|
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.
Hormone Replacement Therapy
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.
|
