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A couple of weeks ago the TV show 20/20 did a two-part show on fear, worry and anxiety in America. The bottom line was that the media, fueled by corporate interests and politicians, stir up fear to get your business and your votes. Scary stories get more viewers than happy stories. Most of the scary stories are taken out of context or blown out of proportion. Take for example the big shark attack scare of a few summers ago: in truth, there were no more shark attacks that summer than any other summer, but since there were no big news stories to get our attention, the shark story got a lot of play. If you watch your local news every day, you’ll be convinced that the U.S. is teeming with murders, rapes, robberies, kidnappings and carjackings. The truth is that in America, on average, we’re much safer, healthier and wealthier than we were 50 years ago.
The medical community, including alternative medicine, is no exception when it comes to stirring up fear and worry. Most of the fearmongering is sponsored by those with something to sell. High blood pressure! High cholesterol! Heart attack! Obesity! Cancer! Insomnia! Oxidation! Heavy metals! Nutritional deficiencies! Aging! Of course health problems can plague us, and if we’re not feeling well we want to delve in and find out why, but most of us need lifestyle adjustments more than pills and potions.
Did you know that about 60 percent of women going through the menopausal transition experience few physical symptoms? A few hot flashes here and there, a little crankiness and weight gain, maybe some vaginal dryness. Granted, that still leaves millions of women who are hurting enough to need significant help, but the majority of women can solve their menopause problems with minimal effort.
Dr. Christiane Northrup is Back with More Good Advice
The emotional turmoil of menopause can be as much about empty nests, dissolving marriages and wrinkles as hormone imbalance. For that side of menopause, Dr. Christiane Northrup is back with a show on PBS called Menopause and Beyond: New Wisdom for Women, and a book called the Wisdom of Menopause. I watched her PBS show, and while she seemed hesitant and a bit behind on the physical/medical details, when she was addressing the “rebirth” of the menopausal transition, she was engaging, funny and original. Her show is airing on PBS stations around the U.S. this month, and it’s worth watching.
Beware! vs. Be Aware
If you’re reading this newsletter you’re interested in maintaining optimal health, but let’s strive to avoid the Beware! syndrome, which is anxiety-provoking, and focus on a Be Aware attitude, which is about being informed and discriminating.
Skin cream is a great way to deliver progesterone into your body. Within seconds of applying it to the skin, the progesterone is coursing through your blood and into your body’s tissues. Little more than a decade ago, Dr. John Lee was being thrashed by his medical colleagues for suggesting that the skin was a good way to transport hormones into the body. Today the drug companies and doctors are fully on board with skin patches for everything from estrogen and birth control to nicotine and pain relievers. Research into how to deliver more medicines more efficiently through the skin is booming.
If hormones, nicotine and other medicines can move quickly and efficiently into the blood, what else are you absorbing through your skin? The potential for absorbing harmful substances through the skin is enormous. When we lather up in the shower, shampoo, apply skin creams and make-up, we’re getting a dose of whatever is rubbed onto our skin.
What Goes On the Skin, Goes In the Skin
Almost anything with lipophilic (which means oily or fatty) or fat soluble (dissolves in fat) characteristics is likely to be absorbed through the skin. Not everything that goes through the skin is potentially toxic, but unfortunately much of it is. The biggest source of contamination through the skin is body care products, which contain thousands of untested and unregulated chemicals. Well, they are tested, but only to find out if they’re going to make you break out in a rash.
There are virtually no requirements for toxicity or carcinogen warnings on labels, and all sorts of loopholes to avoid honest labeling. A good example is the use of the word “fragrance” on an ingredients label. Just about anything that could possibly be construed to be included in a fragrance can be encompassed in that word, including phthalates, petrochemical plastics that are known to cause cancer and reproductive abnormalities. The other catchall, used most commonly in pesticides, is “inert ingredients,” which can encompass a veritable stew of harmful chemicals.
Another good example of a hidden contaminant is Quaternium-15, a preservative found in many body care products—including baby shampoos—that releases formaldehyde.
