Table of Contents

1) Hormones and Menopause

2) Natural Progesterone

3) Hormone Facts

4) Cancer Prevention

5) Calcium

6) Sex Therapy

Hormone and Non-Hormonal Alternatives for Menopausal Treatment

The Perimenopause is that transitional time that can began as early as 10-15 years before actual menopause and continues until the post-menopause is well established.  For many women, this will typically be around age early to mid 40’s until age 60 or older.  At it’s best; one can have little to no symptoms and a very smooth progression.  Many women will experience some very troubling symptoms including menstrual irregularity, hot flashes, night sweats, and anxiety/depression.

The actual menopause is defined as that phase where the ovaries are either removed surgically or have significantly reduced function. Periods will not have occurred for at least 6-12 months. At this point, female and sex hormones are at a lower and typically more stable level. Significant symptoms may continue during menopause and may require ongoing treatment if severe enough to warrant it.

There are also potentially some changes related to inadequate vaginal estrogen, such as dryness, sensitivity and bladder weakness. In women who have surgical menopause related to the removal of the ovaries, these changes could be more abrupt.  In women who have had a hysterectomy, the lack of periods can make the changes confusing.  It is important to realize that everyone is different and especially in the premenopause or climacteric, hormonal swings occur throughout the day and variations may be noticed with no real predictable pattern. For these reasons, there are no exact hormone tests that offer meaningful information in most cases.

Saliva testing is sometimes used, but is only a “spot-check” and considered less than accurate by most experts.  A professional clinician, with experience in treating hormonal issues, can assess patients more accurately by using symptoms and signs than by lab testing.

The best advice for everyone is to realize that each woman has a very individual situation that benefits greatly by good general health and prevention, diet, exercise and guidance from a knowledgeable healthcare expert. In addition, the situation is constantly progressing, and current options continue to evolve, new information is accumulated and people and attitudes also change. This means that effective help must be re-evaluated on an ongoing basis, at least annually and often much more frequently.

Nutritional and Herbal therapy have been used in place of and in addition to hormonal treatment for many years. The potential benefit of healthy and “natural” ingredients is attractive to many people. These treatments have generally not been as well studied and researched as products from the major pharmaceutical companies.  There is however a growing body of evidence to suggest the safety and benefit of many non-prescription and herbal products, especially those from well-known and reputable companies.  When the choice is to try these products, our advice is to start conservatively using small dosages and proceeding cautiously.  A simple regimen or formula is probably safer than a complex mixture.  There are several well-accepted herbs and supplements currently in the market and many different products.  If initial success with these products is not adequate, we can offer additional advice and suggest additional steps to take.

“Natural hormone” replacement therapy suggests that the chemical makeup of the product is bio-identical or exactly the same as what the human body produces.  Most pharmaceutical company products are actually derived or processed from natural sources.  Premarin estrogen product, for example, is processed from the urine of pregnant mares.  Many other estrogen products are processed by pharmaceutical companies from plant sources. 

“Natural” or compounded hormones is a small industry have become widely available in recent years. Compounding pharmacists produce a custom-made formula with a doctor’s prescription, using any of a variety of ingredients in any chosen dosage.  The benefit here is that a custom product can be created for each individual patient. The formula can be adjusted according to the patient’s needs.  This offers significantly more choice in designing a supplement for a particular purpose.  The disadvantage is that a particular formula may not have as much clinical research backing or testing and the patient and the physician must have trust in the pharmacist who is actually compounding the product in their store or lab.  There may be much more variation in one batch to the next and certainly from one pharmacy to the next. 

Pharmaceutical company factory-made products are known for their consistency and standardization although there is not as much variety and choice in ingredients.  Many products from the pharnmaceutical industry contain "synthetic" hormones which are not chemically identical to what the human body makes. Certainly patients can consider both options and may actually find success with compounded formulas if traditional store-bought products are not effective or cause side effects. It is important to know that these hormones have many of the same potential risks as products made by the pharmaceutical companies.

