Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
30 May

Dear Carrie: Hot Flashes

hotflash2Every week I attempt to field at least one reader question in my Dear Mark series of blog posts. Some of the inquiries that are submitted are outside my scope of knowledge or experience, or are questions that are addressed to my wife, Carrie, specifically. While I could (and have been known to) dig into the research on such topics as cellulite, menopause, nursing, giving birth and the like, I think it’s valuable to offer a woman’s perspective on these and related topics of interest. And so, enter Carrie…

Hi, everyone! It’s good to be back on MDA. I so appreciate the emails I regularly get from everyone. Thanks for all your questions and kind messages. I love this community and always enjoy contributing. I get a lot of questions about family and the female perspective in living Primal. One common topic is menopause. I know how intricate a life transition menopause can be, being I’m navigating it myself now. There are a million questions I think women have about menopause, and I know they’ll be more relevant posts coming up. For today, I thought I’d take up one reader’s forum post about hot flashes and sleep. (Do I already see some heads nodding out there?)

I’ve just been looking around on the forum regarding hot flashes increasing on the primal diet for peri and menopausal women there are several threads on it – so figure I am not alone and wondering if you or maybe a guest contributor could do a more pointed column on this?  (i.e. I am dying from no sleep – up every night between 12 and 5 cycling through hot flashes)  For the first time in 17 months on the primal lifestyle – i feel like crap and its all from the sleep deprivation. I’d like to make one last valiant effort with diet, lifestyle and supplements before I go the Bio ID hormone route and hoping you might have some suggestions?

Thanks to Barb for the great question. Since some three-quarters of women experience hot flashes during the menopause transition, it’s a subject well worth exploring. For those of you unfamiliar with the experience, hot flashes occur when blood vessels in the head and neck suddenly expand. They can come during the day or at night with or without sweating and other symptoms like dizziness, faster heart rate, or headache. Hot flashes can start in the years leading up to menopause (a.k.a perimenopause) as estrogen levels sharply drop. They often resolve themselves over time but can linger for some women well into their post-menopausal years.

Researchers are still filling in some of the picture, but they believe hot flashes are a result of both the hormonal changes happening during the menopausal transition and their effect on areas of physical functioning. Hot flashes are associated with both the withdrawal from estrogen hormones women experience in the peri-menopausal and menopausal years as well as the “surges” of lutenizing hormone that occur during this time. (For the record, men can experience hot flashes when undergoing androgen deprivation therapy, which imposes a sudden and dramatic reduction in their testosterone levels.)

As much of a pain as they are, I should add that some studies suggests that hot flashes bode well for post-menopausal health. Researchers have found that women who experience hot flashes, especially early in menopause, have a lower risk of developing breast cancer, stroke, and heart disease. For what it’s worth in those hot, miserable moments…

During the menopausal transition, the body’s thermostat (part of the hypothalamus function) can take time to recalibrate with ongoing hormonal changes. Hot flashes, experts believe, may be related to this process. Women with severe hot flashes (in terms of both intensity and frequency) can have their sleep regularly disrupted and are at risk for chronic insomnia, like Barb has been experiencing. Given that some women can experience several a night that may last up to thirty minutes each, a good night’s sleep can be next to impossible. The effects can be grueling over time. Moreover, women are at a higher risk for other sleep disorders like sleep apnea during and following menopause because of the shift in hormones.

Although most women will experience some degree of hot flashes during menopause, certain factors like obesity, smoking, and inactivity can put your at higher risk. Caffeine, alcohol, sugar, and spicy foods can exacerbate hot flashes. Exercise and relaxation practices help many women cope with both the hot flashes themselves and the resulting sleep deprivation.

As for alternative remedies, I would give acupuncture a chance. The research looks pretty good as a whole, and I can say it’s had an impact for me personally. In terms of herbs, I’d recommend trying (individually) black cohosh, chasteberry (which are both used in Europe for management of menopausal symptoms), keishi-bukuryo-gan tea (PDF), and perhaps dong Quai (which can help dilate blood vessels). Other common options women try for hot flashes include Evening Primrose oil (less effective in my experience), and maca root. Although your best bet for menopause nutrition is an all around, nutrient dense diet, you might try increasing your intake of vitamin E, and vitamin C (to aid the absorption of vitamin E).

In the last few years, there’s been a trend toward using off-label pharmaceutical treatments (e.g. Gabapentin — a seizure medication, Clonidine –a high blood pressure treatment, and a few anti-depressant varieties) for menopausal symptoms, especially severe hot flashes. Given the potential for serious side effects over time, I would suggest avoiding these medications (as I would conventional, synthetic HRT).

Although Mark tells me they’ll be more to come on menopause in the coming months, I just want to offer a word of support for Barb and other women who are looking at bio-identical hormones. Although I believe in first trying natural ways to handle menopausal symptoms, I don’t consider it failure by any means to embrace the bio-identical HRT route, especially if you’ve tried other measures with little success. I think bio-identical hormones are a reasonable option for women who can’t find relief from natural means when ongoing problems seriously impact their well-being.

A couple of years ago I gave bio-identical hormones a try (a low dose mix of estrogen, progesterone, and testosterone) when I exhausted the possibilities of various herbs and supplements I could find at the time. (For me, it was more memory issues than hot flashes.) Although the hormonal combination didn’t help my memory situation, it eased a lot of other symptoms I was having. I felt great in ways I hadn’t for a long time.

These days I’m still searching for something to address the memory fog. I’ve gone off the bio-identical hormones for now and am trying a new regimen of Chinese medicinal teas and acupuncture that I’ve designed from my research. It’s a work in progress, and I’ll let you know more when I’ve given it time. For now, I’ll say I’m sleeping better and experiencing less dramatic hot flashes, but I haven’t seen as much change on the memory front yet.

MDA readers, I hope you’ll share your thoughts and stories on coping with hot flashes. I’ll be back with more “Dear Carrie” answers in the near future. Have a great week, everyone!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. As a guy, I don’t have any personal experience. but my Mom swears by bee pollen. She takes 1 tablespoon every morning with breakfast. She found that good quality stuff (more different colors, rather than a uniform yellow kind) works much better.

    Just a thought. might be worth considering

    matt wrote on May 30th, 2011
    • Matt,

      Awfully decent of you to share your mother’s experience with us. I like for both genders to be understanding, helpful and (when necessary) sympathetic to the other’s troubles or issues. Makes life so much more pleasant and worth living when we are not at gender odds. Thank you.