Products with Ingredients than can Enter the Bloodstream Through the Skin
Cosmetics – makeup, lipstick, etc
Creams, lotions, gels, moisturizers, wipes
Soap, shower gel, bubble bath
Shaving cream, aftershave
Hair products – shampoos, conditioners, gels and dyes
Fragrances (perfumes, colognes, anything scented)
Nail Polish and nail polish remover
Laundry detergent (especially scented)
Dry cleaned clothing
Polyester and permanent press clothing
Household cleaners, especially sprays
Polishes and waxes
Pesticides, including insect repellants and pet products
Lubricants – motor oil, WD-40
The list of chemicals in the above products that can be toxic is almost endless, so the trick is to find the cleanest products you can, especially when it comes to personal care products. The words “natural” or “organic” on a label are almost meaningless—you can have one organic ingredient out of 20 and call a product organic and “natural” means nothing when it involves shopping. And just because you buy something in a health food store is no guarantee that it’s safe or free from harmful chemicals.
How to Find Healthy Skin Products
A good source of information on ingredients in personal care products has been compiled on the Environmental Working Group (EWG) website. They have a section called Skin Deep that rates products based on how many potentially toxic or carcinogenic chemicals they contain. It’s sad but true that all those chemicals do make body care products feel better, spread better and preserve better, so there is a trade-off in using cleaner products. One of the cleaner brands for hair, skin and body care is Aubrey Organics.
An Ounce of Prevention…
For cleaning products, paints, gardening etc, wear gloves, work in a well-ventilated area and find the least toxic product for accomplishing the task. If your water is chlorinated, get a shower head filter—most of them are inexpensive and easy to install. For pregnant or nursing mothers, painting, finishing furniture, using pesticides or acetones (think nail polish) should be out of the question. In this case it isn’t just about getting these substances on the skin, it’s also about breathing them.
The Goal is to Minimize Exposure
Unless you’re a fetus or an infant, your exposure to any one of these products at any one time (assuming normal use) is unlikely to be toxic; it’s the daily exposure to numerous sources that creates toxicity over time. In 2003 the Centers for Disease Control (CDC) released the results of research that tested for 116 contaminants in the blood and urine of thousands of people, representing a wide range of geography and lifestyle. The majority of people tested had detectable levels of contaminants. Obviously you can’t entirely avoid everything that you might breathe or get on your skin that might be toxic—that would be way too stressful! The goal is to be aware and minimize your exposure.
And by the way, the word “organic” is meaningful for food products, and children who eat organically grown fruits and vegetables have one-sixth the levels of organophosphate pesticides in their urine compared to children who don’t eat organic fruits and vegetables.
Centers for Disease Control and Prevention, “Second National Report on Human Exposure to Environmental Chemicals,” Jan 31, 2003, http://www.cdc.gov/exposurereport/.
Curl, C.L. et al, “Organophosphorus pesticide exposure of urban and suburban preschool children with organic and conventional diets,” Environmental Health Perspectives, 111(March):377-382.
Environmental Working Group, http://www.ewg.org
Mowad, Christen M, “Allergens of New and Emerging Significance,” Dermatol Nurs 2006;18(6):545-548.
Children are more susceptible to the toxic effects of contaminants than adults, and the younger they are, the more susceptible they are, right down to the growing fetus in the womb. One type of contaminant is of particular concern, both because it can cause reproductive abnormalities and because it’s ubiquitous—everywhere—and that is bisphonol-A.
Bisphenol-A is a chemical used to make plastics, including those used in some baby bottles, water bottles, microwave dishes, the lining of canned goods, the lids of jars, dental sealants and many other products. It’s beyond dispute in rodent studies that exposure to even very low amounts of bisphenol-A in the womb or during infancy can cause reproductive abnormalities and chromosomal damage that can be carried through multiple generations. Although much of the research has been done with mice, there’s a large body of indirect evidence that it can also affect larger mammals, including humans.
Bisphenol-A’s primary offense is that it’s a hormone mimic, feminizing male fetuses and masculinizing female fetuses. Bottom line, it interferes with sex differentiation in the brain, which is what makes us male or female. In rodents, even low level exposure to bisphenol-A early in life later leads to declining sperm counts, earlier onset of puberty, birth defects, breast cancer and prostate cancer. Sound familiar? It’s estimated that 95 percent of U.S. residents have measurable levels of bisphenol-A.