A variety of dosage forms can be developed by these specialized pharmacists to meet the specific needs of each woman.  Options include:  1) Transdermal or through the skin dosage forms such as creams, gels, troches, or suppositories, 2) Capsules containing micronized particles for improved oral absorption, 3) Unique ingredients and “lesser” hormones which are not always available in commercial products and may be better suited to an individual woman’s specific needs.

We carry bio-identical progesterone creams, testosterone drops and estrogen creams in our office dispensary. These products are compounded by a licensed compounding pharmacist who is also a board-certified gynecologist. We also use mail-order sources and local pharmacists for other compounding needs.

Weaning off or stopping hormone therapy

If the plan involves going off or stopping hormones, then typically this should be a gradual process over a period of time. My most common recommendation is as follows:

1.     reduce estrogen daily dosage to next lower level every 2-4 weeks until the lowest dosage is reached

2.     if symptoms of lower estrogen become significant, then maintain current dosage for several weeks and, if necessary, increase to next highest dosage for 2-4 weeks

3.     once the lowest dosage is reached, then alternate days on treatment and off treatment

4.     for patch wearers, the last patch at lowest available dose can be followed by no treatment

5.     while weaning or stopping, use Progesterone Cream or non-hormonal alternatives if possible...these may include vitamin E and soy protein foods and, if necessary, herbal supplements such as Promensil, or Remifemin

6.     discuss other options for bone health, cardiovascular health and non-estrogen hormones such as progesterone and androgens for a customized plan of hormone health.

Various Options of Hormone Support Treatment

The Classic Step-wise Approach to any treatment involves trying the simplest and often safest therapy before moving to stronger and often a more intensive strategy. Still, some patients may opt for an aggressive strategy if symptoms are creating major disruptions.  For most patients, a carefully chosen prescription hormone supplement used over a relative short term has a high benefit and low risk profile. Once severe symptoms have been stabilized over a period of time, patients may want to try a lower dosage program or slowly stop prescription hormones completely. Some research studies have suggested higher risks for certain types of cancers and cardiovascular events in certain patient groups. Whether there really are any newly identified increased risks or not, caution should be exercised with the use of any prescription (and non-prescription) medication or products.

First Step for Hormonal Support:

1)  Increase supplemental Vitamin E to 800-1000 units daily.  This is generally safe and effective (Check blood pressure periodically).  Despite some reports, there are generally believed to be vitamin E benefits for cardiovascular and breast problems as well.

2)  Increase nutritional Soy-based foods and even consider Soy protein supplements if absolutely necessary (see food source list under phytohormones).

Second Step:

Choose a scientifically, research-backed, natural progesterone supplement and/or a Vitamin/Nutritional and Herbal combination:

1)  Natural progesterone cream 20-40 mg daily applied to the skin.  We offer a prescription strength bio-identical progesterone cream. This is USP pharmaceutical grade natural progesterone for the best quality available.

See our patient handout or click here for a full description of this highly successful formula.

2)  Women’s Isoguard by Clinician’s Choice ordered by mail or fax from Virginia.

        We have an order form and a toll-free number. Also see www.medeonhealth.com

3)  Promensil 500 mg. daily or Remifemin herbal combination…over the counter.

4)  Estroven herbal combination…over the counter.

  The key is comparing ingredients and trusting a manufacturer for quality and consistency.  Key ingredients are Black Cohosh, Dong Quai, Isoflavinoids and Evening Primrose Oil.

Third Step:

Consultation regarding compounded or prescription formulary hormone replacement products. Some patients should consider hormone replacement in light of specific medical benefits that may outweigh potential risks.  These conditions may include severe menopausal symptoms, osteoporosis, significant sexual dysfunction, Alzheimer’s family history, or vaginal and bladder issues. Women with a history of breast cancer, uterine cancer or significant risks for any female cancer or blood clots, should generally not use certain estrogen products (at least not on an ongoing basis). Natural Progesterone products are generally safe for these patients.