      Megan wrote on November 13th, 2013
  2. I am also riding the waves of menopausal hot flashes. I can make a few suggestions on how to make the ride a little easier. First, get hold of Susun Weed’s “Menopausal Years”. She is an herbalist and has great suggestions on hot flashes as well as other menopausal experiences that range from ‘do nothing and just experience it’ to herbal and homeopathic remedies to medical intervention.

    I’ve stopped drinking coffee altogether. I make a daily infusion of nettle and oatstraw (directions in Susun’s book) and in the hour before bed I put tinctures of chickweed and motherwort in a glass of water and sip slowly. It’s not 100% effective, but the frequency and intensity of the flashes have definitely eased down.

    Like everything in life, what works for one person doesn’t necessarily work for another — but experiment with the options she gives (one or two at a time!!) and see what works best for you.

    Emma wrote on May 30th, 2011
    • “Like everything in life, what works for one person doesn’t necessarily work for another — but experiment with the options she gives (one or two at a time!!) and see what works best for you.”

      +1

      Please realize this everyone! If what you are doing is NOT working then try something else. Make one change. Do something that Carrie recommends. Give it a chance and if that does not work then do something else. We are all unique and you must experiment on yourself.

      Just because A works for Joann does not mean its going to work for you. B may work and it may not. Never give up!

      Primal Toad wrote on May 30th, 2011
  3. i’ve had good experiences with OTC progesterone creme, though Chris Kresser looks askance at topical preparations. those of us with hypothyroid problems might want to avoid maca, as it belongs to the cruciferous category, which are known thyroid depressants.

    tess wrote on May 30th, 2011
    • I, too, would avoid transdermal progesterone. I went to a naturpath who was involved in a study to test the effectiveness and safety of these creams. What they found was that they do in fact work….only too well. In every case, women were overdosing on it. Because the hormone is stored in the fatty tissue, it will build up very quickly. The side effects varied but is some cases were so bad that a couple of women had to be hospitalized for psychosis related to severe anxiety upon withdrawal. This is because progesterone is an anti-anxiety hormone. There are dangers with estrogen creams, too. Your best bet is sublingual drops. They don’t go through the liver, they don’t get stored in fatty tissue. They are absorbed directly into the blood stream. Therefore, ODing is not possible.

      Kim wrote on May 31st, 2011
  4. I’m pretty much where Barb is – often up a few to many times a night with hot flashes – and yes I am desperate for a good night’s sleep. I have already tried exercise, chaste berry, black cohosh, and acupuncture with very little relief. I normally drink very little alcohol and only occasionally caffeine and have been doing similar to a primal diet for months (so low sugar) to little effect. My old doctor said bio identical hormones were the same as conventional HRT but wouldn’t prescribe either and was not very sympathetic. Am seeing a new doctor but have had to complete a lot of expensive tests to make sure I’m “healthy” enough to take them!

    While I’m still suffering I ran across some women who mentioned Vitamin D. Since a recent blood test showed I was at low levels (as most adults are) I started taking supplements of D3. Nothing definitive yet but the flashes seem to generally be milder and usually fewer at night than before. Would love to know if any other women have tried this.

    Joanna V wrote on May 30th, 2011
    • My mom has been battling this for a while, and now is doing a “Standard Process” (supplement company) regimen that includes sage tincture among a few other things (all natural) and has experienced GREAT relief. As in 100% turn around. ;) Won’t work for everyone, I am sure, but just thought I would get that out there!

      Erin wrote on May 31st, 2011
    • I’ve been taking Vitamin D3 for 3 years because I was found to be low and it hasn’t done much for my perimenopause/menopause symptoms which are too long to list here. They include dizziness, off balance, horrific hot flashes which make me feel as though I will pass out or die, etc., etc., etc.

      Menopause has been a complete nightmare. I have never felt worse in my life. I am currently looking for a new neurologist because I don’t know whether my symptoms are menopause, fibromylagia or M.S.

      I take bioidentical progesterone and estrace vaginal estrogen cream. Neither of them have done very much to stop my crazy symptoms. I also take a baby aspirin daily, Vitamin D3, Vitamin B Complex, eat very well, try to work out at home with 3 lb weights. Getting the simplest housework done is very difficult due to my dizziness when standing up. I am at my wit’s end. I never ever had these symptoms till I started going through menopause at age 50. The last 3 years have been H.E.L.L.

      sc341 wrote on September 13th, 2013
      • Hi there, I don’t know if you will get this reply but may I suggest you take a look at adrenal fatigue which is common in menopausal women particularly after years of chronic stress (child rearing, house work, career etc.). The reason for this is that the adrenals help the ovaries produce oestrogen and try to compensate for the decreased hormones; when the adrenals are stressed, adrenaline and corsitol are often released at night between 12 and 5 am producing “hot flashes”.

        Just an idea hope this helps! By the way check you are taking enough D3 as the government recommendations are way too low and reasonable quantities of Vitamin C as this helps support the adrenals and the endocrine system.

        Good luck!

        Philippa wrote on January 28th, 2014
  5. I was late finally getting to menopause–a very long perimenopause–and after a few years on HRT, low dose (no mare’s urine derived), I weaned off last year. The hot flashes returned in a mild form for a few months, but are pretty much gone now. I find that my range of temperature comfort got very narrow. If I got a little too warm, it set off a hot flash. Black cohosh and red clover got me through perimenopause without the serious hot flashes many of my friends suffered.

    Sugarbaby wrote on May 30th, 2011
    • I used black cohosh under the care of a wonderful doctor (since moved) who knew the ideal doses and side effects. Black cohosh in some women can cause liver side effects. After 3 months my liver function deteriorated so I went off it. Bugga too as it worked well. I struggled with flushes and chronic debilitating joint pain until I finally went on bio identical progesterone. So far not needed estrogen but do also use Di indolemethane (also bi identical) to boost estrogen buffering for the inversely high estrogen based on dropping progesterone. I went to a GP to work with me, she said she did not believe in “that untested treatment” but the clinic I use treats 30,000 women in Australia and growing so that’s fine with me. I found a better more open minded GP instead!

