The Beauty and The Tragedy
written by Colleen Dunseth MS, NTP, CHT
We can drift along with general opinion and tradition, or we can throw ourselves upon the guidance of the soul within and steer courageously toward truth… We have a choice in every event and every limitation and….to choose is to create. ~ Helen Keller
We as Nutritional Therapy Practitioners are so fortunate to be a part of the ever growing and evolving field of alternative health. But any growth process is inevitably accompanied by growing pains. As new research and clinical evidence arises, we have a responsibility to not only gather and assess information about the health of our patients/clients, but also information regarding new therapies and treatments. These may include both therapies that we are using, and treatments that our clients may be undergoing under the guidance of other practitioners.
Controversy around treatment techniques is rampant in conventional medicine, but also periodically infiltrates the field of alternative medicine. The current implementation of Bio Identical Hormone Replacement Therapy is one such issue. I have one rule of thumb in these matters (for what it’s worth); if the answers to simple questions on a subject are not clear, comprehensive and easy to find, something’s wrong. This is especially true when extreme opposing opinions abound. Hormone Replacement Therapy in general fits this rule.
I was compelled to write this article after what I have seen in my practice. People are coming in to my office, feeling horrible, and suffering from all kinds of symptoms that their “bio identical hormones” are supposed to subdue. Not to mention the side effects of the poor management of these protocols! I’m certain that you will or have witnessed the same thing.
Since the 1930’s, American women have been led to believe ( I like the term “coerced myself), that Menopause, a natural event in every woman’s life, is rather a “disease”, a new medical condition that requires drug therapy to “cure”. Just coincidentally, a new drug was “discovered” that will do just that: synthetic estrogen! What luck!
Now, menopause is a period of time in a woman’s life in which gradual hormonal changes bring a shift from a focus on childbearing in favor of a more mature condition of mental and spiritual development.
The distasteful symptoms that have become associated with menopause are common only in a specific group of women in history: Northern European and American women in the last 75 years. Outside of this group, menopause is not such a big deal, and is met with much greater ease, as a natural transition in a woman’s life. It seems that a simpler lifestyle and more natural diet provide for an easier transition.
CREATING A MARKET: THE GENESIS OF HRT
This story begins in 1938. Charles Dobbs discovers diethylstilbestrol (DES). It was supposed to be the first synthetic estrogen. Dobbs first thought DES would solve the problems of menopause, but the American Medical Association immediately began to make extravagant predictions for the prevention of “miscarriages” and solving all problems of pregnancy as well
By 1960, it was being found that between 60% and 90% of DES daughters had abnormal sex organs, leading to high rates of infertility, miscarriages and cervical cancer. DES sons were commonly found to have testicular dysfunction and were sterile. As for the Mothers who had taken DES, their risk of breast cancer had been increased by 40% . But still the drug stayed on the market until 1971! No matter, for by this time, ERT
( estrogen replacement therapy ) was off and running.
By 1966, public attention was diverted from the DES disaster by the bestseller “FEMINE FOREVER”. Written by Dr. Robert Wilson, a New York gynecologist and sponsored by the drug manufacturer Wyeth-Ayerst, it theorized that menopause was an estrogen deficiency disease. All the unpleasant symptoms accompanying menopause were the simple result of too little estrogen. Insufficient estrogen supposedly caused a woman to lose her youth, beauty, cheerful attitude and bone density, all in one fell swoop.
The drug industry didn’t miss a beat. They immediately donated $1.3 million to set up the Wilson Foundation for the sole purpose of the development and promotion of estrogen drugs. The usual story ensued: limited studies with inconclusive results, skewing results to please the company paying for the trials and discontinuing studies that weren’t turning out “right”. FDA approval was given for synthetic estrogen on the basis of one study! Throughout 1964-5, fueled by the advertising power of the biggest clients, articles appeared in major women’s magazines proclaiming a breakthrough that would finally “set women free from the ravages of the dread menopause”. Within a few years, with no proof that Wilson was correct and with superficial clinical trials, a new industry was created. It was named, Estrogen Replacement Therapy.
The American public had many opportunities to become aware of the dangers of this therapy. But through the complex rhetoric of the drug industry and their mouth pieces, coupled with our deep seeded trust in our medical profession, (who could understand all those big words if they weren’t absolutely BRILLIANT!) we paid no heed. And besides, the FDA and all of the other agencies that were mandated to protect the public were watching out for us, no?