On hormone treatment for menopause/ perimenopause, our office policy is as follows: We believe that recent studies and the media have exaggerated the risks of hormone therapy. The pharmaceutical companies and overzealous doctors have perhaps exaggerated the benefits of hormones. The real facts are that for some women, some kind of hormone therapy is essential for quality of life, and for other women, certain hormones are dangerous and should be avoided. For the majority of women, an individualized approach should be taken with a careful analysis of that patient’s needs, risks and experience.

Also, this should be reanalyzed regularly (yearly) because options, needs, situations and alternatives change too. Some hormones carry a potential risk of accelerating breast cancer growth, increasing thromboembolic risks, gall bladder risks and may increase EXISTING cardiovascular disease (synthetic progestins, especially Provera are believed by many to be the culprit in lipid change and CVD risk). Hormones definitely help bone strength, bladder and vaginal tissues and probably healthy vascular systems. Most researchers believe there is a benefit in cognitive (brain) function.

If vasomotor symptoms, such as hot flashes, night sweats and heart palpitations are a significant issue, then consideration should be given to using hormones for that alone. If a woman has a uterus, then estrogen should be balanced with progesterone in some way. When low dose topical estrogen is used, such as Estriol, Estrace cream, Estring or Vagifem, the risks associated with using estrogen are very low. These products can be used at least on a temporary basis in virtually all women, even those with usual contraindications to estrogen use.

Generally, we like non-oral routes if the patient agrees, such as patches, creams, drops and rings. Avoidung the oral route, will avoid the "first pass via liver effect". This means that a lower dosage can be used because the hormone does not have to be digested to get to the bloodstream. Topical routes allow the hormone to be absorbed directly into the bloodstream.

Here are some vitamins, herbal and nutritional and general health tips:

Remember basics                                     

Good diet                                                                              

Fiber                                                                                                                                  

Low fat                                                                                                               

High calcium (use a high quality supplement if food sources are inadequate)                                                                                                                            

For Hot Flashes/Night Sweats:

Natural Progesterone Cream

Evening primrose oil  

Black Cohosh (10-60 drops)

Dong Quai (2 capsules)

Vitex (Chastberry, Chaste Tree) 2 capsules 3 times per day)

For Sleep Disturbances:  

Natural Progesterone Cream

Valerian (2 gm capsules)

melatonin 2 mg

For Fatigue, Mood Swings and Low Libido:

Natural Progesterone Cream

Siberian Ginseng (200 mg-1000 mg 3 times/day)

Garden Sage (up to 3 cups tea daily)

Passionflower (14-15drops in liquid)

Vitex (Chastberry, Chaste Tree) 2 capsules

Regular Exercise or Fitness Program

Possible benefit from herbal combinations, such as Avlimil

For Vaginal Dryness:

Use a good quality water-based lubricant as needed

Estriol Moisturizing Cream for improved vaginal strength, elasticity and lubrication

      *this excellent natural estrogen vaginal cream is available in our office...

Borage Oil (2-8 capsules)

Dong Quai (2 capsules)

Vitex (Chastberry, Chaste Tree) 2 capsules                                                                                 

For Vaginal Lubrication:

Many new vaginal lubricants are available commercially now.  These include Astroglide, Slippery Stuff, Gynemoistrin, Replens, and new versions of KY Jelly.  We have two high quality products available in the office for discreet purchase. Any product chosen should be water-based. For more difficult cases of vaginal sensitivity, a short course of vaginal cream or similar product (Estrace Cream, Vagifem tablets, Estring) can offer rapid and lasting improvement.

