Wednesday Bubble: It’s getting hot in here…
Hot flashes.
Does anyone really know what occurs in the body to cause the sudden surge of temperature, the licking of the of the internal flame and the momentary feeling that those droplets of sweat dripping down your face are doing NOTHING to alleviate the heat that is emanating from every pore of your body?
Evidently, researchers are coming closer to discovering the ‘why’ behind the flash. And the reason that this is so important is that when medical experts discover the why, they are then one step closer to figuring out how to fix it.
So, let me tell you what’s what.
As I wrote just last week, experts believe that hot flashes are related to a dysfunction in a process called ‘thermoregulation;’ this is the ability to keep our body temperature in a steady state, even when the environment changes. A decrease in estrogen levels, coupled with increased activation of the sympathetic nervous system (which assists in controlling the body’s functions and the fight or flight mechanism) narrows the natural comfort zone and tolerance for temperature fluctuations. Voila! A flash is born.
Hold on. In a new paper published in the open access Proceedings of the National Academy of Sciences, Dr. Naomi Rance from the University of Arizona College of Medicine explains that while the surface of the skin may feel hot during a hot flash, if one was to measure the internal core temperature, it is not even elevated. Rather, she and her team have identified a role that a group brain cells know as KNDy (kisspepti/neurokinin B/dynorphin) may play. These cells are located in an area of the brain — the hypothalamus — that controls metabolic processes related to the autonomic nervous system, including body temperature.
Dr. Nance and her team have only studied the KNDy neurons in rats so far, but what they’ve found is interesting: when they created a model to mimic menopause by withdrawing estrogen, they found that the KNDy cells response is extreme – they grow extremely large and manufacture greater amounts of neurotransmitters that communicate to the part of the brain that regulates body temperature. More communication equals more signalling that the body too hot and needs to release heat. The result? A hot flash and lots of vasodilation and sweating. But here’s the rub: when they measured the temperature of the tail skin in rats with normal KNDy neurons versus those who neurons were shut off, they found that their skin temperature was lower, even with the depletion of estrogen.
While these findings are not yet specific to women, they do show that the KNDy neurons appear to play an important role in regulating skin temperature and its reaction to signals that ‘it’s getting hot in here.’ Perhaps the silver lining is that if they can take it one step further and figure out how to positively control the KNDy cells in humans, they may be able to influence thermoregulation and literally stop those flashes before they start without affecting our real core body temperature.
Stay tuned!
Read MoreJust breathe
Want to reduce the frequency of your flashes?
Just breathe.
I’m serious. Just as serious as Mayo Clinic researchers who recently published a study about paced breathing in the online version of Menopause. If you are unfamiliar with the term, paced breathing refers to slow, deep breathing from the diaphragm.
Although experts are still unclear as to the underlying cause of hot flashes, they believe that they are related to a dysfunction in a process called ‘thermoregulation;’ this is the ability to keep our body temperature in a steady state, even when the environment changes. A decrease in estrogen levels, coupled with increased activation of the sympathetic nervous system (which assists in controlling the body’s functions and the fight or flight mechanism) narrows the natural comfort zone and tolerance for temperature fluctuations. Voila! A flash is believed to be born.
So where does paced breathing fit in? Here’s the interesting part: paced breathing decreases the activity of the sympathetic nervous system. So, when the nervous system goes into overdrive, paced breathing can theoretically calm the waters. However, as we go through our busy lives, is regular paced breathing even feasible?
To find out, 105 women were provided with either audio recordings of chimes that paced their breathing or were asked to simply breathe normally. All of the women reported having at least 14 or more hot flashes a week, and they also a history of breast cancer. Women assigned to paced breathing were asked to use their audio recordings either once or twice a day and practice taking 6 breaths per minute for 15 minutes. The other women practiced regular breathing (14 breaths per minute) for 10 minutes a day. All of the women kept a daily hot flash diary.