There were a multitude of “peer reviewed studies” reporting the dangers of this new therapy. Trials published in JAMA (Journal of the American Medical Association) reported that using Premarin (estrogen derived from horse urine) in men increased incidence of heart attacks and blood clots. A 1975 documentation in the New England Journal of Medicine showed estrogen use increased the incidence of endometrial cancer in women. A 1976 study linking breast cancer to estrogen use was reported in the New England Journal of Medicine. In 1982 experts reported in Cancer Research that HRT was the leading factor in reproductive cancers. In 1985, the Framinghnam Study showed that cardiovascular events rose in women taking estrogen.
In 1989, a Swedish study reported that when women switched to a combination HRT, their breast cancer risk more than doubled.
( Combination “HRT” included the addition of synthetic progesterone or “progestin” . Progestin has since been shown to be completely replete of the positive effects of progesterone once it is metabolized by the liver, but still retains side effects.)
And on the studies went throughout the 1990’s, showing again and again the association of both unopposed estrogen replacement and combination hormone replacement therapies with increased incidences of breast, ovarian, endometrial and other forms of cancer.
In 2001, premarin prescriptions rose to more than $11 million annually.
In 2002, this news from Washington shocked the world. Government scientists brought one of the largest HRT studies to an immediate halt. “The National Institutes of Health found that daily doses of synthetic hormones given to women participating the Women’s Health Initiative Study ( WHI ) that began in 1998, significantly increased the women’s risk of breast cancer, strokes and heart attacks… [The] use of estrogen and progestin increased otherwise healthy women’s risk of stroke by 41%, a heart attack by 29%, and breast cancer by 24%.”
There is no excuse for this ongoing mistreatment. Study after study shows that women are being used as guinea pigs. Advertisements sponsored by powerful organizations have a vested interest in marketing synthetic HRT, and doctors STILL continue to prescribe it even after the WHI study results. This is unfortunate as there are other safe and natural treatments and safer forms of HRT available if needed. In fact, sadly, the process of producing natural progesterone from yams and soybeans was discovered back in the 1930’s. Unfortunately, science had not yet, not until the 1990’s, discovered the role of proper progesterone levels in the body. Even so, conventional medicine chose to alter this natural form in order to make a profit. Never mind the glaring messages (above), that is was not only NOT working, but killing people. (women)
And so our role as Nutritional Therapists is reinforced. We are educators, and in order to do this well, we must continually educate ourselves.
“As we become more educated about safer alternatives and become more aware of the social, economical, and environmental influences which prolong harmful health habits, we will be able to understand more clearly the distinction between the politics and the evidence.”
Raquel Martin – THE ESTROGEN ALTERNATIVE
And so began the use ofBio Identical Hormone Replacement as therapy for the symptoms not only of menopause, but now pre menopause, PMS and a host of other hormonal “Symptoms”. And as is usual in human nature, we have discovered a new “cure all”.. and many doctors have dived into the use of this therapy feet first, head last.
WHAT ARE HORMONES?
The human body is a community of individual cells, each of which has become specialized to support the function of the community. Each of these cells needs to act in synchrony with every other cell.
Hormones are tiny signaling molecules (messengers), that allow each cell in the body to know what is going on in the outside world and to communicate with each other to coordinate a unified response, thus insuring the safety and survival of the community . (us!)
Hormones are chemical compounds that are players in the most sophisticated and exquisitely balanced internet in the entire body: the endocrine system.
This group of glands, including the adrenals, the pituitary, the ovaries, the testes, the thyroid and the hypothalamus are interrelated in impossibly complex ways, about which we’re just beginning to get glimpses of understanding. It’s a swirling universe of chemical elegance and precision, involving millions of refined little molecular firings which wink in and out of existence every second. “Touch one strand and the whole web trembles” is the way endocrinologist Dr. Deepak Chopra describes it. “The endocrine system controls all other systems of the body by means of tiny biochemical messengers, all who wait for an answer.”
- Tim O’Shea
These hormones are subtle and fragile and transient. They deliver their message, are around for a second or two, (turn in up, turn it down, turn it off or on) and are gone, immediately metabolized by the liver.
Dr. Jonathan Wright, MD, describes hormones as “metabolic keys” in his book, Natural Hormone Replacement for Women:
“Hormones function like two ended keys:
- the R end, or receptor end, fits precisely into a cell receptor and “unlocks” the metabolic door to initiate an action.