      Michelle wrote on June 28th, 2012
  6. I get “slightly warm” flashes and seem to be managing to avoid the worst of the menopausal symptoms. I find that avoiding gluten helps me a lot (if I mess up and fall off the gluten-free bandwagon, the hot flashes start up again). Taking maca also seems to help.

    Nicky wrote on May 30th, 2011
    • I’m with you on the gluten, I started getting waves of nausea quickly followed by a hot flush every few nights, about 2 years ago. I was doing a paleo diet – with gluten probably about once a week or so. 18 months ago I found I had Hashimotos and went of gluten strictly. No cheats at all. I continue to take a good quality multi, fish oil, extra zinc (as it was a bit low) selenium, and vitamin D.
      No peri-menopausal symptoms at all at the moment. I am also dairy free, (except a little cream and butter) legume, nightshade free (occasional very ripe tomato) Minimal nuts.

      julianne wrote on May 30th, 2011
    • I stopped eating wheat in an attempt to lose belly fat and after several months realized I no longer have hot flashes. Once in a while I will accidently eat wheat and every time I wake up in the middle of the night with hot flashes. My co-worker reports the same thing. I am suprised there isn’t much about this in the research.

      Linda Oberg wrote on June 23rd, 2013
      • I’ll add my witness that wheat causes hot flashes. Every time I accidentally eat some (I’ve been gluten free more than a year), I get hot flashes, rapid heart beat, and rapid breathing. I wish more would be done to learn about this connection.

        Treshia wrote on August 16th, 2013
  7. At what age does menopause start?

    I’ve read somewhere that both men and women decline in hormones waaaaay before menopause becomes obvious.
    I remember my mother dealing with hot flashes in her 40′s…and they had gotten REALLY bad in her 50′s. At the same time all the grandparents had died, uncles and other relatives,too, and us kids grew up and moved out.
    I wonder if emotional stress makes everything 10x worse.

    My sister had a histerectomy at age 40. The doctors blamed her uterus for all of her digestive upsets … ironically she is on a high grain diet from the moment she wakes up (mediteranian diet). Now her toxins have no way of leaving her body (monthly period) and just accumulate in her system. Since her histerectomy she came down with several other health problems, the biggest problem her having degenerative cartilage disease with inflammation. She is now on heavy pain killers. Her allergies are out of control. She is ‘allergic’ to everything in sight.

    My husband was also diagnosed being in andropause in his early 40′s and has been taking synthetic testosterone ever since. He is now 48 and still has hot flashes and gets pissy on a regular basis. He also can’t stop eating grains (mostly oats) and sugar (cane sugar).

    I used to be the one with the hormonal imbalances, acne, poor health, temper fits, allergies, digestive problems, bad PMS and severe cramps and joint pain. Since going primal all of this disappeared. Fact is I’m the ONLY person above 20 (i’m 40) in my family that’s now actually healthy…funny how that works.

    Primal Palate wrote on May 30th, 2011
    • Paleo completely eliminated menstrual cramps, and PMS with nasty breast tenderness.

      Magnesium for me makes a huge difference with sleep.

      julianne wrote on May 30th, 2011
    • I had a hysterectomy 5 years ago and it improved my life immeasurably. I’m not a doctor but I don’t think that menstruation is how our body rids itself of toxins. I think it has more to do with a healthy liver and kidneys.

      bbuddha wrote on May 30th, 2011
      • No, periods have nothing to do with toxin release – if it did all women post menopausal would slowly ( or quickly) be poisoned? The uterus does however still make low dose hormones post menopause so a hysterectomy does upset a normal balance. Pity as sometimes it causes more harm than good and has to go. An excellent book is “The Wisdom of Menopause” by Dr Christine Northrup from the UK. All bio identical and some well researched information and links to more. Google search for website and other information.

        Michelle wrote on June 28th, 2012
        • Christiane Northrup, M.D., is American.

          Mary wrote on September 1st, 2013
    • It can be a long process. Some people start in the 30-40s, others later. It can start then stop, and I read somewhere that if you started your periods late, you often have late end to periods. My aunt is 60 and still has periods.

      Sugarbaby wrote on May 30th, 2011
    • For your sister, you may want to check out “The H Word” by Nora Coffey. This book deals with hysterectomy, instead of menopause. A lot of people seem to want to equate the two, in spite of the fact that in menopause uterine/ovarian function remains. That’s a significant difference between the two conditions. Good luck.

      Tawanda wrote on August 22nd, 2012
    • Your sister’s doctors who removed her uterus due to “digestive upsets” sound like QUACKS. Unless she had cancer of the reproductive organs or very bad endometriosis, or a bad Prolapse or something along those lines this operation was most likely unnecessary. I would sue their @sses.

      Most HYSTERECTOMIES are unnecessary. Google it for yourself. Doctors do these operations to make money imo. You need your uterus to hold your bladder in place, etc….

      Always get a second and third opinion.

      Fibroids can now be removed surgically without removing the uterus,.

      sc341 wrote on September 13th, 2013
  8. I am so glad to be done with all that but had many many years of craziness around menopause. I never took hormones but did have many years of acupuncture treatments and herbal teas that my acupuncturist provided.

    Sometimes I thought I was going insane (panic attacks etc.) but the acupuncturist was able to fix the different phases I went through by treatments and varied herbal concoctions. I am soooo grateful for her help with it.

    Classic wrote on May 30th, 2011
  9. Eiselt Double Pro I use as a complement as a meal. Have tried to find reviews about it online but have not found any good ones. I’ll continue to use it. x

    Giorgios Pormaskar wrote on May 30th, 2011
  10. I second Emma’s recommendation of Susun Weed’s excellent book. I also use a low dose of bio-identical hormones and they have helped me so much. I have found that even a small glass of red wine will give me hot flashes in the middle of the night. Stress will cause them during the day and if I manage that better then I can go a whole day without flashing at all! Diet is a key factor and avoiding blood sugar highs and lows will also lessen the frequency of hot flashes.

    Judi O wrote on May 30th, 2011
  11. Chinese medicine did it for me – a combination of about 2 weeks of herbs and 6 weeks of intense acupuncture (she put the needles down my spine, very close together). As I progressed through the weeks, each acupuncture session ‘held’ me for longer periods of time. First session was just through the night, by the 4th I was OK for a week.

    Jac wrote on May 30th, 2011
    • Can you be more specific what kind of herbs were you using?

