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IN THIS ISSUE
Will Wyeth Bully You Out of Your Estriol Cream?
Whole Fat Dairy Products a Good Source of Hormones
Inositol, PCOS and Fertility
Research on Progesterone and the Heart
More Reasons to Avoid Fake Fragrances
Seriously Simple Solution for Foot Pain
Will Wyeth Bully You Out of Your Estriol?
The FDA has begun 2008 by forbidding compounding pharmacists to use estriol in their natural hormone formulations because the agency doesn’t have a specified approved use for it. They took this action because Wyeth complained about it. And yet, Wyeth-Pharma sells two types of estriol drugs in Europe, so we know this is not a safety and efficacy issue.
In case you’ve forgotten, Wyeth is the giant pharmaceutical company that makes Premarin and PremPro, synthetic hormones found to cause heart disease, strokes and cancer. If we do some rough calculations based on statistics from the Women’s Health Initiative (WHI), Wyeth’s hormone replacement drugs have killed tens of thousands of women over the past few decades. Sales of these dangerous drugs have plummeted since the WHI results were announced, and women who were injured by them and sued, are winning millions in damages in courtrooms around the U.S. (You go girls!)
Estriol is a Safe Alternative
Estriol, on the other hand, is a mild (natural) estrogen that’s primarily used in cream form for vaginal dryness and urinary tract problems in menopausal women. It’s been in common use in Europe for 30 years, and its safety and effectiveness are well established. Many doctors in the U.S. who use natural hormones prescribe tri-est and bi-est, estrogen cream formulations made by compounding pharmacies that contain estriol. These formulations appear to be what Wyeth perceives as its competition. If you'd like to know more about estriol, Dr. David Zava wrote an entire chapter about it in What Your Doctor May Not Tell You about Breast Cancer.
Here's what the medical literature states about Ovestin, an estriol cream made in Europe: “Ovestin contains the natural hormone estriol, which is a weak estrogen. It treats urogenital symptoms without causing adverse changes to the endometrium, which means that it can be used without a progestogen in women with an intact uterus…. The absence of progestogen-induced withdrawal bleeds with Ovestin makes it highly acceptable to women.”
The doctors and pharmacists can take the estriol out of the formulas and they’ll still work well because they also contain estradiol, but ironically they probably won’t be quite as safe. Estriol may have some protective properties that balance estradiol’s cancer-promoting effects. In fact, estriol is so safe that it’s the primary estrogen of pregnancy—the fetus is bathed in it.
The Bully in the Neighborhood
It’s shameful of Wyeth to use its clout and money to bully and beat on the competition through the FDA, but by now we expect that behavior from them. The real shame is that the FDA can’t seem to stop itself from being bullied. You can bet there was some major arm twisting going on to push the FDA into this action, because they just have to know that it's been proven safe and effective in Europe, and that thousands of annoyed menopausal women are going to be sending them e-mails. We can only hope that the FDA responds by quickly reviewing the body of excellent research available on estriol and taking action to assign it some specific and approved uses.
In the meantime, if big bad Wyeth succeeds in taking your estriol away, and you can’t have sex because of vaginal dryness, send your partner to Washington to march on the FDA’s doorstep. Just kidding. This is an especially poignant issue for women with breast cancer or who have had breast cancer, because estriol is a safe alternative to estradiol. The estrogen-blocking drugs such as tamoxifen that are used to treat breast cancer can cause terrible vaginal dryness and urinary tract problems, and even without the drugs, these are serious problems for many menopausal women.
Estradiol cream is an effective, albeit less safe, treatment for vaginal dryness and urinary tract problems. Please use the lowest dose possible that relieves symptoms and use progesterone cream for balance. For details I recommend that you read Dr. John Lee's Hormone Balance Made Simple.
High fat dairy products may be a good way to increase your progesterone levels, according to a presentation made at the 30th Annual San Antonio Breast Cancer Symposium in December. This is an entertaining piece of research. How about a celebrity ad that says, “Low progesterone? Drink Milk.”
