The May 1997 issue of The Journal of Clinical Endocrinology and Metabolism brings up the PEPI report on weight gain in the four hormone groups vs the placebo group. Yes, just as expected, the women in the placebo group gained the most weight, and the women on Premarin alone the least, also preserving the most slender waistline. The hormonal regimens (all of them using .625mg Premarin), however, provided "only slight protection against postmenopausal weight gain."

In a nutshell: women assigned to hormonal treatments gained on the average 1 kg (2.2 lbs) less over three years than those assigned to placebo. The least weight gain was noted in women on Premarin alone (.7 kg, or 1.54 lb), together with the least increase in waist girth (1.1 cm, which is slightly less than half an inch). The continuous Premarin/Provera regimen came next. With cyclical Provera and progesterone, the results were a tad worse, but the differences were not statistically significant. Women assigned to placebo gained an average of 2.1 kg (4.62 lbs). Thus, placebo-takers gained twice as much weight as HRT users.

Women aged 45-54 showed much greater increases in weight than women aged 55-65.

Why the advantage of Premarin alone? Probably because it reduces insulin resistance, resulting in lower insulin levels, while Provera and unfortunately to some extent natural progesterone as well tend to increase insulin resistance (thats why progesterone is now commonly used to fatten cattle; but it takes pregnancy levels of progesterone, not NHRT levels, for a serious metabolic impact).

The researchers found that smoking was associated with upper-body obesity (a factor predisposing to diabetes), and that "women who were assigned to active treatment and who also smoked cigarettes did not obtain the same protection from weight gain as did those who were non-smokers. This suggests that smoking interferes with estrogens effect. (. . .)

In non-obese smokers, increased smoking correlates positively with increased waist girth and negatively with hip girth (. . .)

Peripheral hyperinsulinism has also been reported to be a characteristic of smokers." Smoking results in lower serum estrogen levels. This is due to increased estrogen clearance. The same phenomenon can be seen in heavy coffee drinkers.

Now, heavy smokers often are also heavy coffee drinkers. They need to drink more coffee to even notice the effect, since their clearance of caffeine is also much faster.

"There was a modest trend of PEPI women who reported greater alcohol intake to gain less weight."

Alcohol has been shown to 1) lower insulin levels (see below); 2) elevate estradiol levels if the woman takes oral estrogens, which go to the liver first. The effect is much less pronounced with dermal estrogens.

Another way in which estradiol helps prevent weight gain is by increasing brain serotonin, which acts as an appetite suppressant. In addition, estrogens promote the secretion of growth hormone, which is very important for preventing the dangerous abdominal obesity. In fact, its possible that estradiols waistline-preserving action is due entirely to its stimulation of growth hormone secretion; i.e., so far as we know, its growth hormone alone that prevents and melts the "spare tire."

Considering that smokers have lower estrogen levels, you may be wondering if they have a lower risk of breast cancer. No way. They do have only one half the risk of endometrial cancer, which depends on estrogenic stimulation in a very direct way. When it comes to breast cancer, however, smokers either have the same risk as the population at large, or, if they are unlucky enough to be in a subgroup known as SLOW ACETYLATORS (slow detoxifiers), they are at a hugely elevated risk (more on this in another newsletter).

Jewish women in particular tend to be slow acetylators, while Asian women are predominantly fast acetylators.

Back to PEPI and weight gain. I think its a terrible shame that the study doesnt include more active groups, including dermal estradiol and progesterone alone. Since women are refusing to take part in placebo studies (they want the benefits of hormones, and who can blame them), there may not be another opportunity for a truly controlled study.

Source: Espeland M et al. Effect of postmenopausal hormone therapy on body weight and waist and hip girths. J Clin Endocrinol and Metab 1997;

82:1549-56.)

LIGHT TO MODERATE ALCOHOL CONSUMPTION ENHANCES INSULIN SENSITIVITY

This is not a new study (1994), but one of the many examples of potentially useful findings that seem to get lost in the shuffle. Male and female subjects were given 10-30g of alcohol (10g = one glass of wine); it was found that this kind of alcohol intake resulted in significantly lower plasma glucose levels, lower fasting insulin, and higher HDLs. The author quotes other studies confirming his results, including one that measured triglycerides and found that alcohol consumption also lowered triglycerides. While much has been made of alcohols ability to raise HDLs, its ability to lower blood sugar, insulin, and triglycerides is rarely discussed (but see last issues advice on drinking DRY wine).

As for the anti-obesity effect, is it a mere coincidence that Frenchwomen have been found to be the most slender of all European nationalities? And that they have the lowest cardiovascular mortality in the world? (You may be wondering about my own drinking habits. Alas, I cant practice what I preach, since wine doesnt agree with me; my principle is that ones own body knows better than the experts. But men usually tolerate a glass of wine with dinner very well indeed, and I think its benefits are more essential for them than for estrogen-sufficient women.)

