity • Need for customized therapy for PMO which have • Estrogenic action like Natural selective estrogen modulator nSERM • Estrogenic activity with safety in Post menopausal osteoporosis • Increases bone forming activity • Increase proper mineralization of bone matrix • Reduces osteoclastic activity • Deficiency of vitamin K2-7 leads to calcium paradox

26. Calcium, Vitamin D and Soy isoflavone during osteoporosis • Combined calcium and vitamin D supplementation is an essential component of the management of osteoporosis1 • Soy phytoestrogens in combination with vitamin D may synergistically induce osteoblast activation and prevent pre-osteoclast and osteoclast differentiation, through the increase of vitamin D metabolites. • Soy isoflavonecould improve some menopausal syndromes and was effective on increasing bone density3 • J Intern Med. 2006 Jun;259(6):539-52. • Nutrients. 2012 Nov 6;4(11):1610-21 • J ClinBiochemNutr. 2013 Sep;53(2):102-7 ER: estrogen receptor

27. milk • the tryptophan in milk helps you fall asleep at night paired with bone-strengthening exercise and adequate rest, milk drinking women could be on their way to a lowering their risk of osteoporosis and incurring bone fracture in later life.

28. CALCIUM • It's best to divide this into several servings; usually 400 to 500 milligrams because that is the most your body can process at one time. That equates to two ounces of low-fat cheese, a cup of fat-free plain yogurt, or about a cup and a half of breakfast cereal. . • To ensure that the calcium is fully absorbed and deposited in the bones, it should be combined with foods rich in phosphorus such as (peanuts, meat, cheese, onions, garlic)

29. Tofu Tofu is made from soybeans and soy is a natural estrogen stimulant. Tofu is packed full of calcium. Just 240 ml of this meat alternative can contain 258 mg of calcium. Be aware though, tofu is made from soybeans and soy is a natural estrogen stimulant.

30. Sesame seeds .Sesame seeds are rich in calcium, magnesium, vitamin B1, zinc, and dietary fiber. Not only do they help improve bone health, but they also provide relief from migraines, lower high blood pressure, and can prevent the risk of cancer.

31. Flaxseed and flaxseed oil • Flaxseed and flaxseed oil contain alpha-linolenic acid (ALA), a precursor to the essential omega-3 fatty acid that partly and inefficiently converts into DHA and EPA -- more active omega-3s -- in the body. While flaxseed hasn't yet been shown to improve heart disease risk, there's good evidence that flaxseed and flaxseed oil may lower cholesterol levels.

32. Chest pressure, squeezing, or pain Pain in the jaw, neck, arms, shoulders, or back Nausea, sweating orfeeling faint Shortnessof breath Heart Disease Signs & Symptoms differ in Females

34. General Management • Eat right: DASH diet • DASH diet eating plan is a diet rich in fruits, vegetables, low fat or nonfat dairy. • It also includes grains, especially whole grains; lean meats, fish and poultry; nuts and beans. • It is high fiber and low to moderate in fat. DASH: Dietary Approaches to Stop Hypertension

35. Dietary Tips • Salt restricted diet • Cut down on sugar • Reduce caffeine, alcohol • Eat more fruits & vegetables • Include lean protein in diet • Choose heart healthy fats • Increase fibre & whole grain content of meals The DASH diet can likely reduce most of the metabolic risks in both men and women. Diabetes Care. 2005 Dec;28(12):2823-31

36. Special Role Of Specific Ingredient • Probiotics - It is better to take supplements containing probiotics in large numbers to restore the healthy microbial flora of intestine. Fermented products like yogurt, curd, buttermilk etc. are essential for normal gut flora. • Antioxidants - Free radicals produced in the body can cause damage and antioxidants act as scavengers for free radicals preventing or repairing damage by them. Commonly known antioxidants are vitamins and minerals. vitamin A and carotenoids present in carrots, tomatoes, mango orange and other bright coloured fruits and vegetables, vitamin C present in citrus fruits, berries, green leafy vegetables, vitamin E in nuts and seeds, whole grains, green leafy vegetables and selenium present in fish, shellfish, red meat, grains, eggs etc.

37. Oil intake • recommended daily calorie intake is 2,000 for women. Fat should provide 30% or less of this total. Saturated fat should be limited to less than 10% of the total daily calories because it raises blood cholesterol and increases the risk of heart disease. Saturated fat is found in fatty meats, whole milk, ice cream and cheese. • Plant sources of omega-3 fatty acids include flaxseed (ground), oils (canola, flaxseed, soybean), and nuts and other seeds (walnuts, butternuts and sunflower).

39. Certain Facts • Plenty of fluids and physical activity improves long term health. • Whole fruits and vegetables as well as whole grain products have been established to be beneficial. • Proper denture is needed for chewing the food. • Fortified products & specially prepared soft foods are now available in market for elderly. • Healthy lifestyle, less consumption of addictive food, proper exercise & meditation is needed for a good health.

40. Foods to Avoid • High-salt diet leads to bone mineral loss and increases blood pressure. • Excess phosphorus in carbonated and soft drinks promotes calcium loss; hence, these should be avoided in menopausal women. • Alcohol prevents absorption of the bone-building minerals. • Hydrogenated oils should be avoided as natural vitamin K is destroyed in the process of hydrogenation. Sources: Prentice A. Public Health Nutr. 2004;7(1A):227–243. National Osteoporosis Foundation. http://www.nof.org/ foods. Accessed September 12, 2013.

41. Take home message • Dietary Fiber Cuts Breast Cancer Risk. • High Protein, Low carb Snacks Increase Weight Loss • Probiotics boost brain health and overall immunity • Magnesium Deficiency Linked to Higher Risk of Osteoporosis • Soy/Milk Protein Dietary supplements linked to Lower Blood Pressure • Low salt, low fat, low calorie and low spices preferred • Say no to Aerated beverages alcohol and smoking

43. ENJOY MENOPAUSE AFTER ALL THIS IS THE AGE OF FLYING THANK YOU