Perimenopause

Q: I am 45 years old, in the perimenopause phase. I suffer from fatigue and other symptoms. I would like to take DHEA but am open to other alternatives. What would you advise?

 

A: Most, if not all women are deficient in DHEA by the time they are in their 40’s. However, a woman’s need for this hormone is less than a man’s. The typical recommended dose for women is 15 mg in the morning, though many women take 25 mg to 50 mg of DHEA for its mood-elevating effects. In addition to DHEA, topical progesterone cream is recommended to mitigate symptoms of fatigue, irritability, depression, memory loss and severe PMS. According to Dr. John Lee, author of What Your Doctor May Not Tell You About Menopause, many of these symptoms are the result of a progesterone deficiency, which can be remedied by using progesterone cream. In the British Medical Journal [1985 June1;290(6482):1617-21.], a double-blind crossover trial showed that maximum improvement occurred in the first month of treatment with progesterone. ProFem cream contains 30 mg of progesterone per 1/2 teaspoon. The general recommended dose is 1/2 teaspoon applied twice daily to a different fatty area of the body. It may take as long as two to three months for some women to see results. For more information, please see the Female Hormone Modulation Therapy protocol.

Q: I have started taking ChronoForte and am now considering replacing my multi-vitamin with Life Extension Mix. However, I note that the combination of ChronoForte and Life Extension Mix may give me high doses of biotin, zinc and selenium. What combination of products would you recommend so that I may obtain the appropriate levels of the Life Extension Mix ingredients plus the acetyl-l-carnitine, l-carnosine, nettle and alpha lipoic acid that I now get in ChronoForte?

A: The three nutrients you are concerned about-zinc, selenium and biotin-are not toxic at the levels that would be ingested if you took the total daily dose of Chronoforte and Life Extension Mix. These totals would be: zinc 50 mg, biotin 6 mg and selenium 300 mcg. Zinc is recommended at doses of 50 mg for poor night vision, wound healing and enhanced immunity; doses of up to 100 mg are recommended for prostatitis. According to the Journal of the American Medical Association [252 September 21,1984: 1443-1446], men who were given 150 mg of zinc twice a day showed no evidence of untoward side effects, though other studies show that no more than 100 mg of zinc should be consumed on a daily basis. Biotin is a water soluble B vitamin; toxicity in humans has not been reported. Biotin has been administered in doses as high as 40 mg per day without untoward effects. The optimum daily allowance for selenium is 200 mcg to 400 mcg for cancer prevention and 100 mcg to 300 mcg for heart disease. Various studies show that long-term daily selenium doses of up to 500 mcg to 750 mcg produce no signs of toxicity.

Q: Can I take Life Extension Mix with coumadin?

A: Certain ingredients in the Life Extension Mix, such as vitamin E and ginger, act as mild platelet aggregation inhibitors and should be used cautiously when taken with any anticoagulant prescription drug such as coumadin. Whether or not this will be a problem for you depends on many factors, including your blood density and what dosage of coumadin you are taking. Many people have taken Life Extension Mix with coumadin. Coumadin interferes with the coagulation factors that are dependent upon vitamin K, and Life Extension Mix does not directly interfere with vitamin K production. However, it is recommended that regular scheduling of Pro Time and INR blood tests be done as an aid in helping your doctor determine if it is safe for you to combine coumadin and Life Extension Mix.

Q: I was wondering if you could give me some specific information on alpha lipoic acid, as I have not been able to answer these questions with my own research. How can alpha lipoic acid be best absorbed, on an empty stomach, or with fat? What is the maximum dose that can be used before toxicity arises? How is it best taken, all in one go, or spread throughout the day? What is the half-life of alpha lipoic acid? Can it act as a pro-oxidant? If so, how? Are there any other nutrients that should be taken along with alpha lipoic acid?

A: Alpha lipoic acid is a potent antioxidant, which is both lipid and water soluble. It is a potent promoter of glutathione synthesis and an important cofactor in energy production, and helps to regulate glucose metabolism. Since it is lipid and water soluble it can be taken with or without food. However, given that alpha lipoic acid can cause gastric irritations in some people, it is best taken with food. German studies have shown that alpha lipoic acid has been used for peripheral neuropathy in doses of up to 1000 mg, with no toxicity. Since alpha lipoic acid has a short half-life, it is best taken in divided doses. It can help recycle other antioxidants, but whether or not it becomes a pro-oxidant depends on the oxidative state of the organism. Finally, according to Dr. Lester Packer, author of the Antioxidant Miracle, biotin supplements should be taken when the daily intake of alpha lipoic acid exceeds 100 mg. This is because it can compete with biotin and in the long run, interfere with biotin's activities in the body. Also, a study suggests that thiols, such as alpha lipoic acid, can split the carbon cobalt bond and destroy cobalamins. In normal healthy people this should not be a problem. However, if you are deficient in B12, you should considered taking a B12 supplement.

Q: Do you have any published studies to back up your statement that high-quality supplements are 100% bioavailable ("Vegetables Without Vitamins," March 2001, p. 32)?

 

A: No, we based that statement on new research showing that supplements frequently deliver more nutrients than food, and the notion that the nutrients in supplements are not bound to proteins that can impede absorption. However, while most definitions of bioavailability focus on absorption, there is another aspect to bioavailability. According to a different definition, the term bioavailability "encompasses the sum of impacts that may reduce or foster the metabolic utilization of a nutrient." (Schumann K, et al., Arzneimittelforschung 47:369.) Under this definition, facilitating the utilization of a nutrient (i.e., adding something that might enhance its utilization) is just as important as keeping out factors that could impede its absorption. Manufacturers of high-quality supplements try to do just that. For example, high-quality mineral supplements are chelated with the proper amino acid. Fillers that could impede the absorption of vitamins are left out. But although in theory high-quality supplements are 100% bioavailable, in practice we probably haven't gotten there yet. Therefore, we regret leaving the impression that all high-quality supplements are 100% bioavailable in practice. We're working on it.