- The E end, or enzyme end, fits precisely with cellular enzymes that transform the hormone into another hormone, or into a metabolite for excretion.
This amazing communication system is a system of delicate balance. The hormones work together as a synergistic whole. Dr. Deepak Chopra’s analogy is beautiful and bracingly accurate. If we have learned one thing about the endocrine system in these 70 years, it’s that you can’t just throw a hormone into the system because the levels are low. There is the potential to disrupt the entire balance. This is the current “replacement” model adopted by conventional medicine, and is being used in alternative medicine protocols as well. We’ve begun fooling around with this highly tuned system because we’ve discovered a few coarse, synthetic or naturally derived substances that resemble real hormones. We really have only the vaguest notion of what we’re doing because of all of the overlapping relationships. For example: the adrenals, thyroid and ovaries are not 3 separate and independent entities. They’re more like
3 ingredients in a cake, or 3 members of a yacht crew. It is beneficial to understand at least a bit more about what is known regarding the relationships in this grand play!
WHAT IS A SYNTHETIC HORMONE?
A synthetic hormone is a plant based hormone that is then biochemically altered so that it can be patented. ( so far, there are laws preventing big pharma from patenting a natural substance, but NOT discrediting their use! )
These substances are slightly askew, for instance their R end may be recognized by the body, but the E end is different. Can you see a problem here? These types of hormones cannot properly be transformed into other hormones and in a timely manner, be removed from the body. Think of the Christmas fruitcake….the “gift that keeps on giving”!
These hormones remain in the body indefinitely, promoting processes that are normally controlled by the feedback loops and are meant to turn on and off in synchrony. They disrupt the delicate balance and clog the liver as well, producing the life threatening side effects discussed above. Oh, and the levels cannot be tested in the human body, as they are foreign substance. Hmmmmmm.
HOW DO BIOIDENTICAL HORMONES DIFFER?
Bio identical hormones are just that. They are biochemically identical to the hormones found in our bodies, They are formulated from naturally based plant substances such as yam and soy, with added conversion factors such as enzymes to help them assimilate. They have the same molecular and chemical structure as those hormones found in the human body. OK, so they are biochemically identical…but…are the “Natural”.
The jury is out on that since they require the addition of certain enzymes and activators to make them useable in the body.
But are they safe?
Well, currently there have been no major studies done, like the WHI, and most have not been approved by the FDA. But it does make sense that they could certainly be a safer alternative. It will be some time before clinical trials can answer this query.
The problems that I and others are witnessing don’t seem to be with the actual hormones themselves however, as long term studies and clinical feedback is necessary but rather the ignorance with which they are given. Our doctors are not taking time to educate themselves. The reasons are multiple and complex I am aware: medical school debt, too much paperwork, hospital duties and their own lives. We however, as NTP’s have two superhero doctors on our side. Both Dr.’s Janet Lang and Dr Datisse Kharrazian have clinical experience AND have managed to do their homework on this topic. Their Endocrinology seminars are offerd through Standard Process and Apex Energetics. I cannot recommend them highly enough. They have both been educating doctors and other practitioners on this topic for years. In a one weekend seminar, you will know more about this topic than almost ANY doctor out there.
Generally speaking, most doctors and practitioners are giving hormones based on symptom presentations and are not performing any baseline testing, nor monitoring progress. There is much to consider and much more that we don’t know yet. So, if / when you have a client either ON BHRT, or considering bio identical hormone replacement therapy, (synthetic hormones should NEVER be considered based on the WHI Study), there are certain things to be aware ofthat you may pass along to them.
NOTE: Both estrogen and testosterone are available only by prescription
( bio identical or synthetic)
You do NOT need a script for pregnenolone, progesterone or DHEA
( although the FDA is currently threatening to allow DHEA by prescription only. )
HERE ARE SOME GUIDELINES WHEN CONSIDERING BIO IDENTICAL HORMONE REPLACEMENT THERAPY*
( the tip of the iceberg considering the “ we don’t know what we don’t know” part. ) Although almost any hormone can be compounded, we will be referring to the sex hormones from here, as they are most commonly replaced in this way.
1. The sex hormones are part of a group of hormones made from cholesterol. These are called “Steroid Hormones”. Others made from this substance are cortisol, DHEA, and the precursor Pregnenolone. Remember cholesterol is produced and regulated mainly by the liver, and is produced from the proper type and ratio of dietary fat. Dr. John Lee has provided us with a very clear summary of the Cholesterol or Steroid Hormone pathway.