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Herb Safety Questioned
Hormone Replacement Therapy
HRT Risks
Alternatives to HRT
Ask Dr. J: Blood Pressure/Lipids
In the Health News
Diet and Disease
Recipe of the Month: A Light Summer Fruit
Salad
References
Dear Friends,
A recent news headline suggested that herbs are toxic, and
that if you are smart, you will probably avoid them. In reading
through the rest of the article you find out that two patients
took a combination of Chinese herbs, used by Chinese physicians
for specific therapy, and they developed serious liver disease.
(The authors scoured the medical reports to find 29 other
patients who had some side effects from these herbs.)
These are not the common therapeutic herbs increasingly used
in western medicine, but potent Chinese prescription medications
used for more serious diseases (perhaps inappropriately in
these cases for minor problems). They might have some significant
side effects, but it is only by inappropriate extrapolation
that you could consider the common herbs taken every day by
millions of people to be significant risks to health.
The authors argue that the lack of regulation of herbs leads
to serious risks. But this is clearly not the case. The prescription
drug market is highly regulated in the United States. These
medications have uses that often save lives and relieve suffering
when used appropriately. Nevertheless, even when used correctly,
side effects of prescription drugs in the United States are
serious, frequent, and potentially lethal.
These statistics do not even account for the situations when
they are improperly prescribed or administered, or when they
are abused. Drugs that are recommended every day by physicians,
kill far more people than car accidents. In fact, over 100,000
deaths are attributed to correctly used drugs. When it comes
to dangerous side effects, they are in a completely different
league than herbs, vitamins, minerals, essential fatty acids,
and other dietary supplements, even those with the highest
risk profile. Regulation is apparently not a cure for the
dangers of serious herbal side effects, since it has not eliminated
risks from prescription medications.
I think the real objection of most doctors would be that these
risks are unnecessary, because they do not believe in the
therapeutic value of herbs. This is another issue that was
not discussed in the article. It makes me wonder how many
people have been helped by their use of these herbs, and how
many people were able to avoid drugs through their use of
unregulated Chinese medicines.
The most common herbs in use in western cultures, such as
saw palmetto, ginkgo, nettle, milk thistle, ginseng, ginger,
St. John’s wort, and garlic, among others, are extremely
safe, have only rare minor side effects, and are often very
effective in treating the conditions for which they are recommended.
I use these herbs all the time in my medical practice, and
have only rarely encountered side effects, and am often able
to reduce or eliminate the need for more risky prescription
drugs.
The Journal of the American Medical Association (JAMA) recently
published an article on hormone replacement therapy (HRT)
in menopausal women reporting data from the Women’s Health
Initiative (WHI).
The report was widely carried in the press because it concluded
that a long-term study of HRT should be stopped early because
of the increased risks of invasive breast cancer and heart
disease. Since then I have been extensively questioned by
patients, friends, and relatives about the issue, asking if
they should continue their HRT.
When I recommend hormones, I always suggest those that are
identical to the ones produced in the body. This study examined
the effects of two commonly prescribed hormones that I have
never recommended. Premarin, estrogens derived from horses,
and methylhydroxy progesterone (Provera), a synthetic analog
of progesterone, not progesterone itself.
These hormones are not identical to human hormones, and they
have different effects. The supposed benefits of Premarin
and Provera have been questioned earlier, and this study is
just a confirmation of other work. For example, in the Heart
and Estrogen/progestin Replacement Study (HERS), heart disease
risk was not lowered, although estrogen can improve lipid
levels.
Estrogens can dilate coronary arteries, but the addition of
Provera negates that beneficial effect on circulation. A 1999
study showed that Provera also leads to progression of coronary
disease, increases lipid uptake in plaque, causes abnormal
sugar regulation, and increases the likelihood of blood clots
in blood vessels. It is not surprising that an increased risk
of heart disease was shown in the latest study.
A study in 1997 showed that estrogens increased the risk
of breast cancer, and that administering synthetic progesterone-like
hormones added to the risk. In the Journal of The National
Cancer Institute, regarding combined hormone therapy, the
authors concluded: “This study provides strong evidence
that the addition of a progestin to HRT enhances markedly
the risk of breast cancer relative to estrogen use alone.”
It is easy to see why conventional HRT is increasingly questioned.
However, the evidence suggests that using natural hormones,
identical to those produced in the body, does not pose the
same risks, and indeed may reverse them. In addition, they
may help preserve youthful skin, brain function, heart health,
and bone density, while controlling hot flashes and other
menopausal symptoms.