WARNING: if you take oral estrogens, be aware that alcohol increases the levels of estradiol. In the next issue well discuss the recommendation that women on oral estrogens drink no more than half a glass a day.

Source: Facchini, M. Light to moderate alcohol intake is associated with enhanced insulin sensitivity. Diabetes Care 1994; 17: 115-19.

LESS KNOWN SYMPTOMS OF HYPOTHYROIDISM

I hope you all know the major symptoms of hypothyroidism, so common among postmenopausal women: low basal body temperature, chronically cold hands and feet, yellowish tinge to the skin, physical and mental sluggishness, low metabolic rate resulting in weight gain and low energy. But the symptoms of hypothyroidism are myriad. Dr. David Williams, a well-known holistic practitioner, points out that a metallic taste in the mouth, for instance, if not related to a medication, can be an indication if hypothyroidism. So can chronic morning headaches, puffiness of the upper eyelids, and thick mucus.

Hypothyroidism is perhaps the most undertreated hormone deficiency, especially among postmenopausal women. It has been linked to incorrect estrogen metabolism, poor immunity, and a higher risk of breast cancer. "Chronic fatigue" often stems from both hypothyroidism and adrenal insufficiency.

Progesterone, DHEA, and testosterone are all "thyroid helpers," and may be enough when the hypothyroidism is very mild. Aerobic exercise also increases the conversion of T4 to T3 (but the exercise should not be overly stressful). When you are truly hypothyroid, however, life can be quite miserable until you find the right physician.

In my sad personal experience, and judging from the accounts of other women whove written to me, a typical endocrinologist is a disaster when it comes to diagnosing and treating hypothyroidism. You need to find a doctor who understands that as we age we get less and less efficient at converting T4 (thyroxine) to the much more active T3, and hence feel much better on a mixture of the two hormones than on thyroxine alone.

The Broda Barnes Foundation recommends Armour, since it also provides T2 (whose function is not well known, but it may be important) and calcitonin, which helps prevent bone loss. My endocrinologist immediately denounced Armour as "slaughterhouse product." I had to search for another doctor. I firmly stated that after 20 years of being miserable on Synthroid I simply wasnt going to take it anymore. Ive been on Armour for 2 years now, and love the energy. I never knew I could have so much energy! And my skin isnt yellow anymore. I used to think that it was genetic.

Yet the very first day I took my first dose of Armour, in mid-afternoon I noticed not only that my hands got warmer, but also that a certain rosiness started creeping into my cheeks . . .

Dosing is critical, since T3 is very powerful in stimulating the heart, and an overdose can be dangerous. A good doctor will start you fairly low, and give you frequent blood tests at first. Its worth it.

BUTT ATROPHY? (MALE)

While hiking in Onion Valley (Eastern Sierra Nevada, CA), we chatted with a young backpacker who said, "We have a 70-year-old in our group, and he has real trouble carrying his backpack. No butt."

Those gluts are a great undersung asset to both men and women. Generally, the more muscle, the more youthful the metabolism. Thanks to their higher metabolic rate, for instance, muscular individuals burn more calories even while resting, so its easier for them to resist weight gain. But the sad fact is that unless correct hormone supplements are used, muscle atrophy takes its toll.

Between the ages of 50 and 80, the average untreated person loses up to 40% of his or her muscle mass. Among women past 80, its not unusual to be so weak and atrophied that lifting a loaded grocery bag is out of the questionor even tightening the faucet all the way.

Women are often unaware of muscle loss at first because its covered up by the increase in fat. The good news is that estrogens help maintain muscle mass. For men, testosterone hardly needs promotion when it comes to muscle building. And yes, lifting weights definitely works too. For the elderly who have already lost a lot of muscle, growth hormone may be needed.

Returning to our buttless hiker, hes in luck. Androderm is being vigorously promoted, with the slogan "Aim for the physiological ideal." Glossy ads feature graphs showing no increase in PSA. How different from the dumb Climara ads that stress how convenient and "invisible" the estradiol patch is, as though women were concerned that their menopausal status would be detected, and put that ahead of their health.

While Androderm is probably a fine option, your mate can get the same benefits at a fraction of the price by ordering T gel or cream from a compounding pharmacy, and not have to worry about skin irritation, common with the patch. WIP currently charges $17.21 for a months supply, regardless of strength. Now thats a bargain for muscle and bone maintenance, not to mention cognitive and cardiovascular benefits (yes, T improves a mans blood lipids). The effects on libido are well-known.

Some men cling to the illusion that aerobic exercise such as running will keep them physiologically youthful and muscular forever (just as many women naively believe that taking calcium pills will save their bones). While there is no doubt that runners stay in much better shape than couch potatoes, a study of 2000 male runners, published in the May 1997 issue of American Journal of Clinical Nutrition, found that even the most dedicated runners still developed the "spare tire" as they agedexcess fat around the middle, the bad fat associated with increased risk of heart disease and other degenerative disorders.