Because males have steadier hormone levels than females, researchers measured the saliva progesterone levels of 17 men for a baseline, then asked them to eat three servings of high fat dairy foods (2 tablespoons butter, 2 ounces cheese, and a quart of premium ice cream) over a 24-hour period. They measured saliva levels again and found that progesterone levels rose by 30% to 100%. Apparently high fat dairy products are an effective delivery medium for progesterone—who knew?
Milk Comes from Pregnant Cows with High Hormone Levels
But wait, there’s more! These days almost all milk comes from pregnant cows and it contains almost as many different kinds of hormones as Premarin (which comes from pregnant mares). According to Harvard M.D.s Chavarro and Willett who wrote the new book, The Fertility Diet, milk also contains estrogens (estrone and estradiol), testosterone, androstenedione, DHEAS, sex hormone binding globulin, prolactin, gonadatrophin-releasing hormone, insulin-like growth factor-1 and more—some 200 substances in all. According to other research, the more pregnant the cow, the higher the levels of hormones in the milk. Who needs hormone replacement therapy when you’ve got high fat dairy products?
…the more pregnant the cow, the higher the levels of hormones in the milk. Who needs hormone replacement therapy when you’ve got high fat dairy products?
Because many of the hormones, including progesterone and estrogen, are spun out in lower fat dairy products, you might think that’s the answer, but think again. Chavarro and Willett point out that while progesterone and estrogen are lower, the androgens (male hormones) and many others remain. Thus, they recommend that women with fertility issues, who often already have high androgens, eat high fat dairy products so they’ll get the progesterone. Let’s not tell them that they could just use a little progesterone cream and achieve the same result—it would spoil the fun for all those women who get to eat Ben & Jerry’s while they’re trying to get pregnant. On the other hand, women whose infertility issues are caused by polycystic ovary syndrome (PCOS) need to avoid sugar, so in that case stick to whole milk, yogurt, cottage cheese and so forth.
The amount of progesterone present in high fat dairy products is relatively small for a woman—about 0.02 mg per 6 ounces. An ovulating woman makes 15 to 30 mg daily during the middle of her cycle. For a man, who makes only 2 to 3 mg of progesterone daily, that’s a more significant amount.
Homework for Researchers
Unfortunately the researchers who did the progesterone and dairy products study don’t appear to understand hormones very well, because they theorize that the progesterone in high fat diary foods may contribute to early menarche in girls and breast cancer. Sorry guys, progesterone is gender neutral and is protective against breast cancer. Maybe I’ll send them a copy of What Your Doctor May Not Tell You about Breast Cancer. I wasn't able to find out who paid for this research—maybe the soy industry is trying to scare people away from milk. Before you turn to soy milk please read this article: Use Caution with Soy Foods.
If you need a hormone fix and feel like gaining a few pounds and producing a lot of mucus, a pint of high fat ice cream might be just the ticket. If you’re African American, Native American or Asian, chances are excellent that you’re lactose intolerant, and dairy products will cause postnasal drip and make you gassy and bloated. For the rest of us, as always, moderation is the key.
While we’re on the subject of fertility, two research groups in Italy, both led by Enrico Papaleo, have done excellent studies with the dietary supplement myo-inositol and polycystic ovary syndrome (PCOS), showing significant benefit, which is great news for women who suffer from this disorder as it gives them an alternative to the diabetes drugs that American doctors typically prescribe for PCOS.
Polycystic ovary syndrome is one of the leading causes of infertility. It also tends to cause hair growth where it’s not wanted, acne and difficult menstrual cycles. Although a few months of avoiding sugar and refined carbohydrates and getting daily exercise almost always resolves PCOS, American doctors instead tend to prescribe diabetes drugs such as metformin to help regulate insulin levels. (It’s so much easier to write a prescription than it is to help women deal with diet and exercise.) This is unfortunate as these types of drugs have a lot of side effects and don’t address the underlying issue. Myo-inositol is a good middle-of-the-road approach.