      Ala wrote on June 6th, 2011
  12. Although other females in my family did not experience menopause until their 50′s, after having an ovarian cyst removed 5 years ago, at the age of 41, menopause hit me – slowly at first and in the last year, like a train. I spoke to a GP about it and said it can be brought on by major abdominal surgery – even though one ovary was left. She also said that in Japan, there is no word for menopause as it’s symptoms are not considered serious enough to warrant a word for it. She believed that soya in their diet is the reason for it. So armed with this information I bought soya supplements – it took a month but all hot flashes disappeared completely. I thought it was perhaps a fluke, but after going away for a couple of days, I forgot to take my supplements with me. The flashes returned, not badly and I had them under control as soon as I returned to soya.

    Thanks to soya, my ‘personal summers’ are a thing of the past

    SuzieP wrote on May 30th, 2011
    • Soy doesn’t do anything for hot flashes. There was a recent study which proved this. Soy is also bad for Thyroid Function. Beware of eating a lot of Soy.

      From a Huffington Post article:

      Isoflavones, the plant-derived estrogens found in soy, are very weak estrogens, so it is not surprising that they have not shown to be as effective … as hormone therapy,” says the lead author of the study, Silvina Levis, M.D., the director of the osteoporosis center at the University of Miami’s Miller School of Medicine.

      “Women taking soy isoflavone tablets to alleviate hot flashes and prevent bone loss at the time of menopause might want to reconsider,” she adds.

      During menopause a woman’s body produces less estrogen and progesterone. Hormone therapy, which entails replacing one or both of these hormones via medications, significantly reduces menopausal symptoms and helps maintain bone health, but it can also increase the risk of blood clots, stroke, heart disease, and breast cancer.

      Soy protein, a fixture of Asian diets, has been considered a possible alternative to hormone therapy for years, ever since researchers observed that women in Asia tend to have lower rates of bone loss and osteoporosis than their counterparts in the West. However, clinical trials of soy in menopausal women have had mixed results.

      In the new study, published this week in the Archives of Internal Medicine, 248 menopausal women were randomly assigned to receive a placebo pill or 200 milligrams of soy isoflavone supplements per day — a dose “equivalent to approximately twice the highest intake through food sources in typical Asian diets,” Levis says.

      At the end of the two-year study, bone scans showed no differences in bone mineral density between the two groups. (The amount of bone loss in the study was quite low overall, perhaps because most of the women were overweight, the researchers say; women are generally less susceptible to bone loss if they’re overweight.)

      Likewise, the soy supplements did nothing to ward off hot flashes. In fact, 48 percent of the women who took soy experienced hot flashes, compared with just 31 percent of those in the placebo group. Roughly one-third of the women in the soy group also reported constipation as a side effect, versus 21 percent in the placebo group.

      So if soy isn’t beneficial, what options are women left with?

      To prevent bone loss, women should stick with the basics, Levis says. That means getting enough calcium and vitamin D, exercising regularly, and, in some cases, taking bone-strengthening drugs such as bisphosphonates.

      As for hot flashes and night sweats, the anti-seizure drug gabapentin or certain antidepressants in the selective serotonin reuptake inhibitor (SSRI) class may help some women, says Deborah Grady, M.D., a professor of medicine at the University of California, San Francisco.

      “There’s evidence that some of the SSRIs work, but they don’t seem to work as well as estrogen,” says Grady, who cowrote an editorial accompanying the study. “That leaves us with estrogen. It’s too bad, but that is the answer.”
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      The article says to take bisphosphonates, these drugs such as Fosamax are horrible drugs which cause terrible side effects. Please do the research! Don’t take these drugs, they are bad news.

      sc341 wrote on September 13th, 2013
      • From the NY Times:

        May 9, 2012, 6:32 pm
        New Cautions About Long-Term Use of Bone Drugs
        By TARA PARKER-POPE

        In an unusual move that may prompt millions of women to rethink their use of popular bone-building drugs, the Food and Drug Administration published an analysis that suggested caution about long-term use of the drugs, but fell short of issuing specific recommendations.

        The F.D.A. review, published in The New England Journal of Medicine online on Wednesday, was prompted by a growing debate over how long women should continue using the drugs, known as bisphosphonates, which are sold as generic versions of brands like Fosamax and Boniva, as well as Novartis’s Reclast.

        The concern is that after years of use, the drugs may in rare cases actually lead to weaker bones in certain women, contributing to “rare but serious adverse events,” including unusual femur fractures, esophageal cancer and osteonecrosis of the jaw, a painful and disfiguring crumbling of the jaw bone.

        Although the concerns about the long-term safety of bone drugs are not new, the F.D.A. performed its own systematic review of the effectiveness of bisphosphonates after years of use. The agency’s analysis, which found little if any benefit from the drugs after three to five years of use, may prompt doctors around the country to rethink how they prescribe them.

        The F.D.A. review analyzes only long-term use and does not address whether a woman should be prescribed a bone drug in the first place to reduce her fracture risk. Because serious complications are so rare, most doctors believe that for women with documented osteoporosis who are at very high risk for spinal fractures, the benefits of the drugs far outweigh the risks. However, some women with moderate bone density and no other risk factors continue to take the drugs for years even though they are unlikely to gain any benefits.

        “I think a lot of people are going to come off this drug,” said Dr. Clifford J. Rosen, an endocrinologist and researcher at the Maine Medical Center Research Institute.

        Bones are in a constant state of remodeling, but after age 30 or so, a woman’s bones start to dissolve faster than they can be rebuilt, and after menopause she may develop thin, brittle bones that are easily broken. Bisphosphonates slow this process. The drugs are incorporated into newly formed bone and can persist there for years, long after a patient stops taking them.

        The F.D.A. report offered little specific guidance about long-term use, saying that the decision to continue or stop treatment should be based on an individual assessment of risks, benefits and preferences discussed between a patient and her doctor. The agency did say that women at low risk for fracture or with a bone density near normal may be good candidates to stop therapy after three to five years, but older patients at higher fracture risk and bone density “in the osteoporotic range” may benefit from continued therapy.

        But an accompanying article by Dr. Rosen and others, also published in The New England Journal of Medicine, offers more specifics, concluding that the women most likely to benefit from long-term use of the drugs are those who, after three to five years of treatment, continue to have very low bone density, as measured by something called a “T score” that is lower than minus 2.5. Women with a history of spinal fracture or with an existing fracture also are most likely to benefit from long-term use of the drugs, the researchers concluded.