After the age of 50, the runners tended to lose weight while keeping the "spare tire"a sign of muscle atrophy.

The percentage of lean body mass (muscle and bone) is considered one of the most reliable biomarkers of aging. For both men and women, the prescription for maintaining lean body mass in spite of aging is the same: correct natural hormone replacement and weight-bearing exercise.

CONTRACEPTIVE REGIMEN THAT PREVENTS PERIMENSTRUAL MIGRAINES

In menstruating women, 60% of all migraines occur during the perimenstrual phasejust before, during, and just after a period. When estradiol levels fall too low, so does brain serotonin, and this apparently destabilizes the vasoconstriction-vasodilatation mechanism, leading to vascular headaches in susceptible women.

While most doctors appear clueless about how to deal with perimenstrual migraines and other common "female complaints," our wonderful CyberDigest gynecologist, Dr. Joseph McWherter of Fort Worth, Texas, has found the solution to perimenstrual migraines: dont level estrogen levels drop too low! Dr. McWherter writes, "My basic regimen for perimenopausal women with menstrual migraines especially if not on a BCM is to take Ovcon 21 days on and stop for 3 days instead of 7. The 3 days off they then apply a 0.05mg estrogen patch (Estraderm). At no time does the estrogen level suddenly drop below that magic setpoint which can induce headaches. This regimen is successful almost 95% in a properly selected population."

OvCon is the "feel-good" birth control pill, the only one which gives women that radiant high-estro feeling, which probably has a lot to do with high serotonin levels. OvCon differs from other brands in not having a more favorable estrogen: progestin ratio. This results in better mood, more energy, better skin, and fewer side effects in general. My only concern is that like other brands, OvCon makes the breasts sore (though actually less so than some other brands, perhaps because there is less water retention; reactions are very individual and vary). I wonder if this breast soreness could be eliminated or at least alleviated through the use of natural progesterone.

If progesterone alone works for your headaches, you are very lucky. It never worked for me, not even if I took as much as 1gwhile a bit of Estrace works like magic.

Lets make sure all women understand the principle of migraine prevention:

keep brain serotonin above a certain level by keeping estradiol above a certain level. In other words, if you are prone to migraines, you mustnt let your estradiol drop too low. Keep it as steady as possible by using some form of slowly diffusing dermal E, or by taking Estrace (or generic equivalent) in SMALL, FREQUENT DOSES (4 x/day seems to work). You cant imagine how happy I am to be free of migraines after decades of misery. And now I see that it was possible to feel great and be migraine-free even before menopause! Please spread the word. Thank you, Dr. McWherter, for sharing this valuable information.

IN DEFENSE OF DR.ROBERT WILSON

Menopause has been defined as "puberty in reverse." What has been given to you in your teens in now taken away. Breasts and genitals atrophy; erotic female curves give way to a thick-waisted, pot-bellied unisex figure.

Hair loses its sheen, eyes their sparkle, the mind its sharpness. Cheeks go from youthful roundness to that sunken, haggard look as subcutaneous fat leaves the face. Even lips seem to atrophy, losing their fullness and color.

Gynecology textbooks, in the few pages they devote to meno, use terms such as "ovarian failure" and "senile vaginitis." I will never forget my horror when I read: "The menopausal woman is a physiological castrate." After I recovered from shock, I realized that this was just an objective statement of fact, but the horrible dryness of it still makes me wince.

Its been observed that gynecology textbooks are written by men for men, and womens feelings are of no concern. This makes Dr. Robert Wilson, author of "Feminine Forever," stand out even more. Wilson noticed that women SUFFERED during menopause.

He didnt dismiss them as neurotic empty-nesters, as so many Freud-influenced physicians of his day did (even hot flashes were considered by many to be imaginary and "neurotic" until they were proven to be an actual physical phenomenon sometime in the 1970s, when someone decided to measure the womens temperature while they reported having a hot flash. PMS, cramps, and post-partum depression were of course also classified as psychological disorders, a bad case of penis envy.).

Wilson pointed to the cause of the meno symptoms and of the rapid aging that followed, and proposed a solution. I am not sure that 30 years later we can fully realize how revolutionary it was to define the menopausal woman not as neurotic, not as hysterical, not as a penis-envying female-role rejector who was trying to castrate her mate by losing her libido, but as estrogen-deficient.

These days its fashionable in some circles to bash Wilson. There is a reactionary school of feminists who reacts very badly to the term "feminine." You might call them "anti-feminine feminists." If its the female hormones that make women feminine, then meno is a liberation from femininity.

(Note how contemptuously Dr. S. Love writes about the "domesticating hormones," and how she presents meno as a return to the state of zest and self-confidence of an 8-year-old girl. Basically, she sees femininity as "estrogen poisoning.")

