Life Extension Magazine®

Issue: Apr 2002

How Women Can Overcome Memory Loss at Midlife and Beyond

An interview with Elisa Lottor and review of her book, Female and Forgetful.

By Ivy Greenwell.

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Elisa Lottor, the main author of Female and Forgetful, is a board-certified naturopathic physician who has been in practice for seventeen years. She holds a PhD in nutrition, as well as advanced degrees in homeopathy. Dr. Lottor is also an educator, lecturing on memory loss, menopause and the food-mood connection, as well as other health topics. She resides in Southern California. Life Extension interviewed Dr. Lottor on January 19, 2002, about her book and her practice.

Life Extension (LE): You are a naturopathic practitioner. Can you explain to our readers what naturopathic physicians do?

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Female and Forgetful
by Elisa Lottor, PhD, ND
and Nancy Bruning
Warner Books, 2002
Soft cover, 336 pages

Elisa Lottor (EL): While a chiropractor focuses on the spine, and an acupuncturist on energy meridian points, a naturopathic physician- takes a holistic approach, treating the whole person and looking at a lot of factors. I have my patients keep an exercise and diet journal, for instance. I ask about the stress in their lives. Counseling on issues such as coping with stress is included in naturopathic practice. Naturopathic physicians examine a patient's whole lifestyle before formulating a treatment protocol.

LE: What motivated you to write this book?

EL: There were several reasons.

Initially, a patient of mine-who had had a hysterectomy and was moderating an on-line hysterectomy support group-asked me to be the medical advisor for the group. I was answering hundreds and hundreds of questions, and noticed that the predominant theme was issues of memory and cognitive dysfunction. I began to realize that there was a groundswell of suffering women who are looking for answers-and what about all those women who were not accessing my website. I wanted to reach out to them too.

Secondly, I noticed that in my practice, a lot of women were complaining about memory problems. Initially, I thought it was a midlife issue. But I started seeing memory loss and cognitive problems in younger women as well. There is a growing silent epidemic of memory problems among baby boomers. Women are having trouble with their memory and don't know where to turn.

Another reason was that I was having my own issues with memory; entering menopause caused me to take an inventory of the factors that could be causing memory problems other than hormones, and these range from diet to stress. In my book I give quizzes so women can identify where their problems may be coming from, and what appropriate measures to take to solve their problems.

Although the book is a basic introductory approach to memory restoration and enhancement, I feel it gives some specific guidelines for addressing memory loss. I have seen simple things like dietary modification, beginning to exercise, and taking a multivitamin and mineral supplement have profound effects on the body. Sometimes a simple thing like balancing blood sugar can work wonders.

As 43 million American women begin to enter perimenopause, the issue of memory becomes more profound as the adrenals begin to take over making hormones. Many women suffer from adrenal exhaustion; consequently, their body is not doing a great job of making its own hormones. Some women eat high-fat diets, getting a lot of exogenous estrogen from too much dairy and animal proteins. Some women don't realize the causal relation between food and health, and the necessity of a healthy lifestyle.

I am not saying that my book is a cure-all, but perhaps if one idea causes an "ah hah!" reaction in some women and they take the ball and run with it, I have accomplished my goal. So essentially, my purpose in writing the book is to get the information out there to those women who can't come into the office.

LE: Can you share one of your many interesting case stories?

EL: Let me tell you about a woman who seemed to lead an exceptionally healthy lifestyle, and yet was having memory problems. Cat was a private trainer in a celebrity gym in Los Angeles. She seemed to have a perfect body, well-toned and with high definition. Like many people in the field of exercise, she was very concerned with her looks. She went overboard and eliminated one complete food group. I often see that, especially with the latest fad diets.

What brought Cat into my office was concern about her breaking and thinning hair and nails, dry skin and a change in her menstrual cycle. But more important, she was losing her short-term memory. She forgot appointments and would write clients' names in the wrong time and dates in her book.

When I began to review her food journal, I saw that she was so frightened of losing her body that she consumed virtually no fat in her diet. This was taking its toll, not only on her hair, skin and nails, as well as on her immune system and her menstrual cycle, but also her memory. She seemed to get one cold after another, and was skipping periods.

We spoke about including some good quality fats like olive oil or nuts and seeds, but I could see that she was not open to this, so I suggested taking fish oil capsules. She immediately noticed the difference. Gone were the aches and pains, and her periods became regular. She saw improvement in her hair and nails after several months, and her memory gradually improved. She then grew willing to include good quality fats in her diet.

