Thank you for this article. I’m an ApoE 4/4, lost my mom to AD and am trying to determine if I should start HRT, but I’m also a breast cancer survivor…I went through menopause nine years ago with very few side effects, so I hate the idea of introducing any by taking HRT or increasing my BC risk, but I want to protect my brain health. A LOT to consider here!
Hi Heather! I am so sorry for your loss and for the fact that you are dealing with these complicated factors. Consult with your oncologist first. Some women can start HRT after breast cancer after a certain amount of time has elapsed but that depends on the type of tumor and stage. But as you already know, the greatest brain benefit for HRT happens early in the menopausal transition. Late starters may not get the same benefits and are more likely to have complications. Would love it if you could consult with a neurologist about 4/4, too, to make sure you have all those boxes checked regarding the latest preventive strategies.
Annie, thank you for responding. And my apologies on your journey with your mom. It’s such heartbreaking experience. Since learning of my APOE status, I have been working with an MD and Bredesen-trained functional practitioner, whose helping me understand all the interventions I should be focused on— many of which relate to lifestyle. Do mainstream neurologists understand the APOE landscape from a prevention standpoint? I have no symptoms, and this far, I have found regular doctors, including my oncologist knows very little about Alzheimer’s prevention. What should I be asking for? Thank you for your help.
Some neurologists will be well-versed in ApoE4 but many will not. Most neurologists have their hands full taking care of patients with neurodegenerative diseases, and theses numbers are constantly going up. All you can do is keep asking for a neurologist (or a nurse practitioner, registered dietician, genetic counselor or other health care team member) who has an interest in prevention.
Again, I thank you for your in-depth research and dissemination for us all.
My question is this : my wonderful functional medicine doctor is encouraging me to begin low-dose estrogen, patch for my brain, etc.
However, so much of what I’m seeing about the efficacy and safety has to do with pre-menopausal and menopausal timeframe. I am 65. Of course she knows this and has taken this and I’m just wondering what your take on this is.
I carry one of the apo4 genes and there’s no history of cancer in my family, however, my immediate family is rife with Alzheimer’s. I take super good care of myself, eating clean food and more and in that regard (btw) love with your gorgeous cookbook and all you do.
Just wondering how you feel about low-dose estradiol, patch or cream for me at this point in my life. I am gung ho to do everything I can to protect my brain, so I’m reaching out to you for your take on the situation for me.
Hi Deborah. Thank you so much for your kinds words! Your situation is a little tricky. The studies we have don't show clear brain health benefit starting ERT at 65. Some studies indicate there could be adverse health outcomes, but most were based on oral estrogen and sythentic progestin that increased blood clots slightly. The ApoE4 data, as you know, is very compelling if estrogen is taken early in the perimenopause. On the other hand, a small dose of estrogen in a patch is not likely to cause problems. It may help you personally in the brain health realm if you still suffer from any vasomotor symptoms, especially if they disrupt sleep. Your physcian would probably want you to get a calcium score of your heart to rule out underlying disease before you start. If all of this is reassuring, estrogen for you may be a little bit like chicken soup--possibly beneficial, probably not detrimental. But also not a crucial factor. For you, these factors are probably most important: nutrition, exercise, DHA intake, sleep, and stress mitigation.
I am African-American (which I understand can make a difference in research findings) and have a mother with Alzheimer’s so this topic is near and dear. I’m 52. Still firmly in perimenopause, which I guess is good. Unfortunately, I deal with two of the main issues that place me at higher risk. I’ve never had a hot flash but have night sweats every now and then. Maybe a couple of times a month or less. More worrying is that I deal with some brain fog… lots of tip of the tongue moments with words for about the past 5 years. So 2 questions, 1) what is considered “severe hot flashes” and 2) have you known HRT to help with brain fog. I’ve heard varying opinions. Some women say HRT helped everything except the brain fog.
Hi Trina. Yes, HRT can help with brain fog both directly and indirectly by treating the night sweats that lead to sleep disruption. Night sweats and hot flashes arise from the same mechanism (we think, as it's not well studied) so are both considered vasomotor symptoms. Vasomotor symptoms are severe is they disrupt daily life or interrupt sleep. A few a month is not considered severe. Studies are mixed on HRT and barin fog because it can come from many sources--lack of sleep, poor nutrition, dehydration, medications. All of those things have to be corrected first. And yes, we definitely need more research looking at menopause in non-white women. There are some but not nearly enough.
Thank you for this info! Is there a year limit for how long women should take HRT post menopause? Isn’t there an increased risk of breast cancer when taking HRT for too many years? Thank you!
Hi Tosca. The duration of use should be decided case by case. The risk of breast cancer associated with taking HRT is very low, and some studies show a reduced risk of breast cancer in women taking estrogen alone (without progestin) that is greater the longer they take it: less than 1 additional case per 1000 in women taking estrogen alone; less than 3 additional cases per 1000 in women taking synthetic estrogen + progestin. Estrogen is no longer thought to be a causative factor in breast cancer in women. Women no longer need to stop their HRT at a certain age or after a certain duration of therapy as long as they continue to be good candidates.