Not infrequently, Wilson is downright demonized as the man who defined menopause as a hormone-deficiency condition and thus supposedly opened women to further exploitation by the medical-industrial complex.

Sadly, even the proponents of HRT tend to dismiss his achievement, and nobody seems to point out that he dared to have vision and compassion. He dared to take meno seriously as a legitimate medical condition, and do something radical about it. But right away his view wasnt just the elimination of meno symptoms. It was an anti-aging approachthats why he insisted on life-long use.

You call also say that his was a "pro-sexual" approach. "Must women tolerate castration?" Wilson asked. He saw how traumatic the loss of sexuality and secondary sexual characteristics was to the older woman.

While Ive certainly met women who insist that they cant wait for sex drive to disappear, most do appear tremendously distressed by the loss of libido and lubrication. Wilson saw that the problem was hormonal, not psychological, and there simply was no need to suffer.

(To be fair, its only recently that depression in older menthe "grumpy old man" syndromehas been linked to testosterone deficiency.) Wilson was by no means the first clinician to use ERT. Previously, though, its use was pretty limited. Margaret Mead, for instance, persuaded her doctor that she needed estrogen shots for "circulation," and thus managed to get ERT for some 12 years. Wilson suggested that every woman needed supplemental estrogen, that the supplementation begin as soon as deficiency is detected, and be continued indefinitely.

Its also striking that Wilson kept saying that a woman has a RIGHT to full vitality and sexuality, has a right not to suffer from deficiency symptoms, has a right to enjoy life regardless of age. In a sense, he insisted on womens rights long before the womens movement, though his definition was more fundamental, being biological, and designed to correct the cruelties of biology.

Its amusing to us today to see the amount of space Wilson devotes to trying to reassure the reader that taking Premarin wont make women "immoral." And yet . . . have the times changed that much? There are still plenty of people, some well-known feminists among them, who appear to be very uncomfortable with the idea of a woman in her seventies or beyond still having sex drive. In an older man, thats admired, strong libido being since times immemorial a marker of male vitality; in an older woman, libido is still often seen as indecent, out of place. Wilsons belief in a womans right to sexual pleasure at any age seems extraordinary to me.

Wilsons approach was primitive in the light of todays knowledge. Through no fault of his own, he didnt understand that meno means a multi-hormone deficiency, and that unopposed Premarin (horse estrogens) is not the optimal replacement. But one cant expect advanced knowledge in a pioneer. For some women, Premarin seems to work pretty well, and after taking it for 30 years or so (this includes Dr. Wilsons wife) they are straight-backed, energetic, and sharp-minded.

Studies have shown that such long-term users tend to have much less tooth decay, arthritis, Alzheimers, heart disease, stroke etc. The youthful looks of some of these octogenarians are pretty stunning (hence perhaps Loves rather desperate ploy of classifying HRT users as the type of person whose attitude is, "I dont care what the studies say, women on estrogen look younger to me.") Good looks bring us back to the question of femininity. To the sneering question, "Do you really want to be feminine forever?" I say an unhesitating yes. Would it ever occur to anyone to ask a man, "Do you want to be masculine forever?"

To view femininity as "estrogen poisoning" and heterosexual sex drive as a disease finally cured by menopause is surely pathological thinking. Isnt this like being both Jewish and anti-Semitic? I dont believe women are empowered by the notion that their hormones are carcinogenic and psychologically debilitating.

When Dr. Wilson wrote "Feminine Forever," he dared to suggest that femininity has a great value and is worth preserving. In an even more revolutionary way, he put himself against the tradition of seeing menopause as the gateway to the "autumn of her years," or the "twilight" to which women should accommodate without complaining. He claimed that far from being twilight, menopause should be the high noon of a womans life. And why not?

From the start, Wilson belonged to what I call "the menopause left." His position was that you didnt wait for the woman to suffer; you gave her hormones as soon as she needed them, in order to PREVENT the consequences of hormone deficiency.

The "menopause right" is best exemplified by a woman who told me, "We should not interfere with the aging process." While she never explained why not, I could not help noticing the large number of herb extracts and homeopathic remedies stashed in her house.

Now this somehow correlates with Loves horror of human estrogens, coupled with the recommendation of feeding large amounts of soy products to young girls in order to have the soy estrogens differentiate breast tissue. Because of his vision, courage, and compassion, I see Dr. Robert Wilson as one of the greatest modern physicians. And by the way: whos going to write "Masculine Forever"?

Lynne writes:

About Wilson: I vividly remember reading his book as a teenager. Now in retrospect, it seems even more impressive and revolutionary. I cant imagine why you think I would object to your defense of his position. I havent run across any (not one) anti HRT feminists. But I also havent read Susan Loves latest bookonly her long piece in the New York Times. I dont quite understand how anyone would think the disabling (sexually, intellectually, physically) of women would make them better.