Dietary Recommendations For Menopause:

1.     Consume smaller, more frequent meals or snacks.

2.     Reduce consumption of simple sugars and refined carbohydrates.

3.     Increase intake of foods high in phytohormones, especially soy protein-based foods.      

            (see list)

4.     Increase foods rich in calcium.  (Milk, yogurt, cheese, Total cereal, etc - see list)

5.     Increase water intake, 1 to 2 quarts daily.

6.     Eat at least one boron-rich food daily.  (See list)

7.     Reduce or eliminate caffeine.

8.     Reduce or eliminate alcohol.

9.     Reduce salt intake.

10.   Reduce intake of animal protein.

Hot Flash Trigger Foods:  (Keep a hot flash diary to track patterns in flashes)

1.     Acidic foods like oranges, tomatoes, berries                         8.          Garlic and Onions

2.     Alcohol                                                                                            9.          Ginger

3.     Caffeine                                                                                        10.         Hot Drinks

4.     Cayenne                                                                                       11.         Salt

5.     Chocolate                                                                                     12.         Spicy Foods

6.     Fat                                                                                                  13.         Sugar

7.     Large meals                                                                                14.         Meals eaten too quickly

Foods High In Phytohormones:

Phytohormones closely resemble our human hormones, providing Estrogen and Progesterone effects and may have less risks and side effects than are associated with prescription hormones.

Soy-based Foods and Products -           Tofu, soy nuts, tempeh, soymilk, soy-fortified foods

Special fortified source products -          Nutlettes cereal 1- 800-233-3668

                                                                    Beef (not) protein granules 1- 800-233-3668

                                                                   Take Care High Protein Beverage 1-800-445-3350

Alfalfa, apples, barley, carrots, cherries, date palms, fennel, garlic, green beans, oats, parsley, pomegranates, potatoes, red beans, rice, rye, sage, sesame, tomatoes, wheat, yams.

Boron Rich Foods:

Apples, broccoli, carrots, pears, other fruits and vegetables

Calcium Rich Foods:

Yogurt, milk, sesame seeds, blackstrap molasses, spinach, mustard greens, okra, almonds, rainbow trout, tofu BEST TIP - Total ™cereal for an excellent source of vitamins, fiber, and a full day’s calcium requirement.

 Hormone Facts July 2005

Fact:  As women and men age, shifts in hormonal balance is inevitable.  Hormonal imbalances can foster many unpleasant – and sometimes dangerous- side effects.
 
Fact:  Much of the current thinking and medical practice relating to hormone balance is inaccurate, inappropriate or misguided, and often based on self-serving goals of the pharmaceutical industry.

Fact:  The ovaries serve important functions in female reproduction, such as egg development.  The ovaries also produce the sex hormones, e.g. estrogen, progesterone and testosterone.  The interaction of these hormones plays a vital role in maintaining the body’s optimum health and functions.  Hormonal production will decrease with age and the ratios of all three of these hormones will change over time. Hormone supplementation and balancing can be done to maintain the optimum levels and ratio of all sex hormones.

Fact:  In the latter part of the female reproductive life phase, progesterone levels are the first to decline; in fact, progesterone levels drop 120 times more rapidly than estrogen.  As progesterone levels drop and estrogen becomes proportionately higher, certain symptoms can emerge.

Fact:  Unbalanced estrogen and progesterone can have negative effects the body. The symptoms of estrogen dominance can include PMS, weight gain, breast health issues, hot flashes, night sweats, weight gain, breast health issues, osteoporosis, memory loss, premature aging, depression, mood swings, decreased sex drive and a greater predisposition for uterine or endometrial cancers. 

Fact:  When unpleasant symptoms associated with hormonal imbalance begin to occur, human-identical progesterone replacement is an initial treatment of choice for many patients. 

Fact:  Many patients with menopausal symptoms can benefit by using supplemental hormones that are safe, effective and properly balanced. 