Women seeking alternatives to any hormone replacement therapies
have many options, including for menopausal symptoms such
as hot flashes, vaginal dryness, depression, anxiety and loss
of libido. Plant chemicals similar to estrogens in soyfoods
and flaxseeds may help relieve hot flashes and vaginal dryness.
Supplements of bioflavonoids (2000 mg daily) and vitamin
E (800 IU) often control hot flashes, although adding black
cohosh (standardized extract, 80 to 120 mg) can also help.
The emotional symptoms may be relieved with St. John’s
wort(900 mg of standardized extract) or calming herbs, such
as valerian. Exercise is one of the best treatments for anxiety
and depression, and it often relieves hot flashes.
For reducing heart disease, a whole foods diet, regular exercise,
and supplements of vitamins C and E, B6, folate, and B12,
as well as magnesium, coenzyme Q10, garlic, and octacosanol,
among others are very helpful.
For reducing osteoporosis, and even building bone, a number
of lifestyle changes are valuable. Weight-bearing exercise
and a diet that contains soyfoods, such as tofu, and is low
in animal proteins, sugar and other refined carbohydrates,
and caffeine, are all important. It is essential to get adequate
calcium and vitamin D, and it may help to take supplements
of ipriflavone (600 mg), a compound related to the isoflavones
found in soy, and the mineral boron (3 mg).
For cancer prevention, follow these same lifestyle changes.
Be sure to exercise regularly, maintain a healthy weight,
eat a diet high in protective compounds found in vegetables,
fruits and berries, whole grains and beans, and protect your
defenses, including your immune system, by controlling stress
and taking a variety of dietary supplements (antioxidants,
selenium, flavonoids, and immune supports such as proanthocyanidins
from grape seeds, several mushroom extracts, and a variety
of herbs).
To maintain brain function after menopause, persisting in
regular exercise, both physical and mental, is essential.
It also helps to maintain cultural activities, such as reading,
playing music, and going to theater, and maintaining rewarding
social interactions. Supplements of ginkgo biloba, vitamin
E, N-acetyl cysteine, and acetyl L-carnitine all appear to
help, as well as melatonin and alpha-lipoic acid, which are
excellent brain antioxidants.
Hormone therapy may still be valuable, as long as you choose
natural hormones that are bio-identical to those produced
in your body. This means natural progesterone, not synthetic
analogs, and estrogens that are identical to human hormones–mainly
estriol, with small amounts of estradiol and estrone (this
is commonly referred to as “tri-est” by compounding
pharmacies). These are much safer than the hormones reported
in the JAMA study, and do not have the same side effects.
Your doctor can prescribe specific levels for you, depending
on your medical history and appropriate testing.
Q. I have been battling high blood pressure andcholesterol
for six months with great success, but my pressure is still
140/80 and my cholesterol is 255. Do you have any supplement
suggestions? GF, Maryland, via Internet
A. Sounds like you have been doing many of the right things
with diet and exercise, but you might need more than three
days of exercise a week, and some stress management. While
you say your diet is good, and you have lost 30 pounds, you
still have a bit more to lose, but you should focus on health
as the goal of your diet, rather than weight.
My guidelines for diet are mainly vegetarian, whole foods,
with small amounts of fish, non-fat, organic yogurt, and organic
eggs. Avoid sugar, white flour, and especially hydrogenated
oils, such as margarines and shortening. Including freshly
ground flaxseeds and other seeds and nuts will give you some
of the vital essential fatty acids. Focus on vegetables, fruits,whole
grains, and beans, including natural soy products.
For supplements, many might help. I recommend a higher potency
multi than the one you are taking (Ultra Vitality from QCI
Nutritionals is a good one). Your chromium is fine at 600
mcg, as it helps to regulate blood sugar and lipids. Vitamins
C (3 to 4 gms) and E (400 to 800 IU) can lower blood pressure,
as can fish oil (4 to 8 gms).
Magnesium (500 to 1000 mg) also helps with blood pressure,
as it relaxes the blood vessels. Coenzyme Q10 is not only
an excellent antioxidant, it also lowers blood pressure while
supporting the heart, reducing heart failure, unlike some
medications which lower blood pressure by suppressing heart
function.
For cholesterol, try a supplement called octacosanol (10
to 20 mg), which is better and safer than statin drugs. It
is also known as policosanol (see the article in the April
issue on my website). Any of the following might also be helpful:
deodorized garlic (1000 to 2000 mg), inositol hexaniacinate
(1600 mg), pantethine (1000 mg), or red yeast rice extract
(1000 mg).