Bisphenol-A and Insulin Resistance
There’s also rodent research showing that exposure to bisphenol-A early in life can cause obesity later in life. Additional research showed that it creates insulin resistance, which is a precursor to obesity and diabetes. Sound familiar? The primary cause of obesity and diabetes is poor eating habits and lack of exercise, but it’s plausible that exposure to bisphenol-A could be aggravating the epidemic of obesity and diabetes in the U.S.
What You Can Do to Avoid Bisphenol-A
It would probably benefit all of us to avoid bisphenol-A, but pregnant women and mothers with infants would do well to be vigilant about it. Start by avoiding canned goods. Try to avoid drinking bottled water. If you need to carry a water bottle around, put filtered water in the hard plastic kind that can be found at sporting goods stores (they’re often called event bottles). Microwave in glass—there are plenty of microwave-safe glass containers available these days.
Breastfeeding is the best possible way to avoid plastic baby bottles and plastic baby bottle liners, but if bottle feeding is necessary the first choice should be glass—just be sure to check them regularly for chips and cracks. Evenflo makes glass baby bottles.
Resources for Healthier Children
For more information about reducing the toxic burden on our children, visit the website of the Children’s Health Environmental Coalition, a national non-profit organization dedicated to educating the public about environmental toxins that affect children's health.
I also highly recommend the book, The New Breastfeeding Diet Plan: Breakthrough Ways to Reduce Toxins and Give Your Baby the Best Start in Life by Robert Rountree, M.D. and Melissa Block, M.Ed. (McGraw Hill 2006).
Alonso-Magdalena, P et al, “The estrogenic effect of bisphenol A disrupts pancreatic beta cell function in vivo and induces insulin resistance.” Environmental Health Perspectives 114(January 2006):106-112.
Hunt, PA et al, “Bisphenol A exposure causes meiotic aneuploidy in the female mouse,” Current Biology 13(April 2003):546-553.
Nielsen, JB et al, “In Vitro Percutaneous Penetration of Five Pesticides—Effects of Molecular Weight and Solubility Characteristics,” Ann. occup. Hyg., Vol. 48, No. 8, pp. 697–705, 2004.
Rubin, B.S. et al, “Evidence of altered brain sexual differentiation in mice exposed perinatally to low, environmentally relevant levels of bisphenol A,” Endocrinology 2006 Aug;147(8):3681-91.
Susiarjo, M et al, “Bisphenol A exposure in utero disrupts early oogenesis in the mouse,” PLoS Genetics 3(January 2007):e5.
Black cohosh (Cimicifugae racemoscae) is plant whose root has been used to ease hormonal imbalance symptoms in women for centuries. The Complete German Commission E Monographs, a thick volume commissioned by the German government to standardize herbal medicine and assure people of its safety and efficacy, lists its uses as including, “Premenstrual discomfort, dysmenorrheal or climacteric [menopausal]…” Its actions are listed as, “Estrogen-like actions, luteinizing hormone suppression, binding to estrogen receptors.”
Michael Moore on Black Cohosh
Michael Moore, one of the all-time great herbalists, recommends black cohosh in his book, “Medicinal Plants of the Pacific West,” saying in part, “The antispasmodic effects of Black Cohosh help ease regular, spasmodic cramps in the tube muscles, and many women will attest to its value for uterine and fallopian cramps. With its effect on skin vasodilation helping to increase the organizing secretions of menstruation—those fluids that add volume, prevent coagulation and inhibit bacteria—Black Cohosh is especially useful for cramps that accompany a slow, spotty-clotty menstruation. …The estrogenic compounds of the root are not the type that have an effect on the uterus or the breast tissue, but rather they are perceived by the hypothalamus of the brain as an estrogen metabolite and tend to lessen the pituitary surges of luteinizing hormone (LH) in the absence of ovarian estrogens. This makes is useful for women who are in menopause and have hot flashes….”
One Negative Does Not Outweigh Ten Positives
Between 2003 and 2006 there have been 10 clinical trials with black cohosh showing a positive effect on hot flashes.
What happened, then, in a widely publicized study of black cohosh published in December 2006 in the journal Annals of Internal Medicine that concluded, “Black cohosh, used in isolation, or as part of a multibotanical regimen, shows little potential as an important therapy for relief of vasomotor symptoms.”