Fact:  Some synthetic hormones do not have the same molecular structure as the hormones produced by the ovaries. Consequently they do not exactly fit the body’s hormone receptor locks.  This “bad fit” can trigger many harmful reactions within the body. Some clinical studies have suggested that certain synthetic hormone replacement products have been linked to an increased risk of heart disease, stroke, breast, ovary and uterine cancer, and Alzheimer’s disease. 

Fact:  Human-identical hormones do have exactly the same molecular structure as the hormones produced by the ovaries.  As a result, they function within the body as a “key” that exactly fits for the body’s hormone receptor locks.  Because the body recognizes the molecular structure of the human-identical hormones, adding them into the human system will not trigger side effects, only anticipated replaced hormone effects.

Fact:  Every woman suffering from the symptoms of hormonal imbalance can potentially benefit from a regimen of human-identical hormones but ONE SIZE DOES NOT FIT ALL.  A complete and individualized hormone profile is needed to determine the levels of each of the three sex hormones, e.g. estrogen, progesterone and testosterone, before a physician can develop an individualized program for correcting their patient’s hormone imbalance through human-identical hormone replacement. 

Fact:  There is such a thing as “male menopause”, or andropause.  As they age, men will also have a change in their hormone levels that can impact them physically, mentally and emotionally.  Men suffering from hormone imbalances are also candidates for an individualized program of human-identical hormone therapy.

Fact:  Today, no one has to suffer from the symptoms associated with hormone imbalance.  Human-identical hormone therapy offers physicians and healthcare consumers a safe and effective option for successful treatment of the health issue as well as elimination of the unpleasant symptoms.

Symptoms of Hormone Imbalance

Symptoms of hormone imbalance are most often associated with menopause but the medical reality is that they can occur – for both men and women - at any age. 

Female Hormone Imbalance /PMS/Perimenopause/Menopause*

• Mood swings
• Hot flashes
• Night sweats
• Fatigue
• Headaches
• Depression
• Anxiety
• Nervousness
• Irritability
• Tearfulness
• Memory lapses
• Weight Gain
• Premature Aging
• Vaginal dryness
• Heavy menstrual periods
• Irregular menstrual periods
• Spotting before periods
• Bladder urgency and leakage
• Breast tenderness
• Decreased Sex Drive
• Sexual response changes
• Osteoporosis
• Bloating

Male Hormone Imbalance/ Andropause

• Low energy
• Abdominal fat
• Prostate problems
• Decreased mental clarity
• Decreased sex drive
• Increased urinary urge
• Decreased strength
• Decreased stamina
• Difficulty sleeping
• Decreased urine flow
• Irritable
• Depression
• Sexual dysfunction
• Hot flashes
• Night sweats
• Poor concentration

Human-Identical Hormone Progesterone Therapy Treatment Options

Human-identical progesterone can be dispensed in capsules, tablets, gel caps, suppositories (vaginal or rectal), sublingual drops and creams.  Topical creams have been shown to be the most effective mode of administration.  When human-identical progesterone is applied topically, it is absorbed transdermally (through the skin) immediately into the bloodstream and then distributed and utilized in progesterone target tissues. Transdermal progesterone is rapidly absorbed and enters the blood stream directly, without having to be digested first. It then has an internal effect that is essentially the same as the progesterone that is produced naturally within the body.

In contrast, progesterone taken orally been found to be much less effective.  When progesterone comes into the body in oral form, it must be digested, then pass through the liver to be metabolized, where some of the progesterone is lost.  What remains is then metabolized into more than thirty-five different biochemical substances before it can enter the bloodstream.  Some people cannot metabolize progesterone effectively at all. That is why high-quality topical or cream formulations of real progesterone are much more effective than oral forms.  Transdermal absorption allows the body to receive, recognize, and utilize human-identical progesterone in exactly the same manner as would the progesterone produced by the body's own ovaries.  

You can purchase various forms of "natural" Progesterone cream over-the-counter in most health food stores.   The fact is that you don't always know what you are getting.  Most of the product labels do not specify whether or not they meet the following criteria for product excellence. 

