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The Hopkins Health Watch is back as the Virginia Hopkins Health Watch! Although there's a new name and a new location, you'll find the same useful, down-to-earth news and research about bioidentical (natural) hormones, natural alternatives to prescription drugs, helpful new discoveries in alternative medicine, and whatever else comes across my computer screen that bring us all closer to optimal health.
Dr. John Lee's Hormone Balance Made Simple
By now you probably know that the last book written by Dr. John Lee and myself, Hormone Balance Made Simple, is now available. For those who just want a simple, straightforward guide to achieving hormone balance, this is the ticket. Here's where you'll find sample chapters and a chart you can download to help you keep track of symptoms.
Suzanne Somers' New Book, Ageless
I've received quite a bit of e-mail from people wondering about the new Suzanne Somers book, Ageless. Without going into detail, once again Suzanne has done a great job explaining and making a case for natural hormones, but please don't use high doses of hormones – that's just plain asking for trouble. You'll find very user-friendly instructions on doses and timing in Hormone Balance Made Simple.
In this first new issue I'm going to catch you up on some of the recent research that's come out about progesterone. The biggest hormone news in 2006 came out near the end of the year.
In November 2006, research was released by cancer centers around the U.S. showing that breast cancer rates have dropped dramatically since 2002. Most doctors and researchers agree that the drop was created when millions of women suddenly stopped using hormone replacement therapy (HRT) after the Women's Health Initiative (WHI) study group announced, in the summer of 2002, that HRT users had an increased risk of breast cancer, stroke and heart disease. Estimates are that as many as 50 percent of women using HRT stopped taking it within six months after the WHI results came out.
How large was the drop in breast cancer? It depends on who's reporting the statistics and how they're interpreting the numbers. Most of the data came from the National Cancer Institute's (NCI) cancer registry.
Here's How Dramatic It Is
- There was a 2.5 percent drop in breast cancer cases in 2002, and a 7 percent drop in 2003.
- If you just look at estrogen-driven cancers (the most common kind and the kind caused by HRT), in the months between August 2002 and December 2003, there was a 15 percent drop in breast cancer cases.
- If you just look at women between the ages of 50 to 69, when women are most likely to be using HRT, there was a 12 percent drop in breast cancer cases in 2003.
- A northern California group led by Kaiser and Stanford University combined their own numbers with the NCI numbers and reported a 10 to 11 percent drop in breast cancer cases between 2001 and 2003.
Preliminary numbers for 2004 show the decline is continuing. Suffice it to say that no matter which way you crunch the numbers, breast cancer rates have dropped significantly for the first time since 1945.
Thousands of Lives Saved
According to the American Cancer Society, in America, breast cancer is the most common major cancer in women. This amounts to about 200,000 cases of invasive breast cancer each year. If you do the math (these are very crude estimates, but it gives a sense of the magnitude of this decline), a 7 to 15 percent drop in breast cancer cases represents between 14,000 and 30,000 women a year who won't be getting breast cancer.
When we look at breast cancer mortality (women who die from breast cancer), the numbers get a bit more muddled because women may die from the side effects of radiation and chemotherapy, but that may not be counted as dying from breast cancer. Most estimates are that 40 to 50 percent of women with invasive breast cancer die from it within 20 years. If we crunch the numbers again, at the current rate of decline, in one year between 5600 and 15,000 women's lives will be saved. Wow!
Putting Out the Breast Cancer Fire
Most breast cancers take seven to ten years to develop from a few cells to a lump detectable by mammogram or breast exam. So how did this decline show up so quickly after the WHI results were announced? There is some evidence that adding conventional HRT (e.g. PremPro) to an already existing breast cancer can cause much more rapid growth, and some theories that it may stimulate otherwise “quiet” cancers to grow. In other words, adding PremPro to an already existing cancer may be like throwing gasoline on the fire.
I'd hazard an educated guess that in addition to the millions of women who dumped their PremPro, the decline is also related to the millions of women who have switched to natural hormones since the late 1990s and as a result have actually prevented breast cancer altogether.
Two large and well-done French studies following women for 9 to 20 years who were taking estradiol (a natural estrogen) and an oral progesterone, found no increased risk of breast cancer and in fact even a slight decrease in breast cancer in one.
Marin County Breast Cancer Cause is Found
Back in 2002 my friend and co-author, the late Dr. John Lee, was scheduled to give a talk in Marin County in Northern California near where he lived, an area with very high rates of breast cancer. In the December 2002 issue of the John R. Lee, M.D. Medical Letter he wrote, ” It's the estrogen, stupid! That was my first reaction to a newspaper headline I read this morning: ‘Researchers say pollution not cause of Marin County breast cancer.' No, it's not the power lines, it's not the styrofoam cup factory, and it's not the quarry. It's the estrogen!”