Growing passive as our hormones decline does not make us superior females, taking control of our fate does. And this idea that its Natures plan to not have a libido drives me nuts (but thats part of this whole bogus philosophical position). If Susan Love (or her co-writer) claims this, this is yet another place Love and I part company.

I dont think the phrase, "anti-feminine feminists" quite captures their position. Loves position falls within a tradition of thought broader than the sex hormone therapy field. Femininity means different things to different people (though I agree language is not a personal medium) and I have had this discussion with friends about the word "feminine." Some feminists think it means "weak"but not many.

Loves conceptual faction falls within a whole breed of philosophical Naturists whose position does not bear scrutiny when taken to its logical extension. Are we supposed to let disabling symptoms take their course, whether or not the word "disease" is used? Why take vitamins then? Why buy good food? Why exercise beyond your profession?

(If Im a writer and get on a treadmill, am I treating the sedentariness of my profession like a disease?) Isnt exercise a contrivance if you are not a farmer or some other active profession?

It is no defense of women to let them decline as their hormones wane.

Though, for sure, not all women seem to need HRT. But for the majority of us who want to perform at our bestLove insults us by calling what were doing, "treating a disease." Feminism is essentially about, is it good for women or is it bad for women? If hormones just made us feel better or feel sexy ---and had no other redeeming value, they would be good for us.

And why does Love think (she did this on TV) eating a lot of soy isnt "treating" menopause. Like I said, the position of the philosophical Naturalists doesnt bear scrutiny. Dr. Wilson understood thisyou do what you can, where you can to feel vital.

Ivy, this was intended as a short note. I think what youre writing about Wilson is super! Nobody else saw womens symptoms as a simple hormone decline back then. They attributed it to the basic flawed character of the female sex to go nuts at 45. Wilson was a feminist, no doubt about it! My only reservation is about calling Susan Love and followers anti femininebecause I think their slipshod logic falls into the larger Let Nature Be school of thought I have discussed. Their thinking is so backward. Even in the nineteenth century, feminists yelled, "Biology isnt destiny! Biology is history!" They werent going to let anything get in their way of feeling active.

Also: Dont you think male HRT will be a requirement in ten years and the whole issue will disappear as a feminist issue? At my holistic docs office (a large facility) all the males working there (about 20) take testosterone and some of them are barely forty. Ive seen several male friends and relatives go into a decline in recent yearsthe expressions on their faces are deflated even making them look smaller.

One of the worst cases, my friend Walter, would pull a Susan Love and say, even if it were true (T deficiency) it was meant to be. But then this a guy who thinks microwaves and dishwashers are unnatural.

Ivy replies:

Lots of wisdom and insight hereand what great lively style. I hope Lynne continues to contribute to CyberHealth.

As for the idea that female hormones prevent a woman from achieving her full human potential, what physiological nonsense! The brain relies on estradiol for many of its functions; in the male brain, testosterone is aromatized to estradiol. Women are sharper around ovulation, as confirmed by research; also, some women (including my mother) report great surge of creativity and intellectual energy during pregnancy.

When menopause started, it felt as though I'd lost half my I.Q. The main reason I use hormones is so that I can function intellectually. Cardiovascular and other benefits are dandy, but believe me, the impact on brain function would be enough for me. Without hormones, it's not that I feel less female; I feel less ME. *

Starr, a feminist leader in Santa Monica, CA, writes: "Let's appreciate our bodies without distortion. The history of feminism is the history of confronting one prejudice after another. Let's confront, examine this long bias against our bodies. Let's have feminism that's not reactionary--not in reaction to the patriarchy but grounded in our own bodies. Long live estrogen!"

Ivy replies:

How refreshing to hear this in a testosterone-worshipping culture. Its true that testosterone builds bigger muscles and makes one prone to more aggression (when combined with stress hormones), while estrogens make a woman smell sweeter, behave more calmly under stress, be verbally quick-witted, socially perceptive and intuitive, and communicate well. Women need to become aware of the many effects of their dominant hormones, to learn just how phenomenally powerful and magnificently health-giving estrogens really areI think that knowledge would be very empowering.

I also appreciate Starrs distinction between REACTIONARY FEMINISM and the kind of feminism that affirm being female and celebrates the female body, female beauty, and female mystery; that doesnt seek to be less female, castrated and sexless.

* * * * NUTRITION RESEARCH * * * *
KEEP ON CHEWINGAS LONG AS THE GUM CONTAINS XYLITOL

The good news for people who like to chew gum is that sugarless gum sweetened with Xylitol seems to reduce tooth decay. Xylitol has been found to inhibit the Streptococcus mutans bacteria which cause cavities.

Of course just bathing your teeth in abundant saliva helps prevent cavities. Thus chewing anything sugarless helps. So does estrogen replacement, since estrogens increase salivation, ending the dry mouth that many women experience after menopause, and consequent tooth decay and tooth loss (tooth loss can also be related to facial osteoporosis).