        However, many women who are prescribed bone drugs have been given a diagnosis of osteopenia, moderate to low bone density that is not low enough to be called osteoporosis. These women are unlikely to benefit from long-term use and should probably stop taking the drugs after about three years, the researchers said.

        It is not clear how many women would be affected based on those recommendations, but many women tire of the therapy and stop taking it on their own anyway, partly because of inconvenient requirements like remaining upright after taking the drugs and common side effects of heartburn, nausea and flulike symptoms. Even so, the researchers estimate that perhaps 60 percent to 70 percent of current users would be candidates for stopping the drugs after three to five years.

        The recommendations are based on findings from two industry-sponsored studies led by the University of California, San Francisco, that focused on long-term use of the drugs. A study of Fosamax, which is sold generically as alendronate, continued for 10 years, and a study of Reclast, an injectable form of the drug zoledronic acid, continued for six years. According to the F.D.A. analysis, both studies showed significant reductions in fracture risks during the first three to four years of use but little or no benefit with longer use.

        In the Fosamax trial, 10.6 percent of Fosamax users suffered a fracture during the first three years of use, compared with 21 percent of those in the placebo group, according to the F.D.A. analysis. But there was no benefit seen among women who continued the drug for the next 5 to 10 years. In the Reclast trial, 9.8 percent of women taking the drug suffered a fracture in the first three years of the study, compared with 20 percent of women who were taking a placebo. By four to six years, the benefit had narrowed, with 8.6 percent of Reclast users suffering fractures, compared with 12 percent in the placebo group.

        The two studies did not show any increased risk of serious side effects with long-term use of bisphosphonates, but experts say the studies simply were not large enough to detect a relatively rare adverse event. Even so, there have been numerous case reports of the unusual fractures and other side effects, prompting widespread concern about the risks with long-term use. No one knows how common the femur fractures are, but estimates have ranged from 1 in 10,000 users to 10 in 10,000.

        Women should be reassured that serious complications are rare, said Dennis M. Black, a professor of epidemiology and biostatistics at U.C.S.F. and the lead author of the article that accompanied the F.D.A. report.

        “The reality is there is a lot of uncertainty in this situation,” Dr. Black said. “The F.D.A. report was very general, and we tried to be much more specific and use evidence from the best trial available. Hopefully people who are using this drug will be reassured.”

        Dr. Rosen said that even though the F.D.A. report was vague on specific recommendations, he was pleased to see the analysis published.

        “It’s a very new thing that they submit a paper to The New England Journal that presents all sides of the argument,” Dr. Rosen said. “I think it’s a good thing, because I’ve been on these advisory committees for years, and we get a big crowd in Washington, but the doctors never see the results.”

        *******************

        DON’T TAKE THESE DRUGS, I HAVE READ ABOUT A LOT OF BAD SIDE EFFECTS ONLINE ABOUT THESE DRUGS ON OTHER WEBSITES!

        sc341 wrote on September 13th, 2013
  13. I work for an alternative MD (uses supplements too) and also have an RN degree. I’m in menopause and have been for a couple years now. I’ve got it bad.

    At first the progesterone cream worked, but that stopped. I’ve tried just about everything, including Bio hormones, which made me gain 7 pounds and Bio hormones as in homeopathy drops, which is out there as well, and just makes my hormones “squirrel-y”… I’ve tried all the herbs recommended in Susun Weed’s book too. Nada.

    I think my worst thing was not sleeping at night! And then the hot flashes second. NOW brand has a new “Herbal Pause” out that is NOT any of the traditional S. Weed herbs — that helps the hot flashes for me, so far, more than anything else, including the Bio’s.

    My biggest help was using (for sleep) an over-the-counter product that the doc gets from a company called Sanesco. The product is called “Somni TR”. Even though I am familiar with all the ingredients, and have tried them separately, for some reason the combo works quite well, as far as sleeping goes! THANK GOD.

    Still doing “trials” on myself with other things that come up (like tried 20 mg of Folic Acid, after reading a trial done on it — worked just so-so)…

    can’t wait to hear about the Chinese herb preps Carrie is doing!

    cindy wrote on May 30th, 2011
  14. For Carrie – Regarding your “memory fog” – I had memory fog for about six months. Turns out I had pernicious anemia – low vitamin B12 – which can affect several aspects of your neurological systems. I would recommend getting it checked out.

    Rachel wrote on May 30th, 2011
  15. I also found a lot of support in Susun Weed’s book. The “cooling” herbs she mentions have helped a lot — chickweed, elderflower, violet leaf.

    St. John’s wort herb (tea made from the dried herb, can also use the tincture) usually helps me with depression and concentration issues.

    But the herbal remedies that have helped me the most during menopausal transition are red clover blossom and sage. Red clover help with mood swings, edginess, depression, flashes, etc. It’s rich in phytoestrogens, similar to soy; so could be an option for those who avoid soy. The red clover herb (leaves, stems, and petals) is easier to find than the whole blossoms, not quite as potent but still effective. Sage is also high in phytoestrogens and helped a lot with flashes. I like using fresh sage for tea when I can find it but dried sage is fine.

    Also for me lately, nervousness, agitation, and edginess are pronounced. I quit coffee for a few weeks but it didn’t make much of a difference. The herbs I turn to for these matters are tulsi (holy) basil and skullcap; both are soothing and nourishing for the nerves, calming without being overly sedating.

    Hope this helps! I love working with the plant remedies and learning about them. Susun Weed teaches the Wise Woman tradition which focuses on the idea of nourishment for healing.

    I took a workshop with her a while ago and she startled everyone by recommending what amounted to a mostly primal diet and the health benefits of grassfed meat. (A lot of people in the group were vegetarians and she freaked them out talking about the healing properties of meat!)

    koko wrote on May 30th, 2011
  16. I am one of the one’s whose hot flashes got maximally worse after going primal. For the first couple of weeks my energy soared, then I dropped a couple of pounds and the hotflashes came on like gangbusters, especially every 90-120 minutes all through the night. Other sx of low estrogen were anxiety/panic attacks, depression, and leg aches.

