 Menopause and diet. Why what you eat matters more than you probably think. Now interestingly, menopause symptoms often don't occur in other countries. Why in the world would that be? Other countries, women go through menopause. Why don't they have the same problems that we do in the United States? Well, I'm going to suggest to you that it actually comes down to their gut microbiome. So let me explain. Menopause, as most of you know, pretty much is predicted on your period stopping or slowing down or changing. And I follow hormone levels in all my patients, both men and women. And in women, we can usually predict the onset of menopause or perimenopause by watching levels of FSH, follicle stimulating hormone, begin to rise and rise higher and higher. Follicle stimulating hormone is the signal for your ovaries to produce and pop an egg out. And if those eggs are no longer being produced, your brain keeps sending a louder and louder message to pop these guys out, and quite frankly, nobody's picking up the phone down in your ovaries. So it's a pretty good predictor that menopause is on the way. Now, one of the things that happens during menopause is that estrogen levels drop and usually drop dramatically. And in some women, that drop of estrogen is accompanied by variously called vasomotor symptoms, better known as hot flashes. In some women, probably less than 5% of my patients, we also see evidence of brain fog, of different personality traits during this time. And interestingly, sometimes very tiny amounts of cutaneously applied estrogen resolves the problem without even having detectable estrogen levels in the blood. But as estrogen falls, this is often accompanied by these periods of hot flashes. Now, why doesn't it happen in some countries? And interestingly, when I interview people in little towns in Italy or France, asking them what it was like going through the change, most of the time I'm greeted with, what are you talking about? One day I was having periods, the next day I didn't, and life goes on. And they really don't complain about our complaints. So why would that be? Well, in the upcoming book Gut Check, I talk quite a bit about the type of gut bacteria that is now classified as the astralbion. That is gut bacteria that are capable of manufacturing various hormones like estrogen, like progesterone, even testosterone, or actually modulating how estrogen is manufactured and degraded. Now, a lot of recent information would suggest that it's the health of the astrabalone that actually determines whether or not you're going to have these vasomotor symptoms, whether you're going to have these potential mental changes, or whether you're not. And it may get more interesting than that. Let's back up for a second and realize that estrogen is crucial for both women and men. Yes, men, you do want to be in touch with your feminine side, and yes, you will have measurable amounts of estrogen in your blood, just as women do. Interestingly, we joke that the older we get, the estrogen levels of men go higher than the estrogen levels of women. And the testosterone levels of men in our society go lower and lower. So the joke is the older we get, the more a man becomes feminized and more a woman becomes masculinized. Now, that's a joke, but we should realize that that fluctuation occurs. Now, one of the reasons that this has occurred, that gut bacteria, can actually produce enzymes that are called glucuronidase, and these enzymes can actually decrease or increase circulating estrogen. The other thing that I find most of my post-menopausal female patients don't realize is that their fat cells are actually capable of producing both estrogen and testosterone. And many of my post-menopausal women are shocked when they have measurable levels of estrogen in their bloodstream, even though they haven't had a period in two years. Particularly shocking is when a woman develops breast cancer and that breast cancer is estrogen-sensitive, and we find that in fact they have measurable levels of estrogen in their blood, which absolutely shocks them because they're in menopause. And yet it's the estrogen that's produced in fat cells and now modulated by the astrobalome, these estrogen-modulating bacteria in our gut that are controlling all this really kind of silently and out of sight. It may also explain why a lot of women go through menopause without any of these symptoms because they have bacteria that modulate a low dose of estrogen production throughout their lives, and that may be good in one way. Now, in a paper just out this week, there's a fascinating new study looking at flaxseeds and flaxseed lignans. Lignans are compound in flax oil and in other substances that we've known for a very long time modulate both breast cancer and prostate cancer. In fact, many times breast cancer patients and prostate cancer patients are prescribed high lignan flaxseed oil as a part of the treatment or in many cases as a way of preventing, mitigating against breast cancer or prostate cancer. Now, we've never really quite understood what it is about these flaxseed lignans that do the job. Well, in a brand new paper, American study of microbiology journal just this week showed that the gut microbiome eats flaxseed lignans and produces microRNA, sometimes called mRNA. And I spend a lot of time here in Gut Check talking about microRNA that's derived from the gut microbiome. And as shockingly as it seems, we now know that microRNA, the messaging system, telling DNA, telling cells what to do, can come from the microbiome, can be absorbed through an RNA intestinal tract, and then activate or deactivate cells. And the exciting part of this paper was that the gut microbiome uses those flaxseed lignans to manufacture microRNA that then prevents breast cancer cells from developing. So now we have once again a link between a plant compound that we knew was doing something, but we didn't know how it was doing it. And lo and behold, like I keep saying, it all comes back to the gut microbiome. It's just like the polyphenols in plants. We know that polyphenols are very poorly absorbed, and yet we knew how important they were. And lo and behold, it was the gut microbiome that wanted polyphenols as prebiotics that then turned those polyphenols into active ingredients that then communicated to our cells and our mitochondria. So again, hot new topic, flaxseed oil has lignans. If you buy flaxseeds, please buy them whole, get a coffee grinder, put them in whatever you're eating, your sheep yogurt or goat yogurt or coconut yogurt, put them in a smoothie, sprinkle them on salads, or even buy high lignan flaxseed oil. Now, are there other ways that have been found to help with perimenopausal symptoms like hot flashes? Well, as you probably know, there are a number of soy-based ingredients out there that are shown to bind to estrogen receptors. Now, it's a controversial area. There is some evidence that the estrogen-like substances in soy bind estrogen receptors but prevent the activation of estrogen receptors in cancer cells. There are other studies that suggest just the opposite. My advice is, since soy does contain lectins, that there's probably better alternatives out there than soy-based products. One of the ones that I like a lot is borage oil. Now, some of you have probably heard about evening primrose oil as a treatment for hot flashes and menopausal symptoms. That's because evening primrose oil has a compound called gamma-linolenic acid, GLA. But borage oil has two to three times the amount of GLA than evening primrose oil. So for your money, you're much better off using borage oil. Now, borage oil has been shown in some controlled studies to improve vasomotor symptoms of menopause, perimenopause, and in other placebo-controlled studies, it's not been shown to be very effective. Now, gamma-linolenic acid is part of the Omega-6 family. But what's interesting about it is it's used to manufacture prostaglandin E. And prostaglandin E has been shown to mitigate against vasomotor symptoms, also been shown to improve the symptoms of rheumatoid arthritis. So there is some definite evidence that it's well worth a try. Now, the great news about borage oil is you can buy it in capsules. And what I recommend is you try 1,000 milligrams twice a day. There's some studies that suggest maybe 4,000 milligrams is the magic number. But in my patients, we usually use 1,000 in the morning and 1,000 at night. And see how that does for you. It's not going to hurt you, but you may find there's definitely a benefit. The more we learn about the gut microbiome, the more we learn about how everything that's going to happen to us, even at the hormonal level, is being controlled by minute one-cell organisms that live in your gut. And the secret to a life well worth living is taking care of your gut microbiome and they'll take care of you.