Great information and detail. I started HRT several months before becoming post-menopausal. When you talk about the timing of starting HRT early in the menopausal transition, I assume that you are referring to early in peri-menopause. Is there any research/data on HRT that is started closer to the end of this transition? It sounds like the protective benefits window may have been missed for me. I’d love to hear more.
Starting within 5 years of the last menstrual period is best, but the earlier the better. So it sounds like your timing was good. The problem arises when women are 5, 10, or more years out from menopause.
This is such an informative post ! I am 59 years old and had a partial hysterectomy in 2017 (age 52). I still have my ovaries. Since hysterectomy I have been using the patch ( Estradiol p.o5mg). I also do not have children. I have annual appointment with my doctor on Friday. Should I be concern about the high risk of dementia? What questions should I be asking my doctor?
That’s good to hear! The info was a bit overwhelming and it was better to safe to be safe! Thank you! While talking about women/hormones — weight loss is an issue for me. Do you offer any type of program to help guide older women who are menopausal with weight loss guidance?
I don't have any data to prove this, but so many women have told me that they lose weight at menopause and keep it off by following the food guidelines in my book very closely. It is a more plant based version of the MIND and Medi diets with less alcohol. But exercise is very important, a combination of cardio and resistance, plus making sure you get enough protein. There are articles about this in the archives.
I am ALWAYS BOUYED by your fascinating work that you so generously share with us all. The dazzling cookbook is my constant primer. (Gorgeous! And delicious) I rework for GF and food allergies but never a problem. With 🛟💕🛟 gratitude for all the study info too! D McDowell
Thank you for this article. I’m an ApoE 4/4, lost my mom to AD and am trying to determine if I should start HRT, but I’m also a breast cancer survivor…I went through menopause nine years ago with very few side effects, so I hate the idea of introducing any by taking HRT or increasing my BC risk, but I want to protect my brain health. A LOT to consider here!
Hi Heather! I am so sorry for your loss and for the fact that you are dealing with these complicated factors. Consult with your oncologist first. Some women can start HRT after breast cancer after a certain amount of time has elapsed but that depends on the type of tumor and stage. But as you already know, the greatest brain benefit for HRT happens early in the menopausal transition. Late starters may not get the same benefits and are more likely to have complications. Would love it if you could consult with a neurologist about 4/4, too, to make sure you have all those boxes checked regarding the latest preventive strategies.
Annie, thank you for responding. And my apologies on your journey with your mom. It’s such heartbreaking experience. Since learning of my APOE status, I have been working with an MD and Bredesen-trained functional practitioner, whose helping me understand all the interventions I should be focused on— many of which relate to lifestyle. Do mainstream neurologists understand the APOE landscape from a prevention standpoint? I have no symptoms, and this far, I have found regular doctors, including my oncologist knows very little about Alzheimer’s prevention. What should I be asking for? Thank you for your help.
Some neurologists will be well-versed in ApoE4 but many will not. Most neurologists have their hands full taking care of patients with neurodegenerative diseases, and theses numbers are constantly going up. All you can do is keep asking for a neurologist (or a nurse practitioner, registered dietician, genetic counselor or other health care team member) who has an interest in prevention.
Again, I thank you for your in-depth research and dissemination for us all.
My question is this : my wonderful functional medicine doctor is encouraging me to begin low-dose estrogen, patch for my brain, etc.
However, so much of what I’m seeing about the efficacy and safety has to do with pre-menopausal and menopausal timeframe. I am 65. Of course she knows this and has taken this and I’m just wondering what your take on this is.
I carry one of the apo4 genes and there’s no history of cancer in my family, however, my immediate family is rife with Alzheimer’s. I take super good care of myself, eating clean food and more and in that regard (btw) love with your gorgeous cookbook and all you do.
Just wondering how you feel about low-dose estradiol, patch or cream for me at this point in my life. I am gung ho to do everything I can to protect my brain, so I’m reaching out to you for your take on the situation for me.
Warmly, Deborah McDowell
Hi Deborah. Thank you so much for your kinds words! Your situation is a little tricky. The studies we have don't show clear brain health benefit starting ERT at 65. Some studies indicate there could be adverse health outcomes, but most were based on oral estrogen and sythentic progestin that increased blood clots slightly. The ApoE4 data, as you know, is very compelling if estrogen is taken early in the perimenopause. On the other hand, a small dose of estrogen in a patch is not likely to cause problems. It may help you personally in the brain health realm if you still suffer from any vasomotor symptoms, especially if they disrupt sleep. Your physcian would probably want you to get a calcium score of your heart to rule out underlying disease before you start. If all of this is reassuring, estrogen for you may be a little bit like chicken soup--possibly beneficial, probably not detrimental. But also not a crucial factor. For you, these factors are probably most important: nutrition, exercise, DHA intake, sleep, and stress mitigation.