One answer may be that it was given to the participating women daily for 12 months. As Michael Moore points out, it tends to stop working when it’s overused. In other words, it’s best used to treat symptoms, not as a long-term daily treatment. It’s not meant to be hormone replacement. Another answer may be that the study participants were divided into 5 groups, leaving relatively small numbers in each group, which makes it harder to show real effects.
According to information published by the American Botanical Council, the herbs used in the trial did not meet stability standards, and the amounts given were four times higher than those used in previous trials. It’s a truism in hormone balance that more is not better, and excessive doses of any medicine that affects hormones will often cause more problems than it solves.
Regardless of the reasons for the negative outcome in this study, it doesn’t negate the positive outcomes of the other 10 studies and centuries of use in folk medicine.
Hot Flash Relief
In my experience, black cohosh isn’t necessarily the best choice for women who are having severe hot flashes, such as those caused by a complete hysterectomy. However, for many women having mild to moderate hot flashes, black cohosh—used as directed—can be a wonderfully mild, safe and effective remedy.
Progesterone cream—in the dosage and timing recommended by Dr. John Lee—will also often relieve or lessen mild to moderate hot flashes.
There’s no doubt that nothing relieves hot flashes as reliably as estradiol (an estrogen), but estrogen is a prescription-only hormone that can lead to numerous health problems if it’s not used properly. Black cohosh is less complicated, safer and less expensive.
Remifemin is a black cohosh brand from Germany that’s well known, widely available, well researched and standardized. I know many women who have happily used it to smooth their menopausal transition.
Hot flashes can be caused by a combination of factors and no one remedy works for every woman. Dr. Lee always advised starting with the simplest solutions first, and black cohosh certainly qualifies.
Progesterone Vs. Progestins in Monkeys
Wood CE, Register TC, “Effects of estradiol with micronized progesterone
or medroxyprogesterone acetate on risk markers for breast
cancer in postmenopausal monkeys,” Breast Cancer Res Treat (2007) 101:125–134
This is an important, even landmark study, not in the sense of bringing us new information, but in confirming what’s already known but not substantially proven in published research to the satisfaction of those who don’t quite grasp yet how safe and effective progesterone is in hormone replacement therapy.
Macaque monkeys are about as close as it can get to reproducing in animal research what will happen in humans. The goal of this study was to compare the effects of different types of HRT. Twenty-six macaque monkeys without ovaries were divided into groups and rotated through four HRT regimens lasting two months each, with a one-month washout period in-between. The four groups received either: 1) placebo, 2) estradiol, 3) estradiol and oral micronized progesterone (natural progesterone in a pill, 200 mg daily) or 4) estradiol and medroxyprogesterone acetate (MPA also known as Provera).
Breast epithelial proliferation, a type of cell growth that’s a marker for breast cancer risk, was measured in each group after each type of treatment. Compared to placebo, treatment with estradiol and MPA resulted in significantly greater breast proliferation; treatment with estradiol and progesterone did not.
The conclusion of the authors: “These findings suggest that oral micronized progesterone has a more favorable effect on risk biomarkers for postmenopausal breast cancer than medroxyprogesterone acetate.”
Progesterone vs. Progestins in Humans
Fournier A, Berrino F et al, “Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study,” Breast Cancer Res Treat 2007 Feb 27; [Epub ahead of print]
This is a continuation of the large, ongoing French study of HRT known as the E3N Cohort Study, which has already published results twice, each time more clearly and definitively confirming that progestins increase breast cancer risk significantly, while progesterone does not.
This data involves 80,377 postmenopausal women, 2,354 of whom got invasive breast cancer during the average eight years of followup. Compared with women who had never used HRT of any kind, those who used estrogen alone (presumably women who had a hysterectomy) had a significant 1.29-fold higher increased risk of breast cancer. Women using estrogen-dydrogesterone (a progestin), had a 1.16-fold increased risk; women using estrogen and other progestins had a 1.69-fold increase; and women using an estrogen-progesterone (pill) combination had a risk of 1.00.
The authors conclude that, “These findings suggest that the choice of the progestagen component in combined HRT is of importance regarding breast cancer risk; it could be preferable to use progesterone or dydrogesterone.”
This information comes from a pre-publication online abstract, so it will be interesting to find out the details of the data when the research is published in its entirety.