But of course at the time Dr. Lee got “no respect” from most of his colleagues on this insight, so I was tickled to read the following in a New York Times article (12/15/06) by Gina Kolata:
“The heaviest users of hormone therapy were women in affluent places like Marin County, where high breast cancer rates had long troubled women and researchers. Women in those areas also largely abandoned the treatment after the 2002 report and their cancer rates declined accordingly, Dr. Clarke said. Dr. Marcia Stefanick, a professor of medicine at Stanford University and chairwoman of the steering committee for the Women's Health Initiative, said she found the hormone argument persuasive and felt it helped clear up the mystery in Marin County. Everyone kept saying, 'What is it? What's in the environment?' she said. Now, she said, 'it is becoming clear. The best explanation is hormone therapy.'”
Does the connection between conventional HRT and breast cancer apply to natural hormones?
The best way to answer that is to again quote Dr. John Lee, in answer to that very question:
“Not at all. What I recommend is first measuring saliva hormone levels to find if there is a hormonal imbalance. Then, if necessary, correcting the imbalance using natural hormones in physiologic doses, which means ordinary doses that the body would naturally produce itself. (Please read one of our “What You Doctor May Not Tell You…” books for details.)
Another way to look at this is, from puberty until menopause, a healthy woman's body is making its own natural hormones in synchrony and balance, without giving her cancer, heart disease or strokes. What I recommend is attempting to regain this natural balance as closely as possible.
Conventional HRT not only fails to measure hormones and use physiologic doses, it uses synthetic, not-found-in-nature, “hormones that are foreign to the human body and cause a long list of unwanted side effects.”
Data came from the American Cancer Society, the National Cancer Institute, the Centers for Disease Control, and the Journal of Clinical Oncology (Clarke et al, Vol 24, 33:Nov 20 2006)
de Lingnieres et al, Climacteric 2002
Fournier A et al, Int J Cancer 114:2005
It's pretty hard to get goose bumps reading a scientific review article, but as I was reading “Pregnancy, progesterone and progestins in relation to breast cancer risk,” by a group of Italians led by Carlo Campagnoli, my hair stood on end. Here, in one eloquently worded, organized and argued paper was the same basic argument that Dr. Lee, Dr. Zava and myself made our 2002 book, What Your Doctor May Not Tell You about Breast Cancer about why progesterone is protective against breast cancer and progestins cause it. However, since the article was written four years after our book, it cited even more good research to prove the point.
If you're facing a doctor who doesn't understand the relationship between progesterone, estrogen, progestins and breast cancer, suggest that he or she read this paper.
What You Need to Know about Progesterone and Breast Cancer
Here are some of the major points made by the authors:
- It's the synthetic progestins that contribute to causing breast cancer-not progesterone.
- Even one full-term pregnancy is remarkably protective against breast cancer, probably because progesterone and other pregnancy hormones cause permanent changes in breast tissue that are protective, and because progesterone levels are very high in the last few weeks of a full-term pregnancy.
- Women with the highest progesterone levels, and the highest progesterone/estradiol levels during pregnancy, have the lowest risk of breast cancer.
- It's estrogen, not progesterone, that stimulates proliferation of breast cells.
- They cite five studies showing that menstruating women with the lowest mid-cycle progesterone levels have the highest risk of breast cancer.
- They cite the French studies (see above) and note: “It is important to realize that recent findings relating to the use of natural progesterone, in sharp contrast to those referring to the use of progestins, are reassuring. …It is probable that the increase in BC risk found in other studies with HRT is related to the fact that synthetic progestins, rather than progesterone, were used.”
- Insulin resistance, hyperinsulinemia and high blood glucose (caused by being overweight, eating too much sugar and refined carbs, not exercising, stress and not enough sleep) are associated with an increased risk of breast cancer.
Campagnoli C, Abba C, Ambroggio S, Peris C, Pregnancy, progesterone and progestins in relation to breast cancer risk. J Steroid Biochem Mol Biol, 2005 Dec;97(5):441-50.
Back in January 2001 and again in June 2002 I wrote in the Hopkins Health Watch (then a column in the John R. Lee, M.D. Medical Letter) on research at Emory University with progesterone and brain injury, first in rodents and then in humans. Lead researcher Dr. Donald Stein hypothesized that progesterone reduces the inflammation that frequently leads to dangerous brain swelling following head injury, and slows or blocks the formation of free radicals, which in a brain injury can cause substantial brain cell death. Brain injury kills about 50,000 Americans every year, and disables 80,000 more.
