The Problem with Bioidentical Hormone Replacement

No, it's not cancer risk. We can monitor that risk pretty closely with salivary hormone levels so that the balance between estrogen/testosterone and progesterone (breast cell proliferation) and estradiol and progesterone (uterine) is optimal.

The risk is your doctor not realizing the therapeutic window that needs to be achieved and that blood monitoring is not all that helpful. Too little hormones is a problem, but so is too much. Often, excessive levels of hormones lead to the same symptoms as too little (save for hot flashes): water retention, weight gain, cognitive change, insomnia, irritability.

When we start hormones with the anticipation of it being the only measure that needs to be taken to achieve health, we get into trouble. You cannot ignore the impact that diet, stress and lack of exercise have on health and excpect the hormones to "cure-all". Doing this leads often to starting out with a hormone dose that's too high or continuing to push the dose because we don't feel better all the while ignoring the food sensitivity or heavy amounts of unmanaged stress.

Checking for excess levels in blood doesn't cut it. I once heard the director of a lab quote that hormone levels have to reach 10 times the overdose amount in order to show up in blood as too high. 10 times you ask? That's exactly what we see in saliva. Most women we see in the office on BHRT regimens that are not feeling well have an estradiol level >100 (nl 4-10) and progesterone >2000 (nl 100-300). The lab can't even quantify the number it's so high!

I recently saw a client that had these excessive levels, couldn't understand why she was gaining weight and fatigued and her thyroid was normal. We focused on her hormone replacement regimen and checked salivary levels. They were all undetectably high. After several months of gradually lowering, she came into the office to report that the most recent drop in progesterone dosage (which finally got her saliva level below 1000 for the first time in years) she immediately stopped craving carbs and has started losing weight.

I love BHRT. I have found it to be the missing piece in a lot of women's journey toward health. But it cannot be the only piece, and it cannot be blindly given with no monitoring for balance. Start low and go slow, but also focus on the trifecta of optimal health: stress management, whole foods nutrition and digestive balance. Then make dosage changes based on how you are feeling and the tissue levels of hormone (saliva, not blood).

Hormone Replacement News: Read the fine print

So the coverage regarding the new findings in hormone replacement therapy (HRT), will strike fear in all women. The report is that women taking HRT had more advanced breast cancers and were more likely to die. Ready for the key piece of information buried in the study:

The treatment studied was the most commonly prescribed hormone replacement pill, Prempro, which contains estrogens from horse urine and a synthetic relative of the hormone progesterone.

These are the major issues with the conventional hormones: they are not chemically similar to the hormones that women have naturally. The fact is some women need hormone replacement for relief of menopausal symptoms. Regardless of whether bio-identical hormones are used or not the rule is still lowest dose for shortest duration. But for women who need hormones, this study should help support the need use bio-identical hormones so that the body knows what to do with them and not hormones from horses or synthetics.

It should be noted the importance of monitoring hormone levels during the course of therapy. Several studies have discussed the advantage of saliva for this monitoring as it is a better approximation of tissue levels of hormones. I have a number of cases, and they keep piling up of women who feel terrible and are taking large doses of hormones, as their doctors keep increasing the dose and finding normal blood levels. One of the main drivers of this is the fact that often lifestyle measures, like a whole foods diet and stress management never get implemented or suggested, it is much easier just to increase the hormone dosage. In these cases, checking the saliva hormone levels show significant toxicity as it just keeps accumulating in the tissues leading to fatigue, weight gain, water retention and cognitive changes.

Bottom line is that women who are having menopausal symptoms should be working with providers that use bio-identical hormones, focus on all other aspects of health like diet, sleep, and stress and will monitor the saliva levels regularly to ensure appropriate balance in being reached.

Soy protective for breast cancer survivors

A new study in JAMA shows that breast cancer survivors who consume the most whole soy foods had a lower risk of recurrence of their cancer than those eating lower amounts.

5000 women breast cancer survivors were evaluated for their soy consumption and followed for four years. 7.4 % of those consuming the most soy died, versus 10.3% of the lowest soy eaters.

This echoes a previous study in 2009 showing a potential protective, maybe Tamoxifen-like effect in blocking breat tissue from the body's estrogen.

The most important point is to focus on sources of whole soy foods, not processed soy where lots of soy protein isolate may be used (soy protein isolate and soy supplements have not been studied like this). So focus on organic sources of: Soymilk, tofu, edamame and tempeh.

http://www.medpagetoday.com/HematologyOncology/BreastCancer/17389

Protecting our girls from cancer

"...the risk that a 50-year-old white woman will develop breast cancer has soared to 12 percent today, from 1 percent in 1975. (Some of that is probably a result of better detection.) Younger people also seem to be developing breast cancer: This year a 10-year-old in California, Hannah, is fighting breast cancer and recording her struggle on a blog."  NY Times

With two young girls at home this article speaks loudly to me.  My wife and I certainly have put a strong focus on whole foods nutrtition and fitness as a foundation for health, but have we paid enough attention to the chemicals they are exposed to?

There are a number of books on my reading list covering this topic (The Hundred Year Lie is at the top). I have heard talks at conferences and read articles about the polar bears shrinking genitals and how toxic breast milk is (although still world's better than store-bought formula, I pray).

We are finally getting some data to show that there is a real problem here. This NY Times article  reports:  "...more than 200 other studies have shown links between low doses of  BPA and adverse health effects, according to the Breast Cancer Fund, which is trying to ban the chemical from food and beverage containers."

Certainly in our society, I will never be able to completely eliminate their exposure, but I can clean up my home. We have been very conscious already of the leaching of chemicals from the plastic during microwaving, but we use a plastic cover to prevent the food from exploding all over the microwave, I will find a glass one this week.

Speaking of microwaving, is that a problem? Maybe, but a recent study showed that microwaving vegetables is the best way to preserve their antioxidants.

We are getting rid of all plastic dishes and "silver"ware this week. We only use this stuff for the kids, while I eat on ceramic, wow that seems backwards. I will find metal forks and spoons that fit kid's mouths and ceramic or glass dishes for the kids. No more plastic tupperware.  We have some glass pieces, but now we will have all glass pieces. Cups as well will be glass or ceramic. And we will be more intense about keeping plastic out of the dishwasher, but I think just getting rid of the plastic is what we'll do.

We have previously removed lauryl components and parabens from our shampoos, soaps and lotions.

We are going to bring more houseplants into our home. Houseplants have been shown to help keep the air you breathe clean, this is much needed assistance. An old NASA study supports this. 

I will continue to serve whole soy foods to my girls, organic soy that is. Soy foods have been shown to lower the risk of female cancers when consumed early on in life. So we will keep drinking soy milk, making foods with tofu and serving edamame regularly.

We cannot completely remove the exposure to chemicals, but we can certainly lessen the burden, especially at home. For the uncontrollable exposures, I will have to hope that high quality, clean food, regular exercise, low stress environment, a spiritual connection to God and healthy relationships will give the body the fuel it needs to detoxify the body. That is a detox program, not a tea or a bottle of expensive supplement or foot baths.