A two-month study in Finland, reported in the British Medical Journal (1996; 313:180-84), found that children who chewed Xylitol gum twice a day had dramatically fewer ear infections than children who chewed sugar-containing gum. The authors concluded that Xylitol helps prevent ear infections.

That is possible, but I would like to point out that sugar suppresses the immune system (via excess insulin), and thus the high rate of ear infections in children chewing sugar-containing gum might at least partly reflect this immune-weakening effect.

Also: this generation of baby-boomer women, now entering menopause, is not going to tolerate the image of a toothless little old lady, soaking her dentures in a glass beside her bed, any more than they are willing to end up with a dowagers hump. Maintaining good amount of saliva is crucial, as is a healthy sugar-free diet.

* * *

GREAT QUOTATIONS: LOUISE HAY ON THE VALUE OF LIVE FOOD

"The cells in your body are living and, as such, need living food to grow and reproduce. My basic philosophy on food is: If it grows, eat it; if it doesn't grow, don't eat it. Fruits, vegetables, nuts, and grains grow. Twinkies and Coca-Colas do not grow. Thing that grow nourish your body. Manmade, processed foods cannot sustain life. No matter how inviting and beautiful the picture on the package is, there is no life within that package!" This is something to remember if you find yourself in the cereal aisle, say. No matter how appealing the package, THERE IS NO LIFE WITHIN THAT PACKAGE.

Before your hand reaches for Puffa-Puffa rice, remember: this is dead food. When you eat a stick of celery, on the other hand, you are eating live cells, brimming with enzymes. You feel energized. After a meal that doesnt include any live food, on the other hand, many people feel so heavy and tired that they just want to lie down.

This problem increases after menopause, when hormone deficiencies, and consequently enzyme deficiencies, make digestion more difficult and abdominal bloating more common.

While a little Estrace or equivalent works wonders, often we still need extra help. Thats why its such a good idea to consume more raw foods, which provide fiber and enzymes.

Try it: something raw with every meal. Even one radish. A few slices of tomato and cucumber. A handful of sprouts. It makes an incredible difference.

TEA AND IRON ABSORPTION: PERIMENOPAUSE VERSUS POSTMENOPAUSE

Tea, both the black and the green variety, has gotten great publicity lately for its antioxidant properties. But few people know that it has yet another health gift to offer, particularly to men and to older women: it binds with iron. One cup of tea with a meal can block up to 75% of the iron in that meal.

While iron is essential for hemoglobin synthesis, too much spells trouble, since iron can act as a pro-oxidant. Pro-oxidants promote heart disease and cancer. (Excess copper can function the same way; so can rancid vegetable oil.)

Only women who have heavy periods and strict vegetarians need to worry about getting enough iron. Now, perimenopause is notorious for heavy periods from hell. Women sometimes become anemic. While I recommend progesterone, bioflavonoids, and Advil, (or even, if all else fails, the birth-control pill if you can tolerate it), until you get the bleeding under control you may want to go easy on tea (and coffee and alcohol).

If you are postmenopausal, its best to err on the side of caution and not use any multi supplements which contain iron, or eat iron-enriched foods (also a sign that these are processed carbohydrates). Some experts suggest donating blood on a regular basis in order to lower the bodys iron reserves. And remember that tea, coffee, and wine all lower the absorption of iron from food.

Q&A Corner

ANTIOXIDANTS AGAINST AGING: REALITY CHECK

"Kreatio" asks me to comment on how aged Durk Pearson and Sandy Shaw look in their recent pictures, despite the fact that they gobble heaps of antioxidants in an effort at "life extension."

Apparently no matter how many pills we swallow, there is a limit to how of anything much the cells can absorb. More important seem to be the antioxidant enzymes such as SOD, which decrease with age. It is certainly important to take antioxidants and other nutrients in order to help prevent disease, but obviously this is not the magic answer to aging. What impressed me is the youthful looks of a handful of scientists who have been on DHEA for more than a decade. I am NOT saying that DHEA is the magic bullet, and I suspect that it works vastly better for men than for women, but my impression is that hormones and enzymes are more powerful resources in slowing down aging than heaps of pills.

Both DHEA and estrogens, by the way, are potent antioxidants, as is melatonin. But these hormones have many other beneficial functions in addition to being antioxidants.

By all means do continue taking your vitamins and selenium! Just dont expect too much from that alone.

Calorie-restricted diet is another life-extension powerful tool. Since I certainly couldnt go around semi-starved, I recommend instead a high-fiber, carbohydrate-restricted diet which keeps you satisfied while reducing the calories you absorb.

Between calorie-restriction and DHEA, which is more important? Well, Roy Walford and Bill Regelson are about the same age, but Regelson (DHEA) could pass for 50, while Walford looks pretty aged and awful, in my opinion.