Sometimes it's tweaking the diet in the area that is missing that can make a big difference, and sometimes it's making lifestyle changes such as lowering stress or doing more exercise.

LE: Which causes of memory loss do you find particularly prevalent in women?

EL: Low blood sugar and hormone imbalance are the most noticeable. Many women who come to see me are hypoglycemic or borderline hypoglycemic. They develop "memory fog" when they go a long time without food.

Some women need to eat every two hours to sustain adequate blood sugar. Some need to add more protein and fat to their diet to slow down digestion and prevent ups and downs in blood sugar levels. And some women need to take supplements such as chromium, vanadyl sulfate, cinnamon bark and B vitamins.

LE: You point out that thyroid deficiency often plays an important role in cognitive dysfunction. Do you find that many of your patients have insufficient levels of the thyroid hormones?

EL: Yes. A lot of them have thyroid deficiency. But the problem is difficult to diagnose because blood levels can be normal in the presence of symptoms that indicate a deficiency.

LE: Do you find that many patients still expect a "magic bullet" approach?

EL: This is an era of "instant everything." Many people expect an instant cure. Fortunately, some people realize that it takes a lot of searching and trying in order to see satisfying results.

LE: Even though the treatment must be individualized for each patient, are there a few herbs or supplements that you find especially effective for treating memory loss?

EL: I find that ginkgo is the most effective. Then I'd mention vinpocetine and phosphatidyl serine.

LE: Some conservative mainstream physicians still don't believe that it's possible to do anything to prevent aging-related memory loss, much less restore the brain to more youthful functioning. What kind of answer would you give them?

EL: What I would tell mainstream doctors is to check research and to check with complementary physicians like Dr. Julian Whitaker, Dr. J. Wright, and Dr. Khalsa, who have all done work in this area. In fact Dr. Khalsa has a clinic, and Dr. Whitaker wrote a book on the subject.

Review

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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

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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.

The section on herbs is especially interesting. While everyone knows about ginkgo and ginseng, there are promising new extracts such as huperzine A, bacopa, galantamine (derived from snowdrop or daffodil) and vinpocetine (derived from periwinkle). The book also includes brief information about drugs such as deprenyl and Hydergine.

When it comes to hormone replacement, this reviewer finds attention to thyroid deficiency, so common in midlife women, particularly praiseworthy. "I have found that thyroid hormone therapy may be a better choice than either progesterone or estrogen replacement therapy for some women who are experiencing menopause symptoms, including memory problems, cognitive changes and brain fog," Dr. Lottor asserts. She emphasizes that conventional blood tests for thyroid levels are often inadequate.

Lottor also favors the 24-hour urine collection for testing hormone levels. Likewise, she wisely recognizes the issue of individual variability when it comes to hormone replacement. "There is no single 'right' regimen for all women," she warns. Every woman needs to experiment under the guidance of a holistic practitioner in order to determine the type of replacement or hormone balancing best suited to her needs.

Finally, the section on exercise is not at all the rehash of typical advice we've been hearing for decades. Female and Forgetful singles out mind-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.

Chronic stress kills neurons

Professional women can't be reminded enough that stress kills. First and foremost, it damages and even kills nerve cells. If you want to enjoy good memory, you must "destress and streamline." Stress is causally implicated in almost all serious illnesses, and is especially devastating to women's ability to concentrate, learn and remember. "Overloaded and overwhelmed" has become the description that fits a great number of women, especially those who work two shifts: one at a full-time job, and a "second shift" at home, taking care of their families.

The section on "the stress cascade" reminds the reader that chronic stress means chronically high levels of cortisol, and high levels of cortisol are associated with damage to the hippocampus, the primary brain center for the formation of memory. When the levels of cortisol are chronically elevated, the hippocampus actually shrinks as the neurons die.

Stress also upsets a woman's hormonal balance, and can seriously affect the function of the ovaries in premenopausal women. Chronic stress also depletes the adrenal glands, further decreasing estrogen production, particularly in postmenopausal women. "If your adrenals are depleted, you will have a more difficult menopause, a more difficult transition, and perhaps your experience of memory loss and mental decline will be more obvious," the authors warn.

Why is stress reduction so difficult? It is easy to blame modern lifestyle and information overload. Lottor and Bruning go beyond the obvious. They point out that "in a sense, overloaded women can be considered 'stressoholics'. Like any addiction, the first step to recovery is to get past . . . shame and denial." It helps to remember that "the Chinese word for 'busy' is a combination of characters meaning 'heart' and 'death'. In other words, if you are too busy, you neglect your heart until it dies." A woman who wants to prevent mental decline needs to prioritize her tasks and, very simply, do less.