    At first I tried gabapentin, which did calm the hot flashes and help me get a good night’s sleep at first. but I found that as I increased tolerance to the medication, I had to keep increasing the dose and then it finally just stopped working. But I had had a taste of a good nights sleep and was determined to get that back – in fact it is essential for me to be able to perform my stressful, physically demanding job as a hospital RN.

    Next up was the estradiol patch, with period doses of prometrium (these are both synthetic, but bioidentical hormones). I feel like I got my life back!!! As menopause has progressed, I still have some fluctuations in estrogen level that will bring on maybe one hot flash in a night and the occasional anxiety attack, but nothing I can’t live with. I am on the lowest dose patch (25 mcg).

    My research into doing estrogen was that it seems to be physically safer to use it at the onset of menopause as the body is adjusting (or having trouble adjusting) to lowered estrogen levels. It poses most dangers for older women who are already way past menopause. I see it as a bridge to a happy adjustment to permanently lower estrogen levels and the ride to get there can be less bumpy with an estrogen supplement that can be tapered off in a smoother course.

    I started primal to improve my health and energy levels, not out of some ideological purity. I wear an estrogen patch for the same reason.

    Barb wrote on May 30th, 2011
  17. “As much of a pain as they are, I should add that some studies suggests that hot flashes bode well for post-menopausal health. Researchers have found that women who experience hot flashes, especially early in menopause, have a lower risk of developing breast cancer, stroke, and heart disease.”

    And

    “Although most women will experience some degree of hot flashes during menopause, certain factors like obesity, smoking, and inactivity can put your at higher risk. Caffeine, alcohol, sugar, and spicy foods can exacerbate hot flashes.”

    I find these two statements to be at odds with each other. I’m not a medical professional and I am a 50 year old woman who has never experienced a hot flash so perhaps it’s just ignorance on my part.

    My husband and I have been eating Paleo since last year. We have been walking an hour a day for the past 6 years. Prior to eating Paleo, we ate as close to the tree as possible eventually getting rid of grains in 2010 (although we do indulge on special occasions). We rarely drink, don’t smoke and have been told we have the healthiest hearts the doctor has seen for people of our age. We take no prescription medicines.

    I have watched my sister, who is three years younger than me, practically melt into a puddle with hot flashes. She is overweight, smokes, drinks, takes (at last count) 12 prescription medicines and eats a diet of processed and fast food.

    I find it hard to believe that if I don’t experience hot flashes that when I reach a post menopausal age that I will actually be less healthy than she is because she did experience them given the difference in our two lifestyles.

    I agree with what several people above have said that everyone is different and will react differently to the same situation but I’m really struggling trying to make the two statements above work in my head.

    Lauri Rottmayer wrote on May 31st, 2011
    • Lauri, every person is different. I think it just suggests that otherwise healthy women shouldn’t worry about experiencing them. If they’re exacerbated by one’s lifestyle and food choices, then that’s not a good situation. If you’re doing everything right and experience them nonetheless, it’s not something to worry about. I liken it to morning sickness in pregnancy. Women who have morning sickness have lower risk of pregnancy loss/complication, but that doesn’t mean women who don’t have those things are going to experience complications.

      Jen wrote on May 31st, 2011
      • I like that explanation. I do realize there is a lot that researchers don’t know and may never know. It’s just those two statements seemed so at odds with each other when I read them! :-)

        Lauri Rottmayer wrote on May 31st, 2011
  18. Yes it is hard to comment when one has not experienced hot flashes, and yes, those two statements ARE at odds with each other! The fact is, scientists just don’t KNOW.

    Not only are people SO different fm each other, the hormonal titration that goes on in our bodies is SO unique to each, SO incredibly subtle, that it can’t be measured and documented in any satisfying way. :( …at least not yet. :)

    I know hundreds of women who are overweight and lead unhealthy lifestyles and yet I’m the one falling down with hot flashes that are literally like going into labor. It’s all very mysterious!! :)

    cindy wrote on May 31st, 2011
  19. I did some research on bioidentical hormones on my blog, they seem to be a lot safer than conventional HRT even though the studies are quite limited.

    I hope it’s okay that I post the link in here, since a few people seem to be wondering about them:

    http://www.kriskris.com/bioidentical-hormones-side-effects/

    Kris wrote on May 31st, 2011
  20. I have a comment and a question. I started having hot flashes at the age of 50, and still have them 7 years later. BUT……they are FAR less frequent and intense. When they first started they were literally every 15 minutes of the day or night. Now, maybe one an hour, and then not for several hours, and not very intense. So what i’m trying to say is, it’ll get better, slowly and gradually. Much much better. The question is this: i notice that when i start a “diet” (meaning, cutting out the donuts and chocolates and being “good” again) that my hot flashes increase! I have asked this question to a lot of people and nobody knows the answer. It’s this: are hormones stored in body fat in some way and when you start to lose weight are they released from the fat cells, thereby increasing symptoms? When you lose weight, are substances released from fat cells that you feel in the form of hot flashes?? I would love to hear opinions on that.

    Gabriele wrote on May 31st, 2011
    • I’ve been told and read that fat produces estrogen in small amounts, therefor when having a bit more body fat symptoms would be less severe.

      I just never understood how a passive cell can produce a hormone…beats me lol.

      Lorelei wrote on May 31st, 2011
      • However, it is true that fat cells make leptin, a hormone that tells the brain how much stored energy–fat– the body has. http://en.wikipedia.org/wiki/Leptin

        MFG wrote on September 27th, 2013
    • Interesting! You may be right!

      cindy wrote on May 31st, 2011
  21. My wife suffered for 4 years with hot flashes etc. After much urging from me we went to see a doctor that specialized in bio-identical hormones. We both are taking them and have seen remarkable results. Her hot flashes were gone in two weeks and she lost 20 pounds. My libido improved greatly and am now able to build muscle. BTW, we were both primal for a year before starting. She had tried every natural remedy out there, to no avail.

    dave wrote on May 31st, 2011
  22. I noticed peri symptoms at 40. Used an herbal progestrone cream then (FemCreme). This year (age 51) I started getting hot flashes. I tried plain old herbal supplements & that seems to be working for me. “Female Comfort” by Natures Sunshine or Change-o-Life by Nature’s Way. Took 2-3 weeks & they subsided to near non-existance…
    I still have my coffee in the morning (half-caf)
    so, that seems to be what works for me :)

    peggy wrote on May 31st, 2011
  23. I just wanted to add:

    It may be that some notice posts about women experiencing hot flashes on the primal diet simply because it is that time in thei lives, and not because they are on the Primal Diet. You would probably experience some portion of these things whether you are eating that way or not. It’s also possible that the symptoms would be worse if not on the diet. I know women not on the Primal Diet who complain about the very same issue of sleep deprivation. This is a strong complaint from many women, most who are not on the diet. So I would think that some may inadvertantly think the Primal diet contributes to the sleep issues when in fact they would experience these same issues even if they were not eating this way, possibly even worse.

