When Ann Louise Gittleman wrote "Super Nutrition for Menopause" in 1992, the popular press was just beginning to explore the "change of life."
In her most recent book, Gittleman addresses a related subject. Perimenopause is "a naturally occurring transition before the change," she writes in "Before the Change: Taking Charge of Your Perimenopause" (HarperSanFrancisco). Although menopause is associated with a drop in estrogen, a decline in the hormone progesterone brings on perimenopause.
In the book, Gittleman suggests diet changes, exercise tips and natural supplements to alleviate the symptoms--depression, fatigue, headaches, hot flashes, irritability, memory problems, water retention and weight gain.
"When everyday occurrences start to magnify, coupled with [disturbed] sleep patterns, depression and the blues for no apparent reason, look for hormonal changes as an underlying cause," she says.
A nutritionist in private practice and the former nutritional director for the Pritikin Longevity Center in Santa Monica, Gittleman stresses the importance of eating a balanced diet during this time.
Fat is a key element of such a diet. This may seem a strange order, given Gittleman's work at the Pritikin clinic, which promotes eating little fat. But the nutritionist says she has seen the effects of extremely low-fat diets in her private practice. When people drastically reduce fat, they often replace it with too many carbohydrates, especially simple starches.
"Fat-free eating has affected us all," she says. "Not only has blood sugar become problematic, but [eating too many carbs] has created bingeing and craving."
"I stress balance," Gittleman said from her Bozeman, Mont., home. "Don't go to extremes on anything. Add back some almonds or flaxseed oil. Use a great salad dressing--a bit of olive oil is heart-healthy."
Gittleman, who advocates an eating plan of 40% carbohydrates, 30% protein and 30% fat, says women also have cut back too radically on protein.
Proteins help to stabilize blood sugar and provide even, steady energy. Simple carbohydrates, especially in the form of sugar and processed foods, cause blood sugar to rise and fall quickly. "You won't have food cravings if the diet is balanced and the blood sugar is balanced," she says.
"If a woman has gone off eggs with the notion that they will raise cholesterol, add them back. Have [small amounts] of protein at every meal." She recommends free-range eggs and chicken, fish such as farm-raised salmon, which is rich in heart-healthy Omega-3 fatty acids, beans and low-fat cheese.
Exercise also can help a woman to look and feel better. Gittleman suggests 30 minutes of vigorous exercise five days a week. Walking just a mile a day can help reduce a woman's risk of losing bone density as she ages, the author points out in the book. Housework and gardening count as exercise as much as walking, cycling or swimming.
In the book, Gittleman discusses natural remedies and alternatives for hormone replacement therapy, diagnostic tests and how a woman can be an advocate for her health.
"A lot of baby boomers don't want to take [synthetic hormones] because of the risk of breast cancer," she says, although physicians receive the most information about these prescription medications from pharmaceutical companies. While researching "Before the Change," Gittleman says she found studies on natural hormones such as estriol, which she describes as "the forgotten hormone."
"There are wonderful references, especially in medical journals, about [natural hormone alternatives]," she says. "You don't need a doctor who already knows [about the subject]. If they're willing to learn and to research along with you, (the patient and the doctor) become co-creators of your health."