Myo-inositol, a form of inositol, is a member of the B-complex family of vitamins. It’s not an essential vitamin, as it can be manufactured by the body, but it tends to be deficient in women with PCOS, and restoring it can help regulate insulin enough to restore normal ovulation and thus fertility, and assist with weight loss.
Here's the Research
These aren't large studies, but they're nicely done. Inositol is very safe so there's no harm in trying it, but if you're already on a diabetes drug talk to your doctor first. If you want to get off a diabetes drug, do it gradaully and under your doctor's supervision.
In a double-blind, placebo-controlled study published in the Sept-Oct 2007 European Review for Medical and Pharmacological Sciences, 92 women were split into two groups, and the placebo half got folic acid, while the test group got folic acid plus 4 gms daily of myo-inositol, for 14 weeks. The myo-inositol group had a significantly higher rate of ovulation, higher HDL (good) cholesterol, and they lost weight, while the placebo group gained weight. It’s important to note however, that the heavier a woman was, the less effective the treatment was.
The other study, published in the Dec 2007 journal Gynecological Endocrinology, put 25 PCOS women on a combination of folic acid and inositol (2 gms combined) for six months. The results were reported as follows, “Twenty-two out of the 25 (88%) patients restored at least one spontaneous menstrual cycle during treatment, of whom 18 (72%) maintained normal ovulatory activity during the follow-up period. A total of 10 singleton pregnancies (40% of patients) were obtained.”
Based on these two studies, myo-inositol seems to be a remarkably effective treatment for PCOS, and for restoring fertility. Even better, it doesn’t have side effects and it’s relatively inexpensive. For women who are trying to get pregnant, it’s ideal to combine this treatment with improved diet and exercise, so that the insulin problems aren’t carried into pregnancy.
Here’s where you can read articles about PCOS and infertility by Dr. John Lee and myself.
Progesterone’s effect on cardiovascular health is becoming a topic of interest among researchers, who are beginning to realize that the effects of the synthetic progestins on heart function are dramatically different from those of natural progesterone. In short, while progestins can cause heart spasms and cardiac disease, progesterone can protect the heart.
In What Your Doctor May Not Tell You about Menopause, Dr. John Lee described the research done with monkeys and humans showing that certain progestins caused spasms in the heart. However, at that time, research showing the beneficial effects of natural progesterone on the heart was sparse.
One of the first researchers to study progesterone’s effect on the heart among women using natural progesterone was Kenna Stephenson, M.D. of the University of Texas at Tyler. An abstract of her study was published in the journal Blood a few years back. In short it found “…no markers for inflammation or clotting indicators for most of the serious diseases related to the used of traditional hormone replacement therapy.” In other words, progesterone didn’t increase biomarkers for stroke or heart attack. Stephenson’s research along these lines is ongoing, and her group continues to find that progesterone’s effects on cardiovascular function are beneficial or neutral.
Helps Maintain Normal Blood Pressure
A more recent study of endogenous (made in the body) progesterone levels was published in the Oct 2007 Journal of Clinical Endocrinology & Metabolism. According to the lead author Emily Szmuilowicz, M.D. of Brigham and Women Hospital, “Our study shows that in postmenopausal women, higher blood levels of progesterone are associated with less of an increase in blood pressure and less blood vessel constriction in response to angiotensin II, one of the naturally occurring substances in the body which causes the blood vessels to constrict. Constriction of the blood vessels can lead to increased blood pressure, which can contribute to problems such as heart attack and stroke.”
Protects Against Heart Arrhythmias
In a rodent study done in Japan by Nakamura et al, and published in the Dec 18, 2007 issue of the journal Circulation, researchers found that progesterone protected the heart from rhythm disturbances, or arrhythmias.