• Is the progesterone truly human-identical?
• Is the concentration appropriate for you?
• Do the hormones used in the formulation meet the United States Pharmacopoeia (USP) gold standards for quality and purity?
• Was the progesterone product actually compounded under the strict guidelines approved by the National Association of Compounding Pharmacists?
• Is the concentration of oil in the cream formulation one that will allow proper absorption through the skin?

At Swor Women’s Care, we always suggest using nutritional and medical products that are made to acceptable quality standards. For hormones that are “formulated” by a pharmacist, there has to be trust in the individuals and facilities that supply the products. There are only a few such makers of compounded or formulated hormones that we rely on. The compounded hormones that we offer through our own office dispensary are formulated and produced according to the highest standards by a pharmacist/gynecologist. Because we purchase these products direct from the compounding pharmacist, we are able to offer them at a reduced cost to you. If you prefer to use another pharmacist, we will check their credentials and, if appropriate, write a prescription for you to take and have filled there.

Other high quality hormone formulas we know of are: Emerita's Pro-Gest, Arbonne's PhytoProlief and Prolief, Products of Nature's Natural Woman progesterone cream, Life-flo Health Care Products' Progestacare, The Health and Science Research Institute's Serenity for Women progesterone cream, HM Enterprises' Happy PMS progesterone cream and Restored Balance, Inc.'s Restored Balance PMS/Menopausal progesterone cream.  Again, if there is any doubt or concern regarding any progesterone product, we suggest calling the company to check quality factors and concentration (milligrams of progesterone per ounce).

While over-the-counter progesterone cream can be helpful to many women, these products are only one element in a comprehensive approach for hormone balancing and gynecological health.  Any form of hormone replacement therapy should be monitored by a trained Gyn clinician.

Frequently asked Questions

WEST COAST WOMAN Article  Published in April 2006

Prevent Breast Cancer? Cervical Cancer?

In 2000, approximately 182,800 women in the U.S. were diagnosed with breast cancer.

Approximately 40,800 died from the disease. A simple test can determine your risk of

developing breast, cervical, or other estrogen-related cancers.

From birth, hormones influence the

health, development, and nutritional

status of a female, particularly during

the milestones of menarche (onset of

the menses), pregnancy, and menopause.

During puberty, the complex communication

of hormones determines normal breast

growth. Later on during adulthood hormones

can play a role in cancer development.

Recently, the health risks and benefits of

exogenous (not made by the body) estrogen

hormone therapy have become controversial

and newsworthy. Many hard-to-avoid

environmental chemicals dubbed "hormone

disrupters," contained in commonly used

items from pesticides to plastics, exhibit

estrogenic activity and may have a cumulative

negative health effect on both men as

well as women.

Studies of estrogen-sensitive cancers have

highlighted the importance of an individual’s

estrogen metabolism. Specifically regarding

breast cancers, estradiol (found in birth

control pills and pharmaceutical hormone

replacement) has been shown to play a

major role as a promoting factor in

increased growth of cancerous breast cells.

How a woman metabolizes estrogen,

whether endogenous (made by the body) or

exogenous, is determined by both environ-mental

and genetic influences. With the

knowledge of the effects of diet on estrogen

metabolites, women may now reduce their

risk of estrogen-associated cancer.

Along with modifying their diets, limiting

exposure to environmental estrogens can

reduce cancer risk. Estrogen activity has

been found for nonylphenol, used in the

manufacture of plastic, detergents, toiletries,

lubricants, and spermicides, and in

bishenol, leached from plastics when they

are heated (don’t nuke your food in plastic

containers). Other xenoestrogens (toxic

estrogens) include DDT, methoxychlor, aromatic

hydrocarbons, and the common weed

killer Atrazine that is widely used on corn

crops. (Are you eating non-organic corn

products?) Adjustment of lifestyle to reduce

xenoestrogen exposure by utilizing more

natural products is one major step a woman

can take to control total estrogen exposure.