Over nine weeks, women who practiced paced breathing twice a day reported reductions in daily hot flashes by 52%. Paced breathing practiced once a day reduced hot flashes by 42%. What’s more, women who didn’t slow their breathing deliberately but simply focused on it 10 minutes a day reduced the frequency of their hot flashes by 46%; this suggest that focusing can help alleviate symptoms and that some sort of placebo effect is at play. Still, other studies have similarly reported reductions in hot flash frequency by as much as 50% using progressive muscle relaxation which also has a positive effect on the nervous system. In fact, I just wrote about relaxation and flashes last week.
Most of the women found it challenging to fit 30 minutes of paced breathing into their day, which suggests that perhaps intensifying the effort once a day can provide the same beneficial results. For the most part, there was some initial dizziness but it was mostly mild and likely the result of significantly slowing breathing; more practice would probably help to ameliorate this effect.
It seems to me that it is possible to move away from drugs and towards the body and mind to balance our internal thermostats. The bottom line appears to be that a bit of effort can potentially a long way towards solving a problem that has long eluded the medical community.
Just breathe.
Read MoreWednesday Bubble: Relax, just do it.
You think that hormones are the only solution to hot flashes?
Think again!
This is not the first time that I have reported that the mind-body connection is an important key to menopausal symptoms. Moreover, it probably won’t be the last. In fact, in a second study published within the past 18 months in Menopause journal, researchers are again moving away from hormones and moving towards applied relaxation. (A related study topic-wise can be found here.)
This time, Swedish researchers assigned 60 women in menopause to either ten sessions of group therapy combined with relaxation or to no intervention for three months. All of the women had been experiencing moderate to severe hot flashes at least 50 times a week. During the 10 group therapy relaxation sessions, the women were taught to methodically move through the body’s muscle groups and use breathing techniques to systematically relax each group. They were then provided with exercises to practice daily at home, with the the goal being to learn the relaxation method and self-manage their symptoms. During this period, all participants kept a regular hot flash diary and filled out a quality of life survey on three different occasions. They also provided the researchers with a sample of their saliva.
The findings? Women practicing daily relaxation and engaging in regular coaching sessions actually reduced their daily hot flash count from an average of 9.1 to 4.4 a day; that’s about a 50% reduction. In the group of women who had no interventions, a reduction in daily hot flashes was also observed but on average, these women experienced less than two fewer flashes a day; this is likely the result of what researchers consider a ‘placebo effect.’
More importantly, benefits of relaxation remained for at least three months after the study ended and the final therapy sessions. The women who practiced relaxation also reported improvements in overall wellbeing and quality of life, including sleep and memory. What’s more, saliva testing showed reductions in cortisol; as I’ve written previously, stress leads to cortisol release and ups the hot flashes ratio. Once that cycle starts, who knows how long the endless loop plays out?!
Time to stop the loop? Forget the drugs. Breathe deeply, exhale and repeat. Just do it.
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Wednesday Bubble: Soy takes a hit (again). But what about S-equol?
Soy is back in the news again, with newly published data suggesting that isoflavones may not be particularly effective when it comes to menopausal symptoms. But I can’t stress enough on this blog that sources are as important as substance; in other words, not all sources are equal and neither are the women who use these alternatives.
So, let’s talk again about S-equol. But first, a bit of context is needed.
We know that soy isoflavones, primarily genistein, daidzein and glycitein have been suggested as an effective strategy for combating menopausal symptoms such as hot flashes or night sweats. The beneficial effects of soy are believed to be associated with the ability to soy isoflavones to attach themselves to estrogen receptors. Importantly, our brains contain certain estrogen receptors in hippocampus, which is responsible for consolidating both short and long-term memory and spatial navigation. Moreover, both genistein and daidzein have been shown to have a particular affinity for the very type of estrogen receptors that reside in the hippocampus, which is why researchers have been so interested in determining if ingesting soy can help combat the natural decline in memory and cognition. While findings have been mixed, some women appear to be better metabolizers of S-equol, a metabolite of a major soy isoflavone called daidzein. It has a particular affinity for estrogen receptors and possesses some estrogen-type activity of its own. S-equol is produced in the GI tract however the ability to actually manufacture it depends on the presence of certain microflora. Consequently, only 30% to 60% of individuals are actually able to produce S-equol on their own (although this figure is believed to be higher among Asians and vegetarians).