How much DHA do you recommend per day?
DHA + EPA in a 3:1 ratio up to 2 mg/day; recommendations are higher for those carrying two copies of ApoE4. You can check out this post where I went into this in more detail in the pdf guide:https://brainhealthkitchen.substack.com/p/are-supplements-that-promise-better
Thank you. Your assistance with this really means a lot. Thank you thank you. Yes, she was talking about a small dose of estrogen and a patch.
I will continue to pay great scrutiny to my diet, etc which I have been and look up the DHA that you talk about .
Warmly, and with great gratitude, Deborah
I am African-American (which I understand can make a difference in research findings) and have a mother with Alzheimer’s so this topic is near and dear. I’m 52. Still firmly in perimenopause, which I guess is good. Unfortunately, I deal with two of the main issues that place me at higher risk. I’ve never had a hot flash but have night sweats every now and then. Maybe a couple of times a month or less. More worrying is that I deal with some brain fog… lots of tip of the tongue moments with words for about the past 5 years. So 2 questions, 1) what is considered “severe hot flashes” and 2) have you known HRT to help with brain fog. I’ve heard varying opinions. Some women say HRT helped everything except the brain fog.
Hi Trina. Yes, HRT can help with brain fog both directly and indirectly by treating the night sweats that lead to sleep disruption. Night sweats and hot flashes arise from the same mechanism (we think, as it's not well studied) so are both considered vasomotor symptoms. Vasomotor symptoms are severe is they disrupt daily life or interrupt sleep. A few a month is not considered severe. Studies are mixed on HRT and barin fog because it can come from many sources--lack of sleep, poor nutrition, dehydration, medications. All of those things have to be corrected first. And yes, we definitely need more research looking at menopause in non-white women. There are some but not nearly enough.
Thank you!
Thank you for this info! Is there a year limit for how long women should take HRT post menopause? Isn’t there an increased risk of breast cancer when taking HRT for too many years? Thank you!
Hi Tosca. The duration of use should be decided case by case. The risk of breast cancer associated with taking HRT is very low, and some studies show a reduced risk of breast cancer in women taking estrogen alone (without progestin) that is greater the longer they take it: less than 1 additional case per 1000 in women taking estrogen alone; less than 3 additional cases per 1000 in women taking synthetic estrogen + progestin. Estrogen is no longer thought to be a causative factor in breast cancer in women. Women no longer need to stop their HRT at a certain age or after a certain duration of therapy as long as they continue to be good candidates.
Great information and detail. I started HRT several months before becoming post-menopausal. When you talk about the timing of starting HRT early in the menopausal transition, I assume that you are referring to early in peri-menopause. Is there any research/data on HRT that is started closer to the end of this transition? It sounds like the protective benefits window may have been missed for me. I’d love to hear more.
Starting within 5 years of the last menstrual period is best, but the earlier the better. So it sounds like your timing was good. The problem arises when women are 5, 10, or more years out from menopause.
Hi! Curious - the studies with birth control, is this just the pill or do iuds etc. have the same effects?
Just the pill.
This is such an informative post ! I am 59 years old and had a partial hysterectomy in 2017 (age 52). I still have my ovaries. Since hysterectomy I have been using the patch ( Estradiol p.o5mg). I also do not have children. I have annual appointment with my doctor on Friday. Should I be concern about the high risk of dementia? What questions should I be asking my doctor?
Probably not because you still have your ovaries and you started estrogen.
That’s good to hear! The info was a bit overwhelming and it was better to safe to be safe! Thank you! While talking about women/hormones — weight loss is an issue for me. Do you offer any type of program to help guide older women who are menopausal with weight loss guidance?
I don't have any data to prove this, but so many women have told me that they lose weight at menopause and keep it off by following the food guidelines in my book very closely. It is a more plant based version of the MIND and Medi diets with less alcohol. But exercise is very important, a combination of cardio and resistance, plus making sure you get enough protein. There are articles about this in the archives.
Thank you. As a new fan following you and just got your book. I look forward to learning more and I am determined to get my health back !
Welcome Sherri!
Annie!
I am ALWAYS BOUYED by your fascinating work that you so generously share with us all. The dazzling cookbook is my constant primer. (Gorgeous! And delicious) I rework for GF and food allergies but never a problem. With 🛟💕🛟 gratitude for all the study info too! D McDowell
Thank you Deborah for making my day! It's really nice to hear that you can adapt the recipes as you need, many others have told me that too. xoxo
Annie, This is such useful information. Thank you so much for keeping us so well informed on these important topics. Enjoy Sicily!!! ❤️❤️❤️
Thanks Frances!