Q: First of all, thank you so much for all the help you have given me over the past year.  Last January, I read your book ‘Fat Around the Middle’ – I was skeptical at first, but the case study could have been written about me and I implemented your suggestions with fabulous results.  I feel the best I have for years, but I would still like to maintain my weight and, if possible, reduce it even further. 

However, my problem is that I have difficulty maintaining control when the first ‘strictest’ 3 months of the programme were complete.  When the guidelines are very strictly prescribed I am OK, but when the guidelines are relaxed, I tend to have more and more frequent lapses i.e. eating chocolate etc. 

Do you have any suggestions?  I would very much appreciate any advice on how to moderate these binges.

A: Thank you for your kind words and glad to hear that it has made such a difference not only to your weight but also your health. 

There are some people who actually do better if they have strict guidelines because otherwise when the limits are taken away they don’t eat so well.  There would be no problem in carrying on with the same first three month programme all the time.  It contains a good variety of food and it would not be unhealthy to do so. 

If though you would really like to expand the food out more without the lapses then the best way to do this is to have a proper ‘cheat day’ once a week.  You would then know that it is only on that day that you would have chocolate etc and you keep to that agreement with yourself.  So in a way you give yourself permission to lapse but only on that one day a week, that way it is controlled and you won’t have the frequent lapses.

Q: I am 50 and went onto a daily supplement programme for 3 months following the health detective report. The night sweats and insomnia disappeared, I felt more rational than I had done for a while and in generally better health. The programme came to an end in December 2007. 

 
I’m now on the keeping healthy programme (for over 40 yrs of age) and the night sweats and insomnia have returned to some degree. While I know from experience that while even small amounts of caffeine and alcohol do not help, if I avoid them completely the night sweats in particular can still occur. Is there anything from the daily supplement programme that I should go back to help with this, please?  I would appreciate your advice.

 

A: With the daily supplement programme that you took for three months you had a good multivitamin and mineral supplement (MenoPlus), vitamin C, linseed oil, B complex, zinc citrate, Garcinia cambogia, a black cohosh formula (Black Cohosh Plus) and a bone supplement. You are now taking the keeping healthy programme which is just the multivitamin and mineral, linseed oil and the vitamin C.

As the menopause transition can take a while and you have noticed that the night sweats and insomnia have come back since changing the programme I would suggest that you add back in the black cohosh formula (Black Cohosh Plus) first to the keeping healthy programme. This may be all you need to add in to see the difference that you first felt. Stay on this for another three months and then gradually, taking it a week at a time, reduce the capsules from three a day to two a day and then one a day. This weaning process will allow you to see whether you don’t need them anymore and also whether you need on stay on say two a day for another month and then reduce down to one.

As women we are all different and will experience the menopause in different ways so you will be able to judge the effects of the herbs and how much you need to take. If the black cohosh formula is not enough on its own, then add back in the B complex but if you add in the black cohosh first then you will know whether you need the B complex or not. You don’t want to take supplements you don’t need or to have extra expense. If you are not sure then you could always repeat the health detective. 

Q: I am 56 years old and have been on HRT for nearly six years now and I would like to come off it, what is the best way to do this?  Also can eating phytoestrogens be used to help me come off HRT?

A: The question I am most asked is ‘should I just stop HRT or should I come off it gradually’? You should talk to your doctor about your decision to come off HRT and have any check ups that might be needed. My recommendation is always that a gradual weaning process is actually going to be easier on your body. Stopping HRT suddenly is similar to going ‘cold turkey’ and there have been reports of ‘rebound’ effects from the quick withdrawal of the hormones. The rebound effects can actually give tremendous hot flushes and seemingly worsened menopausal symptoms. 

 

It is better to take three months to gradually wean yourself off HRT. Ask your doctor for a lower dose and if you cannot reduce the dose of the HRT, you could switch to a patch. Because the patch delivers oestrogen through the skin and does not have to be broken down by the liver first, you can get by with a lower dose than if it is taken by mouth. Alternatively, you could use an oestrogen gel, rubbing in smaller amounts of oestrogen each time. Remember, though, that the dose of the progestogen must not be altered if you are on a type of HRT that stimulates a withdrawal bleed. It is important that this happens each month until you come off HRT entirely. 

 

During that three month weaning process, you would then start to introduce phytoestrogens (like soya, chickpeas, linseeds etc) into your diet so that when you stop the HRT you are cushioned by plant oestrogens already circulating in your system and any effects from stopping the HRT should be minimal. If you need extra help then you can use herbs like black cohosh (see Black Cohosh Plus on Resources page). For more information on the menopause see my book ‘The New Natural Alternatives to HRT’.