I’ve been writing about S-equol for a number of years and you can revisit those posts here. Interest in S-equol is in part, related to its potential for augmenting the benefits of isoflavones; in fact, it is possible that women who are naturally producers of S-equol actually experience greater effects from soy products, and this is especially true when it comes to bone health. Hence, vasomotor symptoms — night sweats and hot flashes — aside, you may not want to give up on soy just yet.
So let’s talk bone health. It’s so critical as we age.Declining levels of estrogen are a primary cause of bone loss and resulting osteoporosis in women; indeed, one in five American women over the age of 50 have osteoporosis and about half will experience a fracture in the hip, wrist or spine as a result. What’s more, because osteoporosis is silent in its early stages, causing no symptoms, it’s critical that bone loss is halted or at least slowed either before or during the most critical phases strike. There is no time like the present to take preventive measures, even if you are in your 30s and 40s.
Where does S-equol fit in?
Last year, researchers demonstrated the daily S-equol supplements taken by women who are not naturally producers of S-equol, may improve bone metabolism and attenuate bone loss. And I reprinting this information because it’s too early for a soy verdict.
In this 1 year study of 356 healthy, postmenopausal Japanese women between the ages of 41 and 62, daily intake of 10 mg S-equol via supplement markedly reduced markers of bone resorption in blood and urine compared to women taking placebo pills or 2 mg or 6 mg of S-equol daily. In fact, in women taking the 10 mg dose for a year, declines in a urinary marker of bone resorption (i.e. DPD) were roughly 21% greater compared to placebo. Measures of whole body bone mineral density also showed that S-equol supplementation protected against bone loss, although not to the extent as bone resorption. These results remained even after changes in height, weight, body mass index, lean and fat mass were accounted for. No participant experienced serious side effects from taking S-equol and hormone levels were not adversely affected.
Does this mean that you should rush out and purchase S-equol supplements?
One of the primary limitations of this study is that the process of bone recycling can take as long as 18 months and the time required to complete a cycle may actually increase with age. Thus, the duration of time that the women were studied might be too short to draw any definitive conclusions. Hence, you may want to wait before you start taking S-equol. However, the evidence that’s building continues to put the weight on the benefits versus risks side. Only time will tell. Meanwhile – remember that the source of S-equol is important. If you are going to look for supplements, go for products that state that they are standardized on the label. Food sources, e.g. tofu, are always a good bet but again, not every woman will metabolize soy the same way. Still, here’s to yourhealth. Keep on doing all you can do to keep the faith and stay the course.
It ain’t over til the fat lady stops sweating!
Read MoreI put a spell on you: hot flashes and hypnosis
I have written about the potential of hypnosis for ameliorating troublesome vasomotor symptoms previously, although earlier studies have focused on hot flashes in relation to breast cancer therapy. You can find those posts, and links to earlier reports, here.
Personally? I like hypnosis.
I was hypnotized several decades back by a source for another story that I was writing and recall how relaxing it felt. This particular clinician focused on teaching patients the art of self hypnosis for use in speeding recovery from surgery and the like. But I digress..
Hypnosis for menopausal symptoms? Why not?!
In a study that appears online in the Menopause journal, Dr. Gary Elkins from Baylor’s Mind-Body Medicine Research Laboratory explores the potential of clinical hypnosis — described as a “mind-body therapy to facilitate a hypnotic state, coolness and control of symptoms” — in a field where the effectiveness of alternative strategies continues to be challenged by mainstream medicine.