•Breast cancer may have
some genetic component, but it is unlikely to be the most
serious contributor to the disease. Breast cancer in Asian-American
women in the Los Angeles area has increased dramatically,
and it is contrary to the rates seen in their countries of
origin (Deapen D, et al., Int J Cancer (2002 Jun 10) 99(5):747-50.)
In the past, Asian-American women have had very low rates
of breast cancer, but that is changing (while their genetics
haven’t). From 1993 to 1997, the rate increased by 6.3
percent, surpassing the incidence in black women.The authors
suggested that diet and exercise and other environmental factors
are the most likely contributors to this shift.
•Heart patients on a
cholesterol-lowering diet were put on an exercise program,
with 30 to 60 minutes of walking, jogging, or cycling 3 to
6 times a week. After six months, they further reduced their
LDL cholesterol, while not changing the level of good HDL
cholesterol. Oxidized LDL is the most damaging to the arteries.
Their blood pressure also declined. (Welty FK, et al., Am
J Cardiol 2002 May 15;89(10):1201-4.)
Ground beef that was sold nationwide has been recalled by
ConAgra, the nation’s second largest supplier of food
and meat. The 19 million pounds of ground beef was contaminated
with potentially deadly E. Coli bacteria. The E. coli come
from fecal contamination of carcasses during processing, which
is extremely common. The bacteria can cause bloody diarrhea,
dehydration, and kidney damage. The USDA, charged with protecting
consumers, waited 10 days after learning of the contamination
before notifying the company. I wonder just whom they are
protecting. The risk of bacterial contamination is just one
of many reasons to eliminate meat from the diet. (Reuters,
July 19, 2002)
A healthy fruit salad is a great way to start the day in summer,
when organic fresh fruits are abundant, but this can also
be a meal at any time. Cut up bananas, peaches, pineapple,
oranges, and grapefruits, and add some fresh berries (rich
in antioxidants) and grapes. I like to add chunks of fresh
Medjool dates. Chopped toasted almonds provide protein, fatty
acids, and a toasty flavor. In a small electric coffee mill,
grind up 2 to 3 Tbsp of flaxseeds, and sprinkle these in the
salad. They contain cancer-protective lignans, fatty acids,
and some protein. As a sauce, I mix some orange juice with
organic non-fat yogurt, or soymilk. Instead, you can blend
silken tofu (very creamy) with the juice for a thicker sauce.
Any ingredient is optional, depending on your taste.
McRae CA, et al., Hepatitis associated
with Chinese herbs. Eur J Gastroenterol Hepatol 2002 May;14(5):559-62.
Writing Group, Risks and benefits of estrogen plus progestin
in healthy postmenopausal women.. JAMA 2002 Jul 17;288(3):321-33.
Clarkson TB, Progestogens and cardiovascular disease. A critical
review. J Reprod Med 1999 Feb;44(2 Suppl):180-4.
Khurana PS, et al., Hormone replacement therapy for...coronary
heart disease... Curr Atheroscler Rep 2001 Sep;3(5):399-403.
Persson I, et al., Hormone replacement therapy and the risk
of breast cancer.... Int J Cancer 1997 Sep 4;72(5):758-61.
Ross RK, et al., Effect of hormone replacement therapy on
breast cancer risk: estrogen versus estrogen plus progestin.
J Natl Cancer Inst 2000 Feb 16;92(4):328-32.
Wagner JD, Rationale for hormone replacement therapy in athero-sclerosis
prevention. J Reprod Med 2000 Mar;45(3 Suppl):245-58.
Waring SC, Postmenopausal estrogen replacement therapy and
risk of AD... Neurology 1999 Mar 23;52(5):965-70.
Warren MP, et al., Use of alternative therapies in menopause.
Best Pract Res Clin Obstet Gynaecol 2002 Jun;16(3):411-48.
Nagata C, et al., Hot flushes and other menopausal symptoms
in relation to soy product intake in Japanese women. Climacteric
1999 Mar;2(1):6-12.
Wilson RS, et al., Participation in cognitively stimulating
activities and ...Alzheimer disease. JAMA 2002 Feb 13;287(6):742-8.
Langsjoen PH, et al., A six-year clinical
study of therapy... with coenzyme Q10. Int J Tissue React
12:169-171; 1990.
Arsenio I, et al. ...long-term treatment with pantethine in
patients with dyslipidemia. Clin Ther 1986;8:537-545.
Silverberg DS. Non-pharmacological treatment of hypertension.
J Hypertens Suppl 1990 Sep;8(4):S21-6.
Key TJ, et al., Health benefits of a vegetarian diet. Proc
Nutr Soc 1999 May;58(2):271-5.
drjanson@drjanson.com
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through May: 386-409-7747
June
through October: 603-878-2256
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