Protects Better During a Heart Attack
In yet another rodent study done in India and published in Life Sciences journal in June 2007, researchers gave different groups of rats a heart attack and studied the extent of the damage done. The groups included males, females, females without ovaries, and then each of those groups treated with progesterone. They found that the females with ovaries that were also treated with progesterone had significantly less heart damage. They also came out better on most of the biomarkers used to measure heart damage. The fact that the female rats without ovaries didn’t do as well on the progesterone is most likely an indicator that progesterone and estrogen benefit the heart the most when they work together.
If all fake fragrances were banned tomorrow the world would be a dramatically healthier place by the following day. That’s not going to happen, but the more people who refuse to use them in any form, the faster they’ll disperse (so to speak). But watch out, those who manufacture products containing fake fragrances are sneaky. The word “unscented” usually means that fragrances have been used to cover up fragrances. To actually avoid fragrances you have to look for the words “fragrance free” on the label.
By fake fragrances I mean that they're not found in nature. Oh sure, they may smell like a rose, or mint, or apple, but what goes into creating that aroma has nothing to do with the flower or fruit. Virtually all perfumes, scented laundry soaps and fabric softeners, so-called air fresheners (they should be called air poisoners) and many cleaning products are scented with fake fragrances. Even dry cleaners are getting into the act, handing back clothes that are clean, pressed and exuding fragrance.
Perfumes are All Fake
Well, almost all. Unless they’re pure essential oils, they’re made from a nasty brew of dozens if not hundreds of chemicals which are, of course, a secret. For example, the benzene family of chemicals tends to have a sweetish aroma that is very popular among perfumers. The benzenes are petroleum-based, so they’re cheap, easy to come by, and, by the way, a known cause of leukemia. It was one thing when a woman spritzed some benzene on her wrist before a romantic evening, but it’s quite another when it’s everywhere from clothes to cars to the restroom in the dentist’s office.
Or how about those phthalates, which as you know from the John R. Lee, M.D. Medical Letter, are plastics that can interfere with the normal sexual development of a fetus or infant. Phthalates have recently been banned from toys in California which is great, but how about clothes and bed sheets? Apparently phthalates make perfumes stick around longer so they’re in just about everything scented. Here’s where to find on Xenohormones and phthalates.
Asthmatics Should Look for Fake Fragrances as Causes
I don’t want to downplay those good old-fashioned allergens such as ragweed and cats, but according to the Environmental Working Group, “Fragrance formulas are considered to be among the top five known allergens and can trigger asthma attacks.” Are doctors giving this information to their asthmatic patients? Not very often.
I’ll bet you didn’t know that many processed foods contain fake fragrances. Take for example diacetyl, a chemical that gives microwave popcorn its buttery flavor and aroma, and also causes serious lung disease when heated and inhaled frequently. Diacetyl is being phased out of microwave popcorn, but not before many popcorn factory workers were permanently disabled by it. Now it might take a lot of microwave popcorn fumes to knock down an adult, but how about a child with asthma?
For optimal health, it’s important to avoid fake fragrances, and it’s also important to speak up if they’re in a public area. You’ll be amazed at how many other people will suddenly admit they hate fake fragrances when you speak up. If someone in your workplace is using heavy perfume, or there’s an air freshener in the restroom, do something about it. You have a right to breathe clean air.
Plantar fasciitis is a foot ailment common to 50-somethings. It’s caused by inflammation of the tendons that run lengthwise between the heel and the ball of the foot, and tends to primarily cause heel pain but can also cause pain from the ball of the foot to the heel. Typical advice for this problem includes stretching the foot muscles, ice, heat, staying off the feet for weeks at a time, taping, expensive orthotics and even a foot brace worn at night that’s supposed to stretch the tendons. Most of this advice, as I can tell you from personal experience, doesn’t work very well.
Here’s some simple advice that will probably help: Wear shoes with heels. Seriously, it’s that simple. If you just do that, you’ll likely be pain-free within a week to a month, depending on how long you’ve been abusing your feet with flip flops and moccasins.
If you can’t give up your flat shoes altogether, try some simple, inexpensive Dr. Scholl’s orthotics which raise the heel and support the arch.