rec-woman-sleeping-Stockbyte-thinkstockphoto-4-30-12-mdQ:  My sleep problems started after age 30 and grew worse as I became a mother. I wake in the night and have difficulty getting back to sleep. Why do we have a harder time sleeping as we age, and what can I do?

A:  One of the biggest causes of sleep-maintenance insomnia is faulty blood sugar control. Anytime blood sugar levels drop rapidly, it causes the release of adrenaline and cortisol. If this situation occurs when we are sleeping, it causes us to wake up and makes it difficult to get back to sleep. The best approach is to work to reduce blood sugar volatility during the day by eating a low-glycemic diet, avoiding foods that cause a big elevation in blood sugar levels—such as high-sugar foods or too large a portion of starchy food. I also recommend taking a highly viscous dietary fiber supplement such as PGX, guar gum, or psyllium before meals to help stabilize blood sugar levels throughout the day and night.

Q:  There is so much misinformation out there about hormone replacement therapy. I’m surprised that I still have friends taking HRT. Is it worth the risk?

A:  Despite clear evidence that there is significant risk with HRT, there are still many women going this route. The use of HRT was supported by most physicians until 2002, when the National Institutes of Health halted a major clinical trial of HRT in postmenopausal women because the risks were too high. The study concluded that the risks of taking estrogen and progestin in combination, including an increased risk of stroke, coronary heart disease, and breast cancer, outweighed the potential benefits of the therapy. The number of women using HRT dropped significantly after the study. Not surprisingly, there was a parallel sharp decline in the rate of new breast cancer cases—a number that prior to 2002 had been climbing steadily. But it is a sad fact that approximately 30 million prescriptions for HRT are still filled each year—about a third of what it once was, but still too high.

The natural approach to coping with the symptoms of menopause focuses on improving the woman’s physiology through diet, exercise, nutritional supplements, and botanical medicines. In particular, several nutrients have been shown in clinical studies to be effective in relieving hot flashes, including fish oils, hesperidin (a flavonoid) in combination with vitamin C, pine bark extract, gamma oryzanol (a compound in rice bran oil), and vitamin E. Black cohosh (Cimicifuga racemosa) extract is the most widely used and thoroughly studied herbal alternative to hormone replacement therapy in menopause.

Published issue: 2013 March-April —S&H

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