Studies as early as the 1980s found evidence

that family history, sex hormones,

diet, lifestyle, and environmental exposures

are factors associated with breast cancer

incidence. A recent study in 2001 found

conclusive evidence linking hormone

replacement therapy (synthetic hormones—

not the natural HRT) to breast cancer.

In another case controlled study, there was a

confirmed difference in estrogen metabolites

between women with breast cancer and the

control subjects.

Other studies indicate a

relationship between the ratio of these

metabolites and the transformation of the

human papillomaviruses (HPV), which are

precursors for cervical cancer, to the malignant

phenotype, which causes cervical cancer.

To put it as simply as possible, there are

several forms of estrogen in the body. If it

is converted to a very potent form, 16a-hydroxyestrone,

it can cause certain cells

to reproduce faster, which may lead to the

growth and spread of tumors. If it's converted

to 2-hydroxyestrone, a good estrogen, it

may have a protective effect against cancer.

The important factor that we need to look

at is how an individual is metabolizing the

estrogens in her own unique body.

Estrogen Metabolism and

Your Diet

Simple dietary changes can induce significant

improvements in estrogen metabolism,

which decreases the incidence and death

rate of cancer. The increased risk from estrogen

and estrogen metabolites has led to

intense search for compounds that produce

estrogen-like effects safely and those that

decrease the production of 16a-OHE1. Soy

isoflavones (i.e., daidzein and genistein) are

natural compounds that have come closest

to meeting these criteria. Eating a diet rich

in soy products can increase the amount of

isoflavonoids in the body.

They have little

or no effect on induction of tumors, and

they have many estrogen-like properties.

In addition, dietary intake of soy products

has been shown to favorably modulate the

production rates of 2- versus 16a-hydroxye-strone

, and high intake of soy isoflavones

is associated with a reduction in the risk of

breast cancer in premenopausal women.

Diet also can promote preventive activity

against breast cancer by increasing the

removal of circulating estrogen. Estrogens

are metabolized by certain enzymes induced

by compounds found in vegetables of the

brassica family like cabbage, Brussels

sprouts, cauliflower and broccoli as well as

turnip, mustard greens, kale, rutabaga,

kohlrabi, and collards.

Among the phyto-chemicals

contained in these foods, two

have been identified as active inducers of

2-hydroxyestrone, (the good estrogen)-indole-

3-carbinol (I-3-C) and diindolyl-methane

(DIM).

One to two servings of

brassica vegetables a day can lower breast

cancer risk by as much as 40%. One specific

dietary regimen that has been reported to

be effective is a high fiber diet including the

consumption of 50 grams of cabbage or

100g of broccoli twice weekly.

Flaxseed supplementation at 10 g/d

(1 Tbsp) significantly increases the urinary

2/16 ratio, suggesting a protective effect

against breast cancer in premenopausal

women. Dietary intake of flaxseed has been

found to reduce early markers or risk of

breast and colon cancer, and to inhibit

breast tumor growth.

Also, the long-chain

omega-3 oils from fish, eicosapentaenoic

acid (EPA) and docosahexaenoic acid (DHA)

have also been shown to be protective

against breast cancer.

The Good News

The good news is that we now have a test

that tests the ratio of these metabolites,

which has been a good marker of long-term

risk for breast cancer, as well as other

estrogen-sensitive cancers including uterine,

ovarian, and cervical cancer. This is a simple

urine test that can determine whether you

might be at risk. The following may con-tribute

to your risk: Prolonged use of oral

contraceptives; Synthetic hormone replacement

therapy; Family history of breast

cancer; Obesity or sedentary

lifestyle; Consumption of

two or more alcoholic

drinks a day.

SOURCE: Sara Liebling, ARNP, CNM

1. Cotton, P., Environmental estrogenic agents area of

concern. JAMA, 1994. 271(6): p. 414, 416.

