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How Women Can Overcome Memory Loss at Midlife and Beyond

An interview with Elisa Lottor And review of her book, Female and Forgetful, a six-step program to help restore your memory and sharpen your mind

April 2002

By Ivy Greenwell



Female and Forgetful is a pioneering book that dares discuss a subject that not long ago was taboo: the cognitive dysfunction that is specific to women in midlife and beyond. The sharp drop in hormones around the time of menopause is one of several causes of the acute worsening of memory and attentiveness, but natural hormone replacement is only a partial (though very important) remedy.

The mainstream medical approach addresses only the hormonal deficiency, and very poorly at that. It ignores crucial factors such as low blood sugar, excess stress, malnutrition, lack of circulation-boosting exercise and specific brain-protective nutrients. Elisa Lottor, PhD, ND and Nancy Bruning, the authors of Female and Forgetful, warn that the mainstream medical approach is too limited to save your brain. Nor is there a single supplement that can by itself act as a "magic bullet." Neither estrogen alone nor, say, ginkgo biloba as the sole treatment, is likely to resolve the problem. A multi-level holistic program is needed. The authors proceed to outline the six steps of a program that addresses every major cause of cognitive dysfunction.

Why women tend to suffer more cognitive problems as they age

A title like Female and Forgetful may arouse some criticism as politically incorrect. It's all right to discuss hot flashes, night sweats and mood swings; all women have heard of these common menopausal symptoms. It is also all right to discuss bone loss. But memory loss? Female and Forgetful provides example after example of how devastating this memory loss can be. When menopause starts and women suddenly can't remember not only the professional information that used to be at their fingertips, but even their own phone or Social Security number, or one day simply forget to pick up their kids after school, they panic. Some women worry it's Alzheimer's. Many ask, "Why didn't anyone tell me?"

Lottor and Bruning know that until the silence and the denial are broken and the problem confronted, needless suffering will go on. Next to physiology, political incorrectness is irrelevant. While acknowledging that men's memory and other cognitive functions also decline with age, the authors make a compelling case for the existence of a somewhat different and more acute cognitive dysfunction that affects women.

Female and Forgetful presents the findings that women suffer a greater aging-related loss of neural tissue in areas of the brain related to memory and visual and spatial abilities (men suffer more atrophy in areas related to thinking and feeling). Even more uncomfortable issue is the well-known female predominance in dementia. While men's hormone levels decline gradually, women undergo a sharp drop in hormones at menopause (and also after giving birth). In addition, drugs such as Lupron or tamoxifen are likely to cause "brain fog." Worst of all, many middle-aged women still undergo the ordeal of total hysterectomy, also called "surgical menopause"-and no one tells them that serious memory loss can be one of the side effects.

Women are also more likely than men to suffer from thyroid deficiency, the authors point out. Hypothyroidism has many symptoms, and cognitive impairment is among them. Nutritional deficiencies may be another factor: unlike men, many women are malnourished chronic dieters. Perhaps most important, modern women are also under exceptional stress, and stress is a major culprit in cognitive dysfunction. Other factors specific to women include higher frequency of depression, chronic fatigue, poor circulation and low blood sugar. Lottor and Bruning address these points in detail.

The authors use riveting examples from Dr. Lottor's clinical practice to show that the problem of menopause and aging-related memory loss in women goes far beyond the embarrassment of having a "senior moment." For professional women such as lawyers or teachers, the loss of reliable recall and lower ability to concentrate and follow a track of reasoning can be downright devastating. Such women are already under tremendous stress, and the additional stress of trying to conceal the cognitive impairment only feeds the downward spiral. The authors explain how chronic stress leads to neural damage, particularly in the hippocampus, a part of the brain essential for memory. They also explain how the brain cannot function without sufficient healthy fats, or good blood circulation. Point by point, Lottor and Bruning outline what needs to be done to regain better memory, learning and concentration.

Dr. Lottor's six-point brain-boosting program

Image with Caption
The section on exercise is
not at all the rehash of
typical advice we've been
hearing for decades.
Female and Forgetful
singles out mid-body
exercises as particularly
valuable for brain function,
especially in the area of
attention and concentration.
Martial arts are an example.
For the less energetic
among us, there is yoga
and tai-chi

Stress reduction is one important part of Dr. Lottor's program. She also suggests nutritional changes ("food for thought"), various nutritional and herbal supplements, hormone balancing and regular exercise, both physical and mental. This multi-level program reflects the fact that there is rarely a single reason for memory loss, and likewise there's rarely a single simple solution. "In my practice, it's often necessary to keep on digging, trying various therapies and combination of therapies before hitting upon the right approach," Dr. Lottor states. The challenge is to shift from an unhealthy, brain-killing mode of living to one that is health-giving and brain-friendly.

Nutrition receives special emphasis in the book. Our understanding of nutrition has become much more complex in recent years. Dr. Lottor stresses that there are good fats and bad fats, good carbohydrates and bad (processed) carbohydrates. Food has an enormous impact on your brain health. Protect your brain with phytonutrients and omega-3 fatty acids; avoid processed food and any foods to which you may be allergic, the authors suggest. The section on hypoglycemia will be especially enlightening to those women who can't understand why they feel so confused and forgetful sometimes as soon as two hours after eating a meal that is rich in processed carbohydrates. Likewise, some women still need to learn that "colas and other soft drinks are much worse than coffee."

The usual objection to supplements is that they are too expensive. To this Dr. Lottor responds, "How much is your mind worth?" Bargain brands may be ineffective. To protect the brain, the authors suggest high-potency antioxidants, including lipoic acid and CoQ10, and acetyl-l-carnitine and glutamine, SAMe and phosphatidyl serine. Of special interest is the little-known information about the ability of phosphatidyl serine to synergize with ginkgo, and about its mood-lifting effects when a higher dose is taken.

Another interesting fact that the book provides is that heavy metals can interfere with cognitive function. Selenium, usually thought of only as an anti-cancer supplement, also happens to be "brain-healthy." It is one the supplements that can help detoxify heavy metals.

Among the B vitamins, vitamin B12 is extremely important, the authors explain, since B12 is a co-factor for the production of acetylcholine. In fact, B12 deficiency may result in symptoms resembling Alzheimer's disease. Many elderly suffer from B12 deficiency, and can profit greatly from sublingual supplements (in middle-aged and elderly individuals, B12 is poorly absorbed). Folic acid is another indispensable brain-boosting supplement, with dramatic effects on cognition and mood.