    Sharon C. wrote on May 31st, 2011
    • “It may be that some notice posts about women experiencing hot flashes on the primal diet simply because it is that time in thei lives, and not because they are on the Primal Diet”

      This may be simply coincidence for some but in my case I had my intense period of hot flases behind me by 3 or 4. When I switched to low carb (Protein Power ) and subsequently Primal, I started to experience hot flashes and imsomnia at night. I don’t think it is related to weight loss and fat releasing stored estrogen as I had just lost 30 lb. on Weight Watchers with no flashes.

      AdrianaG wrote on June 3rd, 2011
      • Perhaps it is going low carb rather than primal?

        Insomnia is often linked with low carb. A common side effect in some.

        julianne wrote on May 26th, 2012
    • That is my experience. Ive been paleo for about three years. Menopause for me happened really suddenly. Menstration went from regular to nothing over 8 months. And hot flushes started over a couple of weeks, and have continued through the first 3 months with no cycle. Prior to that I only had hot flushes with gluten in my diet.

      julianne wrote on June 28th, 2012
  24. I thought this was interesting regarding the importance of hanging onto your uterus if possible. It isn’t just for babies and periods.
    http://www.goldenalmond.com/healthy-living/2011/04/a-womans-well-being/

    Turns out our wombs serve a lot of functions throughout our lives. One of the things that the article didn’t mention is that one of the signs of ovarian cancer after menopause is abnormal bleeding. If you’ve had your uterus removed but not the ovaries, you’d miss this important symptom.

    Kim wrote on May 31st, 2011
  25. Acupuncture has helped me a great deal. Both my acupuncturist and an herbalist gave me the same advice for hot flashes. It sounds counter-intuitive, but it does help when I remember to do it:

    A half-hour before you go to bed, soak your feet in a bucket of hot water for about ten minutes. Make the water as hot as you can (think hot-tub) and deep enough to cover a hand’s width above your ankles. Sounds strange, but it works for me.

    It’s true, everyone is different. What works for one woman will not necessarily work for another. And what works for you at one stage may not work at another! It’s a constant process of evolution and discovery.

    Karen wrote on May 31st, 2011
  26. Has anybody tried drinking raw goat milk to relief symptoms?

    Resi wrote on May 31st, 2011
  27. I took Estroven for 8 years – worked like a charm then stopped working 2 years ago – went primal and that worked like a charm until recently…i ve found two different medical professionals recommending oils for hot flashes. A book – The Brain Trust program by Dr. McCleary recommends MCT oil (refined coconut oil) and Flaxseed oil and fish oil (epa) – being primal I am already eating coconut oil and fish oil – but the coconut oil (albeit, its medium chain tricyclerides are only half what MCT oil offers but would think unrefined coconut oil would be better than refined?) – i’ve added flaxseed oil and am waiting to see how my next cycle goes. Also, found this suggestion from a naturopath group in AZ alternating evening primrose and flaxseed oils. http://www.prescottnaturopathicdoctors.com/index.php?option=com_content&view=article&id=80:bio-identical-hormone-replacement-therapywho-needs-it&catid=1:latest-news&Itemid=76

    barb wrote on May 31st, 2011
  28. Bio-identical hormones have worked wonders for me. I tried all kinds of things before and wished I had started them much earlier. I was having mood, memory and concentration problems, I even lost my job. I have always avoided medications but in desperation ended up on one for depression, one for anxiety and one for sleep and still did not feel good. I tapered off all of them after starting the hormones and feel good again.

    Susan wrote on May 31st, 2011
  29. I have a question that may sound a bit weird (my GP certainly thinks so). I have noticed that, when I turn over in bed, a hot flash follows… Has anyone else had that experience??
    I have been in full menopause since I was 46. (I’m 52) Hot flashes minimal until this summer (southern hemisphere), but really melting now.
    I have been gluten free for 18 months (celiac disease) and Primal for about a month…

    Janet NZ wrote on June 1st, 2011
    • i ve noticed the same thing – if i turn to sleep on my side often a hot flash starts up.

      barb wrote on June 1st, 2011
      • Yes! I noticed that too.

        cindy wrote on June 1st, 2011
    • Yes, and also the following situations:
      * when I sit for awhile & then stand up.
      * when I stand for awhile & then quickly sit down.
      Also:
      * before I’m done with a class of wine or beer I get a hot flash.
      Granted, these are the more mild hot flashes, but still you’d think the medical profession would better understand hot flashes given the direct cause n effect observations.

      Lt.Uhura wrote on June 3rd, 2011
      • Oh – thank you ladies!
        It is so nice to know that I’m NOT weird! My GP has said he will ask his other menopausal women if they notice the same thing (I seem to be the canary in the mine for all sorts of things lately!)
        Wine does it to me too, but since going Primal I’m not drinking very often.
        All I need now is for the weight-loss to start! :-)

        Janet NZ wrote on June 3rd, 2011
        • Same for me. I get into bed – hot flush, even in winter, cant tolerate a warm bed anymore. Turn over – hot flush. Other triggers, eating, drinking wine or hot drink, feeling anxious, ccoking dinner (warm stove). Moving from one temperature to another. outdoors to indoors. I dont like a hot house at all now.

          julianne wrote on June 28th, 2012
    • This is exactly what is happening to me while I sleep! I turn over onto my stomach and chest, and boom– hot flash. It’s like hot flash on demand. And I have always been a stomach sleeper mostly, so needless to say, I’ve been waking up a lot because of this…and worrying I might have breast cancer or something else that’s getting “pressed on” and triggering the hot flashes…from the sound of these answers this “turn over” reaction must be normal, but I’d still like to know why…it’s so weird!

      Patricia wrote on July 17th, 2013
    • Well, you can add me to the list of gals with the same problem: turn over in bed and instant hot flash. And like others here, I’m really glad to read this as I thought it was just me that had this issue.