The Emory human clinical study, which began in 2002 on patients entering emergency rooms with brain injuries, was recently published in the journal Annals of Emergency Medicine in October 2006. Now led by Dr. David W. Wright, the study involved 100 adults with brain injury who reached the emergency room within 11 hours of injury. Eighty percent of the patients were given progesterone, and 20 percent were given a placebo. The death rate in the 30 days after injury was 13 percent in the progesterone group compared to 30 percent in the placebo group-those are the kind of odds I'd like to have in my favor if I had a brain injury.
Double the Chance of Surviving a Brain Injury
According to Dr. Wright, “…we found a 50 percent reduction in the rate of death in the progesterone-treated group. Furthermore, we found a significant improvement in the functional outcome and level of disability among patients who were enrolled with a moderate brain injury.”
Other rodent studies on progesterone and brain injury that Dr. Stein has been involved with suggest that: progesterone works better if it is applied continuously rather than by injection; that withdrawing it quickly can lead to complications; and that allopregnanolone, a metabolite of progesterone, works as well or better at protecting the brain after an injury.
Researchers at Emory have also found that progesterone may limit damage from transient and permanent ischemic stroke (caused by a blood clot) and they are planning to initiate a human pilot study to find out more.
Neuropharmacology Nov 2006
Pharmacol Biochem Behav July 2006
Exp Neurol Aug 2006
Ann Emerg Med Apr 2006
Mechanisms of Progesterone-Induced Neuroprotection
Singh, M, Ann. N.Y. Acad. Sci. 1052, 2005.
This is a review on the literature about the effects of estrogen, progesterone and progestins on the brain. The author points out that estrogen has a protective effect on the brain and may even help prevent Alzheimer's, but that research into progesterone's effects on the brain has been neglected. He also points out that that while progesterone clearly has protective effects on the brain, the progestins do not and in fact they may even block estrogen's protective effect.
In the April 2006 review, “Progesterone-induced neuroprotection,” published in the journal Endocrine, Singh says point blank, “Finally, we contrast the neurobiology of progesterone with that of the clinically used medroxyprogesterone acetate (MPA) [Provera, which is the “Pro” in PremPro], and suggest that the 'natural' progesterone may be the better choice when considering which progestin to use for future therapeutic/palliative purposes in CNS-related [central nervous system] disorders.”
In a related article (Nilsen and Brinton, Endocrinology Jan 2002) which Singh refers to, the authors state, “The present study demonstrates the divergent actions of different progestins and their impact on estrogen-mediated neuroprotection. Progesterone and 19-norprogesterone, but not MPA, decreased neuronal damage induced by glutamate excitotoxicity. Not only was MPA an ineffective neuroprotectant, but it antagonized estrogen-induced neuroprotection. …Overall, these results suggest that care must be taken in deciding the formulation of HRT, especially with respect to the progestin used.”
In other words, progesterone protects the brain and nervous system, progestins do not.
There's conflicting research about whether estrogen helps or hurts with Alzheimer's, dementia and brain function in general. However, if you look more closely at the data, it's the synthetic estrogens and the high dose estrogen that either cause damage or don't help the brain, while low doses of natural estrogen (e.g. estradiol) clearly improve brain function in women who are deficient.
Most menopausal women who have been plagued with foggy thinking because of estrogen deficiency can attest to how helpful a little estrogen can be! Judging by the e-mails I receive and the doctors I talk to, the low-dose estradiol patches such as Vivelle work very well when combined with natural progesterone cream.
Yue X et al, “Brain estrogen deficiency accelerates Abeta plaque formation in an Alzheimer's disease animial model,” Proc Natl Acad Sci, Dec 27 2005.
Wise PM, “Estrogen therapy: does it help or hurt the adult and aging brain? Insights derived from animal models,” Neuroscience Nov 28 2006.
Goodman Y et al, “Estrogens attenuate and corticosterone exacerbates excitotoxicity, oxidative injury and amyloid beta-peptide toxicity in hippocampal neurons,” J Neurochem 66:1996.
UNTIL NEXT TIME…….
In the next issue of the Health Watch, we'll explore the evidence that going under anesthesia can contribute to dementia and how to protect yourself; I'll interview an expert on what's in your vitamins that might be more harmful than helpful; and review some new pharmaceutical drugs and natural supplements.