Maybe if he at least wore a toupee, one wouldnt think right away of the victims of concentration camps.

Also he seems to be a grumpy old man, which in my experience indicates a testosterone deficiency. A great scientist, dont get me wrong, (OK, a grumpy great scientist), and of course we should all eat less, but I dont think his is a practical solution.

While DHEA seems wonderful for men, I have a feeling that the right estrogen replacement is primary for anti-aging effects in women. Ive seen a few women whove been on Estrace or Premarin for a long time (including two whove been taking hormones for over 20 years), and there is no question that they look dramatically younger than their non-user peers.

Straight-backed, energetic, sharp-minded, they have beautiful skin to boot! Hormones, antioxidant nutrients, probably calorie restriction in some form (high-fiber diet appears to be the equivalent of a calorie-restricted diet), and moderate exercise are about the best we can do for now, though I am sure that the coming decades will bring more anti-aging developments. We are still in the beginning stage of life-extension revolution, barely getting to be scientific about it. We already realize that there is no single "fountain of age": given the complexity of our physiology, its no surprise that only a multi-level approach makes sense.

The government doesnt seem interested in funding longevity research, and drug companies make money off disease, not healthso progress is relatively slow, with conventional medicine, the FDA, etc constantly trying to hamper it and scare the public away from hormones and supplements until we have the results of long-term controlled trials (which for the most part arent even funded and begun yet). Believe me, it hurts me to say that because I would love to see those controlled trials and have more definite answersbut also know that if we wait, well all be in our graves before the FDA deigns to grant its approval.

"LET THEM EAT CAKE": THE COFFEE-CAKE PARADOX

Linda writes: "After reading what you wrote about carbohydrates i.e. breakfast cereal, I understand why a bowl of low-fat flakes always left me feeling hungry and shaky. Oatmeal must be different. I find a bowl of hot oatmeal with almonds and a few raisins is my bodys favorite (though I still wish cream-filled coffee cake was healthy! Unlike after the "dead cereal," I do feel fine and can easily last till lunch on a breakfast of donuts or coffee cake)."

Ivy replies:

The hungry and shaky feeling is a sign of hypoglycemia: blood sugar falls too low after an initial surge, which brings on an insulin surge. In a hypoglycemic state, your cells are starved for energy and scream for more food. Oatmeal is very rich in fiber, and fiber slows down the entry of glucose into the bloodstream. Almonds provide protein and healthy fat, further balancing the meal.

As for the coffee cake, it at least balances the carbohydrates with fat, so that again the entry of glucose into bloodstream is slowed down. And if the cake is made with eggs, you get some protein too. Cheesecake would probably work even better.

(Interesting: I was just reading about athletes greater endurance on a high-fat diet than on a high-carbo diet.)

While I dont recommend cake, almost anything is better than the ready-to-eat "dead cereal" out of a box. So Marie-Antoinettes immortal words do have a certain ring of truth after all.

One difference between her times and ours is that back then bread was made with leavening, and was in effect a fermented product, with various beneficial nutrients and enzymes that result from natural fermentation.

Todays mass-produced bread is junk food by comparison. Its not the bread that our forefathers ate and called the stuff of life.

A Japanese friend of mine said that she tried the American-style cereal-based breakfast, but it made her sick. "Something was missing," as she put it. Intuitively she knew about dead food vs live food.

So every day Noriko has a big bowl of salad for breakfast, with a small can of tuna thrown in, and whatever vegetables she may have left over from last-nights dinner, and no skimping on red onion, tomato, or olive oil either. While visiting her in Boston, day after day I watched Noriko make her breakfast salad in under 5 minutes, and eat it with great gusto in even less time, without even bothering to sit down.

Year after year, Noriko remains splendidly slender, smooth-skinned, and a crackerjack of energy and health!

Remember, live food gives you energy. Real food. Food from the earth, not from a package.

But if oatmeal works for you, fine. Listen to your body, the best health expert you have.

* * * BEAUTY CORNER * * *

FOR LUSCIOUS LIPS, SUCK YOUR FINGER HARD UNTIL YOUR CHEEKS HURT A LITTLE

Not your thumb. Your index finger works a lot better for this exercise. I didnt used to believe in facial exercises. They seemed mere hideous contortions that would in fact CREATE wrinkles. Then I came across Carole Maggios "Facercise." I thought, OK, Ill try just one exercise. I picked the one which promised fuller lips. I saw the difference in 3 days. After one week, I was astonished by the results.

Postmenopausal women, especially those who dont use hormones, begin to lose not only their waistline but also their lips. Its a sad fact that lips get thinner with age. Look at the lush, full lips of young women; now look at the thin, faded lips of the elderly. Lip atrophy? It progresses in parallel with skin atrophy.

