Most of the concern about the safety of nitrates has arisen from epidemiological data on their potential to form N-Nitrosamines; these are thought to be cancer causing and also responsible for causing “blue-baby” syndrome. However, one must be careful in evaluating the data and when drawing any conclusions. Let us review the data for both these concerns. i) Blue-baby syndrome (methemoglobinemia) One case back in the 1950’s caused considerable sensation when a baby’s hemoglobin was thought to be compromised by supposedly excessive nitrates in well water and converting the hemoglobin to a form that was not able to transport oxygen easily.
Menopause is a normal, natural and inevitable event that affects all women reaching middle to late adulthood. In a very basic sense, menopause occurs as a result of aging. Changes in the structure and function of the female ovaries lead to a drastic drop in estrogen levels and permanent cessation of menses. Unfortunately, its associated symptoms can make this process quite uncomfortable for many women and can negatively impact their social life, psychological health and overall well- being.1
The most common concern in postmenopausal women are hot flashes; these cause an episodic feeling of heat, intense sweating
The most common conventional treatment used to address the concerns of menopause is hormone replacement therapy (HRT). While this therapy may provide relief for symptoms such as hot flashes and night sweats and protection against bone loss, evidence exists to suggest that HRT may also increase the risk of heart attacks, coronary attacks, strokes and even breast cancer. An online survey of 166 menopausal women showed that 27% of respondents stopped or didn’t use HRT at all because of these safety concerns.5
With all of this in mind, it’s no surprise that menopausal women experiencing discomfort want safe and alternative solutions. The good news is that there are many effective options. Let’s take a closer look at some of the best alternative therapies available for the most common menopausal symptoms:
Exercise has long been considered a beneficial treatment for easing the transition into menopause, most notably through reducing the frequency and intensity of hot flashes. It is proposed that the exercise-induced production of beta- endorphins (the “happy” chemical associated with a sense of euphoria) combats the natural decrease in β-endorphins seen with decreasing estrogen levels in aging women.6 These peptides act on many areas of the brain and ultimately may help to stabilize the thermoregulatory centre of the hypothalamus, an area crucial to temperature regulation.6
Multiple studies have reported that physical
activity has positive effects on
various menopause-related symptoms and overall health. As many people are aware, these improved health outcomes include better cognitive function, sleep patterns, mood, bone density, cardiovascular function and energy levels.6 Observational studies confirm this notion.
In a survey of over 66,000 menopausal women in Italy, those that reported the lowest level of regular exercise were significantly more likely to experience more severe symptoms such as hot flashes.7 A 2012 study found that symptoms of anxiety and depression experienced by menopausal women could be alleviated by a controlled physical exercise regimen.8
A 2008 study examined the effects of physical exercise and HRT on “health-related quality of life” (HR-QOL) in 44 post-menopausal women. Only three hours per week of moderate aerobic exercise led to an increased HR-QOL and decreased severity of menopausal symptoms (including hot flashes, insomnia, nervousness, headaches and joint pains) after a period of six months. While the groups receiving only HRT and no exercise showed similar decreases in menopausal symptoms, they did not experience the similar increase in HR-QOL that exercising women exhibited.2
Finally, there is also strong evidence that menopausal symptoms such
It’s no secret that diet affects many aspects of our health. Menopausal symptoms are no exception to this rule and many women have seen firsthand that dietary factors can influence menopausal symptoms for better or for worse. A 2013 prospective
Findings of this study identified one specific type of diet that appeared to aggravate menopause symptoms, and two diet types that decreased the risk of menopause symptoms. Diets high in fat and sugar noticeably worsened hot flashes, while diets higher in fruit and diets closely resembling a Mediterranean diet (greater proportions of garlic, peppers, mushrooms, salad greens, pasta and red wine) appear to be protective of the same symptom. Diets high in meat, dairy and vegetables did not show any trend in either direction.11 Other studies have also found that high fibre and low fat intakes may be associated with reduced menopause symptoms.11
Many other modifiable lifestyle factors that are closely tied to diet
have shown to be risk factors for increased vasomotor symptoms as well. Specifically, women with a higher body mass index (BMI, a measure of body weight relative to height) are at an increased risk.11 A 2012 study actually showed that menopausal women who lost 10 lbs or more through increased fruit and vegetable intake and reduced fat intake were more likely to eliminate their hot flashes and night sweats completely after one year.12 Interestingly, many women who adopted this new dietary regimen but did not lose weight also found some benefit in the form of reduced hot flashes and night sweats. This shows that dietary interventions and weight loss both independently improve these menopause concerns.12
As a final note on dietary and lifestyle factors, women who smoke cigarettes regularly and those with
Black Cohosh (also known as Actea
1. Shapiro M. Menopause practice: a clinician’s guide.. 4th ed. Mayfield Heights, Ohio: North American Menopause Society, 2010.
2. Moriyama C et al. A randomized, placebo-controlled trial of the effects of physical exercises and estrogen therapy on health-related quality of life in postmenopausal women. Menopause 2008;15(4):613–18.
3. Wylie-Rosett J. Menopause, micronutrients, and hormone therapy. Am J Clin Nutr 2005;81(suppl):1223S-1231S.
4. Huntley Aand Ernst E. Asystematic review of herbalmedicinal products for the treatment ofmenopausalsymptoms. Menopause 2003;10(5):465- 476.
5. Pitkin J. Alternative and complementary therapies for menopause. Menopause Int 2012;18:20-27.
6. Daley A et al. Exercise for vasomotor menopausal symptoms (Review). The Cochrane Library 2011.
7. Di Donato P et al. Factors associated with climacteric symptoms in women around menopause attending menopause clinics in Italy. Maturitas. 2005;52(3-4):181-9.
8. Villaverde G et al. Influence of exercise on mood in postmenopausal women. J Clin Nurs. 2012;21(7-8):923-8.
9. Bedell S et al. The pros and cons of plant estrogens for menopause. J Steroid Biochem Mol Biol. 2013.
10. Joshi S et al. Effect of yoga on menopausal symptoms. Menopause Int. 2011;17(3):78-81.
11. Herber-Gast G and Mishra G. Fruit, Mediterranean-style, and high-fat and -sugar diets are associated with the risk of night sweats and hot flashes in midlife: results from a prospective cohort study. Am J Clin Nutr 2013;97(5):1092-9.
12. Kroenke C et al. Effects of a dietary intervention and weight change on vasomotor symptoms in the Women’s Health Initiative. Menopause 2012;19:980–8.
13. Ross MR. A stanbdardized isopropanolic black cohosh extract (remifemin) is found to be safe and effective for menopausal symptoms. Holist Nurs Pract 2012;26(1):58-61.
14. Volker V et al. Black cohosh: just another phytoestrogen? TRENDS in Endocrinology and Metabolism 2005; 16(5): 214-221.
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