Modern women are the victims of the "having it all syndrome," Lottor explains. But one can't have it all; trying to do so will overstress the brain and impair memory. Paradoxically, doing less often means accomplishing more-as well preserving mental sharpness. And it starts with a "compassionate attitude of loving kindness toward ourselves," and a vision of long decades of healthy and productive later life, unmarred by a "fried" brain that has trouble with the simplest memory tasks.

While not a substitute for stress reduction, stress-relieving supplements are yet another helpful tool in the plan to de-stress and make your brain work better. Lottor discusses calming herbs such as kava-kava, valerian and chamomile.

The book also contains simple, practical suggestions on how to compensate for impaired memory so that the impairment itself does not become another stressor. Some of the suggestions are very simple. The authors explain how to do "chunking," for instance, grouping items together into categories or simple subdivisions. Note that telephone numbers are automatically "chunked" to make recall easier. There are many other tips here, some unexpected yet very effective.

Above all, however, the right philosophy of life is a must if you want to live long and well. The authors make a wonderful statement that seems to be the corner stone of stress reduction: "There's an elegance and grace in doing one task at a time." "And doing it slowly," this reviewer wishes to add.

For optimal cognitive function, an older woman needs to stop the insanity of multi-tasking and slow down. Lottor and Bruning point out that while older women may not have the speed of learning and recall they once had, they can compensate with depth. Young people have superior "fluid intelligence": they can deal with a rush of new information. But older individuals excel at "crystallized" intelligence. "Like our relationships, our comprehension and retention of information grows deeper, richer and more meaningful with maturity," the book wisely reminds. An older woman may never be able to recall trivial details as efficiently as a younger woman can; but an older woman can offer depth and meaning instead of speed, the most essential and meaningful details rather than trivia.

The work of many artists becomes simpler and bolder as they grow older, showing the ability to focus on essentials, the authors point out. They also cite research that found that young people remembered more details of a story than older subjects, but older subjects were better at remembering the gist of the story. They brain discarded trivial details, focused on the essentials and integrated them into meaning. Once again, "less is more."

Female and Forgetful is not only a "health book." It is also a book of wisdom, written with elegance and grace. The book contains this memorable quote from an older actress: "When it comes to aging, I think the single most important component is vision in the large sense-vision of your understanding the universe and yourself, vision of what you want to be." Fulfilling that vision depends on keeping your brain sharp. The authors show how to accomplish this essential task of protecting and nurturing our most important organ.

Strange as this may sound, the idea of taking good care of one's brain is a relatively new concept. Mental decline used to be seen as "normal aging," and supposedly there was nothing you could do about it. In fact, it used to be medical dogma that "if you live long enough, you'll get Alzheimer's." Yet people who practice a healthy lifestyle, including a brain-healthy diet, neuroprotective supplements, exercise and staying mentally active, appear to be significantly more resistant to mental decline and dementia. In addition, diets rich in vitamins E, beta-carotene and vitamin C, as well certain supplements such as folic acid, have been documented to lower the risk Alzheimer's disease. Studies also show that drugs such as ibuprofen and cholesterol-lowering statins may play a significant role in preventing Alzheimer's. Even humble aspirin appears to be neuroprotective, helping prevent the tiny strokes that can lead to dementia. Thus, the situation is far from hopeless. One can take a lot of effective steps to prevent brain disease. And that is a revolutionary concept.

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Lucid and warmly compassionate, filled with vivid case histories that will make women nod in agreement, Female and Forgetful brings hope and knowledge to readers striving to recover and preserve brain function. It can be done, the book says, but don't expect a "magic bullet." It takes a holistic program. Several things combined work better than just one thing. The caring tone of the book makes it easier to listen to that message without feeling that the authors are nagging us in any way, or proposing unrealistic solutions. These are gentle solutions; when combined, they can lead to very significant results.

This emphasis on an individualized combination of treatments represents the basic philosophy of the holistic movement. Holistic practitioners utilize the synergy of several treatments in several different modalities (nutrition, relaxation, exercise, supplements). Until our approach to most chronic problems becomes this kind of individualized combination of treatments, we remain in the medical dark ages.

This is an empowering book. Dr. Lottor states, "When you start my program, you start to pay attention to the most important organ of the most important person in your life-you." Women who fully assimilate this message can expect their lives to undergo a beautiful transformation.

-Ivy Greenwell