Saturday, August 23, 2008

Not-so-Goldilocks and the three nights sleep

Not-so-Goldilocks worked late after a long day, so she finally went upstairs. She lay down in the first bedroom recently vacated by her son who had left the previous day for college, but the bed was too hard. She was only able to sleep for 5 1/2 hours, and she felt like hell in the morning(1).

The next night, Not-so-Goldilocks was so tired she headed up to bed at 9 p.m. She lay in the second bedroom that still had her daughter's stuffed animals arranged on a flower spread, but the bed was too soft. She slept like the dead, unmoving, for 9 1/2 hours, and woke up with her head foggy and her back screaming(2).

On the third night, she dragged her sorry self all the way to the end of the upstairs hall to her own bedroom at her usual bedtime of 11 p.m. Then she flopped down on her pillow-top Sealy mattress, and it was just right. Not-so-Goldilocks fell asleep and awoke refreshed at 6 a.m., her mind clear and her eyes unpuffy. She bounded downstairs for breakfast and coffee, ready to wrestle the world to the ground.
(1) Researchers at the University of North Carolina's School of Public Health in Chapel Hill found that women who slept six hours or less were at 14 percent greater stroke risk than those who slept seven hours a night.
(2) This same study found that compared to postmenopausal women who slept seven hours, those who dozed nine hours or more had a 60-70 percent higher risk of ischemic stroke.
(3) The Chapel Hill investigators agreed; seven hours of sleep is just right!

Tuesday, August 19, 2008

Color her clueless

My medical partner showed up one day in a bright cotton outfit. The problem, however, was that the bright top and T-shirt had nothing whatsoever to do with the boldly printed slacks, at least in a color sense. We're not talking clash in a sassy, young-at-heart sort of way--that top, those pants, simply had nothing whatsoever to do with each other by anyone's standards.

There are worse gaffes, for sure, say travel knit paired with linen, or light-colored shoes with a dark pair of slacks. We all wondered in silence whether this was a 'who gives a fig about fashion' statement, or had she just dressed in the dark. And no one said a word to her.

The next day she arrived, fully coordinated, and aghast that no one had mentioned her mismatch. Turns out, she did indeed dress in the dark. How then to explain an entire day spent under bright fluorescent lights, clueless as to her 'glamor don't'?

Menopause moment, for sure.

Estrogen and memory function

A study conducted at the University of Southern California demonstrated that estrogen promotes the growth of those essential neurons in the brain's hippocampus that are critical to memory function. Scientists there created a hippocampal campus in a petri dish, inducing these cells from the memory center to set up housekeeping in the USC lab. They then squirted conjugated equine estrogens (CEEs or Premarin) on the nerve cell colonies and watched the results under a videomicroscope.

The cells literally bristled with excitement. The addition of estrogen juice significantly increased the number of dendrites or outgrowths of the cell membranes which are known to be cellular markers of memory formation. Dendrites hook-up with other neurons to form new connections, a process that promotes brain 'plasticity' or the ability to learn new material and make new associations. In other words, the same cellular events that occur in the hippocampus of the brain during memory formation happened in these brain cell cultures when estrogen was added.

When I see patients going through the menopausal transition, I not only inquire about hot flashes, night sweats, and the quality of their sleep, I also ask "How's your mood?" and "How's your memory?". The lack of estrogen affects women differently, some struggling far more than others in a brain function sense. I think the problems with verbal memory and executive functioning (starting a multi-step task and completing it successfully) along with the increase in anxiety and depression that can accompany falling estrogen levels are too often not addressed in women of age.

Monday, August 11, 2008

Don't mind your hot flashes...

...they may be good for your mind. A new theory suggests that these pesky little episodes may protect your brain through a phase when dwindling estrogen supplies leave central neurons susceptible to damage. As you read on, please remember that this is all strictly a theory.

Because our brains are unable to store nutrients, we rely on a steady supply of sugar delivered via the blood to keep our central nervous system ticking. One of estrogen's many useful functions is to promote the entrance of glucose into the brain--after all, can't have Cave Mom keeling over from low brain sugar! As estrogen levels drop during perimenopause, a condition called 'neuroglucopenia' follows which is a fancy name for a brain-fogging lack of readily available glucose.

Researchers theorize that low brain sugar may set off a hot flash which activates part of our involuntary nervous system, the same reaction involved in a 'fight or flight' response to danger. This may be why hot flashes tend to rip us out of a deep early a.m. sleep, hours after our last meal. The alpha-adrenergic surge that follows corrects the starving brain problem thus protecting vulnerable cells from the destructive effects of no sugar.

Perhaps then the women most at risk for losing brain cells to aging and oxidation in an Alzheimer's sort of way are those who 'sail' through menopause without hot flashes. Neuroglucopenia city in their heads, but no adrenal surges to correct the situation.

Or maybe not.

Tuesday, August 5, 2008

Meal curries no favor with patient

(or no brownie points for me!)

What a great lunch I'd had: green curry with jasmine rice (Tommy Thai's best!) followed by brownies courtesy of a drug rep. One-half hour later, I was in the exam room listening to my patient's update on her back pain. As she went on, I felt a soft blanket of carbohydrates roll over my brain. My eyelids grew heavy, but I struggled mightily to keep them open.

On average, patients don't notice my occasional post-prandial lapse, but this lady was a psychotherapist and, as such, a keen observer of human behavior. To my horror, she stopped abruptly, mid-sentence, and looked at me with alarm.

"Are you O.K.?" she inquired.

A burst of adrenalin cut through my fog, and we both had a good laugh over this doctor's inability to follow her own nutritional advice.