      BTW, I’m 69 years old and have had hot flashes ever since menopause. I used HRT for a while but had to stop when I found I had breast cancer.

      Being Primal for 4-5 years hasn’t helped unfortunately.

      PrimalGrandma wrote on September 13th, 2013
  30. I’ll I know is what my Acupuncturist tells me.She has recommended acupuncture and herbs for menopausal symptoms and I noticed Carrie did too.The amazing thing is my Acupuncturist got real excited about something the Western Community peer reviewed and has many people using for many things,hot flashes is one of them.With the FDA running around you can’t say all that much about anything without side effects.As Mark does intensive research into his articles I thought I could share here as well as it has 25 universities studying with remarkable findings.The MD who found SOD (Suoper Oxide Dismutuse) back in 1969 has created an herbal formula that takes TBars (aging markers) from any age including 80 yr olds to those of a 20 yr old. What it does to oxidative stress which cause more than 400 types of age related diseases is verified as well.It gets the body to release it’s own enzymes and fight free radicals at millions per second and nothing ever created is in the same game. I strongly advise to research before you make any judgements as this is pretty well documented .www.PonceDeLeonFountainofYouth.com

    Jay wrote on June 1st, 2011
  31. It was Bio-Identical hormones that did it for me. If you search online you can find lots of information on it — and also doctors railing against it — equating Bio’s with Prempro — which is made form horse’s urine. Not the same thing!
    Suzanne Somers has written some pretty informative books on this, too.
    I’ve lived in Ohio and PA since I started this and have not had a big problem either finding an OB/GYN who prescribes them and a compounding pharmacy to fill the Rx.

    Meredith Young wrote on June 1st, 2011
  32. Not sure if I am qualified for this post.

    Paleo Josh wrote on June 2nd, 2011
  33. I am not exactly “paleo,” but have been HFLC for more than 11 years. I am 58. Sometime in the past 11 years, I must have gone through menopause, but I honestly couldn’t tell you when it happened. It was a non-event. No hot flashes. No symptoms whatsoever. I like to credit my diet/lifestyle. Of course, I credit my diet/lifestyle with everything about my health and well-being, which is pretty spectacular. Never sick, lots of energy, ability to cycle far and fast, no meds, and …no hot flashes.

    Peggy Holloway wrote on June 7th, 2011
  34. I also found Susun weed’s book to be helpful. I make infusions of red clover and nettles and that seems to be working well for me along with regular acupressure on myself. black cohosh did nothing. I did do bio-identical hormones for a couple years while I was in transition, Tri-est worked well. I absolutley think that they are safer and no way was I going to take anything made from cruelty to horses! But still I was concerned with long term safety so stopped and do only the herbs and acupressure now. I livein the midwest and now is the prime time to gather red clover –the extreme weather seems to have been good for it, I gathered quite a bit of beautiful blossoms. But the area where I had planned to gather nettles was too flooded because of the intense rain. I love Susun weed’s philosophy that herbs are people’s medicine–she suggests becoming aware of what is in your area rather than “exotic” herbs. Very primal to gather your own medicine and food-nettles are delicious!

    Debrah wrote on June 7th, 2011
  35. Fantastic beat ! I wish to apprentice even as you amend your website, how could i subscribe for a weblog website? The account aided me a appropriate deal. I had been tiny bit familiar of this your broadcast provided brilliant transparent concept

    Blackheads wrote on December 3rd, 2011
  36. I use 4 tablespoons of freshly ground flaxseed daily (2 in am & 2 at night). I drink coconut milk or almond milk w/ the flaxseed & blend in some blueberries.
    No more hot flashes. I am 56.
    I just eat chicken, turkey, grass fed beef, veggies, blueberries, walnuts, almonds, chia seed. No grains. Gluten free, milk free, egg free, corn free.

    carie wrote on December 14th, 2011
  37. Hi, I’m 63, look much younger, am generally healthy and have been eating a paleo type diet (leans towards Atkins) for nearly 12 months.
    During this time, I have lost no weight at all but stay with it because I at least feel like paleo is better for my overall health.
    There is a ‘but’ though. I am 15kg overweight and really want to lose it.
    Can anyone suggest why I can’t and what I might be able to do to make it happen.
    What I’m thinking is that the Atkins diet is very liberal with cheeses and since I eat a generous portion each day, it might be the problem.
    I also only walk 30 minutes 3 times a week. I maybe need more.

    Let me know what you think.

    Emma

    Emma wrote on October 24th, 2012
  38. Everytime i lay on my left side….instant hotflash……

    cindy wrote on October 30th, 2012
    • I’ve recently started to get hot flashes and mainly when I lay down and change sides. I was worried this may be something more serious than hot flashes. Also feel ill all the time, dizzy spells, muscle weakness, headaches.

      vinita wrote on February 3rd, 2014
  39. I’m 52 and I started having hot flashes at 34- so yes, for 18 years I have been dealing with them. They started off mild and by last year I was having 5 to 6 every hour and they were bad enough that I would have sweat litterally dripping down my legs and body. I had to bathe very frequently. I did some research and found that many people had found relief with apple cider vinegar. I HATE it. did I mention I hate it? but it works. I drink 2 tablespoons in water wiht honey daily and my hot flashes have all but disappeared… and the few I do have are more like warm spells that are quickly relieved with a hand fan. Wow.

    sylvia wrote on January 4th, 2013
    • I find Kombucha does the same for me, and I think it tastes better. I just have to be careful as to how much I drink since it does detoxify and I just started using it.

      Karen wrote on October 13th, 2013
  40. For what it’s worth, my mom cut out the nightshade family from her diet to help deal with arthritis and her hot flashes vanished within a few days as well, with none to be felt for many months now. She has no intention of eating them again in the interest of science, but it might help to try it out!

    Jen wrote on April 14th, 2013
    • Well it might be early days and I don’t want to jinx myself but I have eliminated my hot flashes (intense for the last 3 years) and I am auto-immune symptom free (severe mouth ulcers for the last 6 years) for the last month. The change I have made is following the Auto Immune Protocol which is part of the Paleo diet. I haven’t been totally strict with dairy and grains but I have been very strict with no nightshades or eggs. Hope this helps someone else.

      Rachel wrote on May 28th, 2013

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