2. Rodriguez, C., et al., Estrogen replacement therapy

and ovarian cancer mortality in a large prospective

study of US women. JAMA, 2001. 285(11):

p. 1460-5.

3. Fishman, J., et al., Increased estrogen-16 alpha-hydroxylase

activity in women with breast and

endometrial cancer. J Steroid Biochem, 1984.

20(4B): p. 1077-81.

4. Newfield, L., et al., Estrogen metabolism and the

malignant potential of human papillomavirus

immortalized keratinocytes. Proc Soc Exp Biol Med,

1998. 217(3): p. 322-6.

5. Muti, P., et al., Estrogen metabolism and risk of

breast cancer: a prospective study of the 2:16alpha-hydroxyestrone

ratio in premenopausal and post-menopausal

women. Epidemiology, 2000. 11(6):

p. 635-40.

6. 14.Kirkman, L.M., et al., Urinary lignan and

isoflavonoid excretion in men and women

consuming vegetable and soy diets. Nutr Cancer,

1995. 24(1): p. 1-12.

7. Lu, L.J., et al., Increased urinary excretion of

2-hydroxyestrone but not 16alpha-hydroxyestrone

in premenopausal women during a soya diet

containing isoflavones. Cancer Res, 2000. 60(5):

p. 1299-305.

8. Vincent, A. and L.A. Fitzpatrick, Soy isoflavones:

are they useful in menopause? Mayo Clinic

Proceedings, 2000. 75(11): p. 1174-84.

9. Fowke, J.H., C. Longcope, and J.R. Hebert, Brassica

vegetable consumption shifts estrogen metabolism

in healthy postmenopausal women. Cancer

Epidemiol Biomarkers Prev, 2000. 9(8): p. 773-9.

10. Zeligs, M., Diet and estrogen status: The cruciferous

connection. J Med Food, 1998. 1(2): p. 67-81.

11. Bradlow, H.L., et al., 2-hydroxyestrone: the

‘good’ estrogen. J Endocrinol, 1996. 150 Suppl:

p. S259-65.

12. Haggans, C.J., et al., The effect of flaxseed consumption

on urinary estrogen metabolites in

premenopausal women. Cancer Epidemiol

Biomarkers Prev, 2000. 9(7): p. 719-25.

13. Rose, D.P., Dietary fatty acids and prevention of

hormone-responsive cancer. Proc Soc Exp Biol Med,

1997. 216(2): p. 224-33.

Calcium

Choosing the best source to meet your body’s needs

Strong healthy bones are important to an active healthy life. Everyone needs calcium to build and maintain strong bones. Calcium is also important in weight management. Food intake is the best source, but if you cannot get enough calcium in your diet, then you should take a high quality supplement. People who have osteopenia or osteoporosis are especially in need of good calcium. This is true, even if they take prescription drugs to help their condition. Unfortunately, many of the popular supplements either don’t work or contain trace amounts of lead. There are many calcium supplements available, but few have the characteristics that make the nutrients safe and useful. Selecting a high quality calcium supplement far more important than shopping for other vitamins, where there are no dissolvability, absorption or lead issues.

Vitamin D is needed to further enhance intestinal absorption of calcium. The new recommended daily requirement of vitamin D is 800 iu. Many people get some vitamin D from exposure to the sun and in the diet. But if that isn’t the case, then vitamin D needs to be supplemented as well.

A calcium supplement should also contain magnesium. Magnesium activates key enzymes that stimulate bone cells and result in proper calcium deposition. The body tries to keep calcium and magnesium levels in balance. A calcium supplement without magnesium will adversely affect the absorption of calcium because the body will try to keep the proper balance between the two ingredients.

Some of the common supplements have been found to contain unsafe levels of lead. This fact was brought to light in a medical research article published in the Journal of the AMA in 2000. It is important that your calcium is lead-free. The human bo