There seems to be something specifically estrogenic about a womans lips, just as there is something androgenic about mens more prominent chins. A womans fuller lips are a sexual signal, a secondary sexual characteristic. So sufficient E replacement is necessarynot just the minimum it takes to eliminate hot flashes (aim for at least 100 picograms; this way you get cardiovascular benefits; everything else is gravy).

But a woman can go beyond maintenance. Just as ballet dancer develops a beautiful strong body through daily exercise, so too, surprisingly, you can "build up" your lips. Carole Maggios exercise is amazingly effective.

Here is what to do:

• Wash your hands
• Put your index finger into your mouth
• Suck on it as hard as you can
• As you suck, slowly slide your finger out of your mouth
• Rest a bit, then repeat until your cheeks are just too tired from the workout. This is hard work! But fun.

An easier version of this exercise is simply puckering up. Or pretend you are blowing out a candle (make a wish!) The fastest results come from the hardest workoutsucking your finger hard until your cheeks hurt a little. But you have to put real energy into it.

You can of course combine puckering up with doing the pectoral lift. Keep puckering up while driving or waiting in checkout lines. I guarantee that IF you do this exercise on a regular basis, your lips WILL get fuller and also more pink. The "parentheses" of laugh lines should smooth out a little (if you feel too much "dry" pull along the laugh lines, apply rich moisturizer on that area before you do the exercise). Your whole lower face will benefit from improved circulation and more muscle development.

Also, its uncanny how energizing facial exercises arenot just locally.

They seem to wake up your brain.

CARE OF THE SOUL
H.D.s vision of the divine feminine

The poet H.D. (Hilda Doolittle, 1886-1961) belongs to the modernist generation of Pound and Eliot; D.H. Lawrence was influenced by her work. Her poems didnt particularly move me until I came across "Eurydice." In the myth, Eurydice doesnt really have a personality of her own. Bitten by a serpent, she dies, and is almost rescued from Hades by Orpheus, who fails her at the last moment.

H.D.s Eurydice expresses her anger at Orpheus. She also discovers that she doesnt need a male savior; she has her own resources.

Its not relevant whether or not D.H. Lawrence was H.D.s betraying Orpheus; it usually takes an accumulation of disappointments and betrayals before a woman wakes up to her own power. As Marion Woodman, a noted Jungian psychologist, writes, "For many women raised in a patriarchal culture, initiation into mature womanhood occurs through abandonment, actual or psychological."

In her later years, H.D. in "Tribute to Angels" turned to explore the image of the Madonna, and found it not quite the image of the divine feminine that a post-reproductive woman (pardon the emerging menopausal jargon) would find satisfying. She describes her own vision of the Goddess:

"Psyche" means both butterfly and soul in Greek.

What thrills me is that this divine feminine figure does not carry a child; she carries a book, "the unwritten volume of the new." The poet identifies her not as Sophia, Divine Wisdom, but as the liberated Psyche (butterfly/soul).

Lets celebrate the fact that postmenopausal women ARE different. They are almost a different species. They dont have periods. They dont have mood swings. They dont have PMS (except those on wrong HRT). They dont have worries about getting pregnant. They dont have worries that a heavy period will spoil their camping tripor their trip around the world.

They may grieve over the loss of youthful beauty, but generally they need no longer worry about sexual harassment or about being appreciated only for their looks, not their abilities or accomplishments. On the right, continuous NHRT, they have steady energy and good cheerand the enormous female strength and wisdom accumulated over the years. All this begs to be put to a larger use.

I am not saying that life becomes idyllic. Just finding the right doctor and establishing optimal hormonal regimen can be major hassles. We do not effortlessly trade PMS for PMZ. But ultimately a new self does emerge.

Gloria Steinem observed that women become more radical as they get older.

Many seem to live by the motto, "Frankly, my dear, I dont give a damn"about the old fears and restrictions.

It is the Psyche, out of the cocoon. It is time to fly into the new.

SPIRITUAL WISDOM

Trained to be nurturing, women often neglect to nurture themselves. Women rarely need to be reminded to do good "unto others." They need to learn to be equally kind "unto themselves."

If you find that its difficult for you to give yourself as much love as you normally give to your mate and children, try these affirmations:

• The more I give to myself, the more I have to give to others.
• I love myself. I take loving care of myself.
• I am a loving parent to myself.

Consider also this statement: "You will do unto others as you do unto yourself. Be loving toward yourself and you will be loving toward others."

Coming up in the future:

• How to slow down brain atrophy
• The geography of longevity
• Estrogens and exercise
• Look to ethnic cuisines for the prevention of breast cancer
• Undroop those eyelids
• Revisioning Lots wife

Books by Joanna, a.k.a. Ivy Greenwell

This newsletter is presented as a free service for women and healthcare professionals interested in women's health. Publication schedule is irregular. To subscribe, please contact me at nhrt@worldnet.att.net The material contained herein is intended as information only, and not as medical advice.