He write that while menopausal symptoms like hot flashes generally start to decline 5 to 7 years after menopause, they may persist in some women for up to a whopping 20 years!!!! Moreover, non-hormonal pharmacological options, e.g. antidepressants and anticonvulsants may seem promising but between side effects and the need to comply strictly to dosing regimens, they may not be a viable or reasonable option for many. Additionally, in the early studies conducted in breast cancer survivors, clinical hypnosis led to as much as a 69% reduction in hot flashes over the course of these trials,findings that are comparable if not better than those seen in women taking Effexor or Paxil.
This time, 187 women who reported having at least 50 hot flashes a week (or seven a day) participated in clinical hypnosis or a training called ‘structured attention control’ five times a week for three months. Women who were hypnotized were given specific suggestions for mental imagery for coolness, safe places and relaxation with the goals of reducing hot flashes and improving sleep. Each session lasted 45 minutes and were recorded, so that the women could practice self-hypnosis at home. In the structured attention session, also 45 minutes long, each woman and a clinician discussed symptoms, exchanged personal information, received guidance on how to avoid negative suggestions and were encouraged. While these sessions not recorded, the women brought home a CD that provided information about hot flashes and were required to listen to it daily.
The findings are pretty impressive. Elkin reports that over the first 6 weeks, women receiving hypnosis had a mean decrease in their hot flashes of almost 64% compared to only 9% in women who had structured attention training. These reductions continued towards the end of the study, leading to a 74% decline in hot flashes compared to the beginning of the study (during the same timeframe, women in the second group only experienced overall reductions of 17%). The severity of hot flashes also significantly declined over the course of the study by as much as 80% among hypnotized women (and only 15% among the structured attention group). What’s more, when hot flashes were actually monitored by a scientific instrument (rather than self-reports) findings were still impressive, with almost a 57% reduction in hot flashes in the hypnosis group and only a 10% reduction in the structured attention group. These women also reported better sleep quality and that their hot flashes interfered less in their daily activities than previously.
Research into pharmacological therapies and alternative therapies confirm that there is always a placebo effect at play. With regard to hot flashes in particular, this placebo effect is evidently substantial. And, with regards to mind-body therapies in particular, some women are negatively predisposed to achieving results, and either are not willing to make the commitment that is necessary for them to work. However, this is not much different than any regimen; if you are not committed to the process, you probably won’t see the best results.
Elkin writes that they still don’t know why hypnosis might work for hot flashes, although it might have something to do with improvements in heart rate and blood pressure (via a process known as ‘parasympathetic tone’). However, if it works, do we really need to know how?
Got severe hot flashes? You might want to delve into that spell before you try drug therapy. If anything, you’ll come out feeling a heck of a lot more relaxed!
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Wednesday Bubble: Packing heat? Tips for the road…
Ladies, are you packing heat?! Seems like there are more of us everyday. In fact, although hot flashes will never come into fashion, they certainly drive fashion choices for many women. The rules of the hot flash road are fairly obvious:
- Keep it light – sure, it’s 25 degrees outside. But you want to be able to remove clothing without being left with nothing on but your birthday suit. Consequently…
- Wear layers – layers, layers, layers. They will be your saviour; trust me.
- Consider wicking fabrics – cotton is great but it can’t wick the wet away from your body when it need it most. Athletic gear is most famous for the more fashionable wicking clothing so if you can get away with a few items, at least on the weekends, go for it. Just stay away from butt messaging and the leisure suit look!
- Pack a change of clothing if you can – it never hurts to be prepared.
- Be prepared to cool down quickly with something like ColdFront – my friend Susie Hadas has invented an easy to hide, readily accessible, personal cooling system. When you’re packing heat, be sure that you’ve got ColdFront on demand.
- Lose the heavy baubles – talk about a sweaty, heavy load!
Got more tips that work best for you or additional instructions for other readers? We’re all ears!
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